Adult GI Disorders

Lower GI Disorders

Appendicitisinflammation of vermiforn appendix d/t infection

• Assessment– Progressive, severe, RLQ or periumbilical area pain

– Pain localized in RLQ(McBurney’s point)• worse with movement, coughing, sneezing

– anorexia, constipation

– nausea, vomiting

– rebound tenderness

– slight temperature

– moderate leukocytosis

Nursing Plan of Care

– Assist with diagnostics, ie UA, IVP, Rectal – NPO, narcotics after cause of pain determined,

maintain bedrest– Pre op: keep in high fowlers– NO CATHARTICS or ENEMAS– Monitor vital signs

Goals

•Recognize and treat symptoms•Prevent death from complications•Re-establish normal bowel function

Nursing Care: Post Op

• Maintain fowlers• Care of nasogastric tube, suction prn• Check for return of peristalsis• May need enema, 3rd-4th day post-op• Health education (review signs/symptoms)• Discharge instruction

– monitor incision, watch for infection, return of bowel function, return of symptoms

Hemorrhoids

• Pathophysiology– congestion of the veins of

the hemorrhoidal plexus

– leads to varicosities of rectum and anus d.t. elevated intra-abd pressure from constipation, straining when defecating, pregnancy

– Heredity,obesity,long standing/sitting occupations

– also with cirrhosis and portal hypertension

• Assessment Data– Internal: painless, bleeding

with defecation– External: apparent outside anal

sphincter• inflammation & pain if

ruptures w/subsequent thrombosis

• itching

• Goal– alleviate symptoms– Provide pre/post-op care for

hemorrrhoidectomy– Health education to prevent

occurence

Interventions

• Medical– analgesic

ointment:Nupercaine

– ice or warm compresses

– sitz baths

– stool softeners

– local sclerosing may be done, R.N. assists with procedure

• Surgical: post op– watch hemorrhage (1st 24 hr

and 7-10 days post-op)

– promote comfort: ice or warm compresses

– watch infection

– bulk laxatives(promote B.M)

– education: sitz bath, bulk in diet(to prevent constipation) encourage fluid, daily BM, stool softeners, laxatives

Evaluation

•Verbalizes plan for bowel elimination•Verbalizes signs and symptoms of recurrence •Verbalizes signs and symptoms of complications, i.e. bleeding, pain, constipation, etc.•Recovers without complications from the surgery

Diverticulosis, Diverticulitis

• Outpouching of mucosa through a weak point in muscle layer of bowel wall that:

• gets impacted with feces(Diverticulosis) or• gets inflammed(Diverticulitis)

• Causes are unknown• Goal: relieve pain & restore normal bowel

function

Nursing Plan of Care• Administer medications

– Narcotics (Demerol) antispasmodics , bulk laxatives(Metamucil) antibiotics

• Assess bowel sounds, report changes(increase or decrease)

• Observe type, color, frequency of stool• Intake and output(record)• Observe for complications

– peritonitis, obstruction, hemorrhage

• Dietary education– high fiber, bran, lots of fluid(8 glasses per day), bulk

laxatives

Evaluation

• Patient establishes regular bowel habits without pain• Patient follows diet principles• Verbalizes understanding of medications• Patient verbalizes signs/symptoms of complications

Ulcerative colitis

• Inflammatory and ulcerative disease of colon• Superficial ulcers seen in mucosa that

– bleed– become edematous– become abscessed causing reduced absorbive surface of

the bowel

• Cause unknown(auto-immune)• May be seen more with certain personalities

– Independent exterior but dependent interior– Structured persons who tend to be perfectionistic

Ulcerative colitis

• Assessment(Physical)– frequent diarrhea

– stool with mucus, blood, pus

– colicky abdominal cramps, distention

– low grade fever

– fluid and electrolyte imbalance

– wt loss, anorexia

– weakness cachexia

• Psychosocial/Cultural

Occurs most often in • Adolescents

Young adults Jewish descent

– causes depression, anger, frustration

– stress may cause exacerbation

Goals

•Restore nutrition/ F&E balance•Combat infection•Promote comfort•Decrease bowel motility•Assist patient to cope with

•Alteration in body image•Psychological problems

Nursing Plan of Care

• Antibiotics to prevent or treat secondary infections• ACTH or adrenal steroids(decrease inflammation)• Bedrest, as needed• Sitz bath, prn• Lomotil to decrease GI motility• Emotional support• Protect perineum, buttock and anal area

– Wash– Lubricants to prevent skin breakdown– Ointments to relieve discomfort

Nursing Care continued...

• Weight, q.d.

• Assess nutritional status (anemia, vitamin K deficiency, dehydration)

• High protein, high calorie diet, TPN

• Record type, amount, character of stools

• Education if surgery indicated

Ileostomy

• Pre op– prepare for bowel

surgery

– no enemas

– watch fluid and electrolyte status

• Post Op– care of skin and stoma

– observe for peritonitis

– maintain high protein, high calorie, high vitamins

– Teaching rehabilitation principles

– Referrals(to community health nurse)

– discharge planning(social worker for financial, etc.)

Evaluation

•Patient has less diarrhea and is able to control or manage other signs and symptoms•Patient maintains their nutritional status•Patient verbalizes knowledge of the disease•Patient follows up on their outpatient appointments

Regional enteritis (Crohn’s Disease)

• Chronic inflammatory disease of small intestine affecting the terminal ileum.

• Results in chronic diarrhea

• Causes are unknown

Crohn’s

• Physical– crampy pain after meals

– chronic diarrhea, melena

– low grade fever

– abd tenderness

– lymphadenitis

– UGI> string sign present, suggests a constriction of a segment of intestine

• Psychosocial– more common in Jews

of European ancestry

– familial tendency

– Age, 15 - 35 years

• Goals– promote comfort

– adequate hydration and nutrition

Nursing Plan of Care

• Diet low in residue, roughage and fat, high in calories, protein, vitamins

• Rest periods• Antimicrobials to control inflammation• Assess F & E status• May need colon resection

• Evaluation– maintains F & E status ,

free of symptoms understands diet

Intestinal Obstruction

• Blockage of intestinal tract that inhibits passage of fluid, gas, feces

• Caused by– mechanical obstruction (strangulated hernia, adhesion,

cancer, volvulus, intussusception)

– neurogenic obstruction (paralytic ileus, uremia, electrolyte imbalance(low K), spinal cord lesion)

– Vascular disease (occlusion of superior mesentery vessels)

Intestinal Obstruction

• Physical– loud frequent bowel sounds

above obstruction

– intermittent & cramping pain

– vomiting (fecal)

– distention, no stool or gas passage

– severe F & E imbalance

– shock

• Goal– relieve discomfort

– return of normal bowel peristalsis and function

Nursing Plan of Care

• Administer intravenous fluid, electrolytes• Administer pain medication (avoid morphine: d/t

effect on respiratory system)• Maintain intestinal decompression using a Miller

Abbott tube, (see nursing care in textbook)• Skin/mouth care• Watch respiration's, abd. distension may cause resp.

distress, V.S.• Check abdomen q2h for changes(distension,

rigidity, or pain)

Nursing Care cont.….• Assess for return of peristalsis

– listen for bowel sounds, check abdominal girth, passage of stool

• If no resolution, may need surgery• Maintain diet according to disease that caused

problem• Teach good bowel habits

– avoid harsh laxatives drink fluid stool softeners , regular exercise

Evaluation

•Patient remains free of pain•Patient experiences normal bowel elimination•Patient normalizes their fluid and electrolyte balance•Patient verbalizes correctly diet changes