nursing care of patients with lower gastrointestinal disorders · pdf filecrohn’s...
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Constipation
• Fecal Mass Held In Rectum
• Feces Become Dry, Hard
• Many Causes
• Prevention: High-fiber Diet, Fluids, Exercise
• Obstipation
Constipation
• Signs and Symptoms – Abdominal Pain
– Distention
– Indigestion
– Rectal Pressure
– Incomplete emptying
– Headache
– Fatigue
– Decreased Appetite
Constipation
• Complications
– Impaction
– Ulcers
– Straining
– Megacolon
– Chronic Laxative Abuse – Fibrosis
Constipation
• Therapeutic Interventions
– High-fiber Diet, 2 to 3 L Fluid Daily
– Strengthen Abdominal Muscles
– Exercise
– Bulk-forming Agents
– Stool Softeners
– Education
Constipation (cont’d)
• Data Collection
– Establish Rapport
– History
– Auscultate Bowel Sounds
– Inspect/Palpate Abdomen
Diarrhea
• Fecal Matter Passes Rapidly
• Decreased Absorption
• Causes
– Bacterial/Viral Infection
– Food Allergies
• Prevention
Diarrhea
• Signs And Symptoms
– Fever
– Foul Odor
– Abdominal Cramping
– Distention
– Anorexia
– Intestinal Rumbling
Diarrhea
• Therapeutic Interventions
– Identify Cause
– Replace Fluids/Electrolytes
– Increase Fiber/Bulk
– Diphenoxylate (Lomotil), Loperamide (Imodium)
– Lactinex Restores Normal Flora
– Antimicrobial Agents
Appendicitis
• Inflammation of the Appendix
• Fever, Nausea/Vomiting, Anorexia, Pain Right Lower Quadrant
• Increased White Blood Cells
• NPO, Surgery
• Postoperative Care
Peritonitis
• Inflammation/Infection of Peritoneal Cavity
• Signs and Symptoms
– Abdominal Pain
– Abdominal Rigidity
– Nausea/Vomiting
– Fever
Peritonitis
• Therapeutic Interventions
– NPO
– Fluid/Electrolyte Replacement
– Naso/Orogastric Tube
– Antibiotics
– Surgery
– Pain Control
Diverticulosis/Diverticulitis
• Diverticulum
– Outpouching of Bowel Mucous Membrane
• Diverticulosis
– Multiple Diverticula
• Diverticulitis
– Inflammation/Infection of Diverticulum
Diverticulum
Diverticulosis/Diverticulitis
• Causes
– Chronic Constipation
– Decreased Intake of Dietary Fiber
• Therapeutic Interventions
– Prevent Constipation
– Intravenous Antibiotics
– Pain Control
– Surgery
Crohn’s Disease
• Inflammatory Bowel Disease
• Any Part of the Intestine
• Remissions and Exacerbations
• Cause Unknown
• Hereditary
Crohn’s Disease
• Signs and Symptoms
– Abdominal Pain or Cramping
– Weight Loss
– Diarrhea
– Fluid and Electrolyte Imbalance
Crohn’s Disease
• Diagnosis
– Laboratory Testing
– Endoscopy with Biopsy
– Ultrasound
– Multiphase CT Enterography
– Magnetic Resonance Enterography
Crohn’s Disease
• Therapeutic Interventions – Medications
• Aminosalicylates: Azulfidine (sulfasalazine) • Antidiarrheal • Biologic: Humira (adalimumab) • Corticosteriods • Immunomodulators: Imuran (azathioprine)
– Avoid Offending Foods – Surgery if Necessary – Elemental Formula or PN if Required – Support and Education
Ulcerative Colitis • Signs and Symptoms
– Abdominal Pain
– 5 to 20 Stools Daily
– Rectal Bleeding
– Fecal Urgency
– Anorexia
– Weight Loss
– Cramping
– Vomiting
– Fever
– Dehydration
Ulcerative Colitis
• Therapeutic Interventions – Avoid Offending Foods
– Medications • Aminosalicylates: Azulfidine (sulfasalazine)
• Antidiarrheal
• Biologic: Humira (adalimumab)
• Corticosteriods
• Immunomodulators: Imuran (azathioprine)
– Surgery if Necessary
– Elemental Formula or PN if Required
Irritable Bowel Syndrome (IBS)
• Altered Intestinal Motility/Increased Sensitivity to Visceral Sensations
• Bowel Mucosa Not Changed
• Psychological Stress/Food Intolerances
• More Common in Women
Irritable Bowel Syndrome
• Signs and Symptoms
– Gas
– Bloating
– Constipation
– Diarrhea
– Abdominal Pain
– Depression, Anxiety
Irritable Bowel Syndrome
• Therapeutic Interventions – Low FODMAP Diet
– High Fiber and Bran Diet
– Avoid Trigger Foods
– Smaller, Frequent Meals
– Stress Management
– Behavioral Therapy
– Exercise
– Medications Depend on Type of IBS
Abdominal Hernias
• Pathophysiology
– Protrusion of Organ or Structure Through Weakness or Tear in Wall of Abdomen
• Etiology
– Weakness in Abdominal Wall with Increased Intra-abdominal Pressure
Abdominal Hernias
• Signs and Symptoms
– None
– Bulging
• Complications
– Strangulated Incarcerated Hernia
Abdominal Hernias
• Therapeutic Interventions
– None
– Observation
– Support Devices
– Surgery
• Herniorrhaphy
• Hernioplasty
Absorption Disorders
• Inability to Absorb One or More Major Nutrients
• Types
– Celiac Disease
– Lactose Intolerance
Absorption Disorders
• Therapeutic Interventions
– Celiac Disease
• High-calorie, High-protein, Gluten-free Diet
– Lactose Intolerance
• Avoid Lactose Foods; Lactaid
Absorption Disorders
• Nursing Care
– Monitor Fluids, Electrolytes, Nutritional Status
– Daily Weight
– Intake and Output
– Education
Bowel Obstruction
• Flow of Intestinal Contents is Blocked
• Mechanical
– Blockage Occurs Within the Intestine
• Non-mechanical
– Peristalsis is Impaired
– Partial or Complete
Bowel Obstruction
• Signs and Symptoms
– Abdominal Pain
– Blood and Mucus per Rectum
– Feces and Flatus Cease
– Fecal Vomiting May Occur
– Bowel Sounds High-pitched/Tinkling or Absent
Bowel Obstruction
• Signs and Symptoms
– Abdominal Distention
– Fluid/Electrolyte Imbalance
• Diagnosis
– Abdominal X-Ray
– CT Scan
– CBC and Electrolytes
Bowel Obstruction
• Therapeutic Interventions – NPO
– Frequent Mouth Care
– Nasogastric Tube
– Fluid and Electrolyte Replacement
– Medications • Antibiotics
• Anti-emetics
• Analgesics
– Surgery
Anorectal Problems
• Nursing Care
– Postoperative
• Pain Control
• Sitz Baths
• Dressing Changes
• Stool Softeners
Lower Gastrointestinal Bleeding
• Causes
– Diverticulitis
– Polyps
– Anal Fissures
– Hemorrhoids
– Inflammatory Bowel Disease
– Cancer
Lower Gastrointestinal Bleeding
• Occult Blood, Melena, Bright Red Stools
• Treat Cause
• Nursing Care
– Monitor Stools, Bleeding
– Vital Signs
– Diagnostic Prep
Colorectal Cancer
• Major Cause: Lack of Dietary Fiber
• Signs and Symptoms
– Change in Bowel Habits
– Blood or Mucus In Stools
– Abdominal or Rectal Pain
– Weight Loss
– Anemia
– Obstruction
Colorectal Cancer
• Diagnosis – Colonoscopy with Biopsy
– Sigmoidoscopy with Biopsy
– Proctosigmoidoscopy
– CT Scan
– Abdominal and Rectal Examination
– Immunological Tests
– Fecal Occult Blood
– CEA
Colorectal Cancer
• Therapeutic Interventions – Surgery
• Resection
• Abdominoperineal Resection
• Colostomy
– Radiation
– Chemotherapy
– Monoclonal Antibody Therapy
– Analgesics
– PN as Necessary
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