Intestinal Elimination Disorders

1
Intestinal Elimination Disorders

• NPN 200
• Medical Surgical I

2
Diarrhea and Constipation

• Diarrhea
• Define the frequent passage of loose, liquid
  stool
• Causes allergies, cancer, stress,
  malabsorption, impactions, tube feedings, viral
• Symptoms cramping, nausea, urgency
• If continues may lead to dehydration, and
  decreased nutrition

• Nurses role assess stool for color and
  consistency, determine onset and exposure to
  virus and dietary habits or changes, any bleeding
• Assess for weight loss, skin turgor, abd
  tenderness, perneal irritation
• Treatment is based on the cause

3
Diarrhea and Constipation

• Constipation
• Defined hard, dry, infrequent stools
• Cause ignoring the urge , frequent laxative
  use, dietary (not enough fiber or fluid), lack of
  activity, surgery, drugs, age changes in the
  intestines
• Complications problems with heart, hemorrhoids,
  fecal impaction

• Nursing actions assess for problem, blood,
  mucus, impaction
• Interventions laxatives, enemas, remove
  impaction, work with diet and fluid intake,
  regular habits

4
Obstruction

• Partial or complete blockage of the intestinal
  lumen
• Decreased or absent peristaltic movement of
  contents due to mechanical or neurological
  disorders
• Leads to dilation, loss of tone, pressure on
  vessels with loss of blood flow, ischemia and
  death of tissue
• Complete obstruction, if untreated, may lead to
  necrosis, shock, and death
• Can occur after abdominal surgery

5
Obstruction

• Causes
• Adhesions form prior surgery
• Tumors and carcinoma
• Foreign bodies fruit pits, gallstones, worms
• Compression of intestinal wall from stenosis,
  intussusception (telescoping), volvulus, tumors,
  atresia

6
Obstruction

• Symptoms for small bowel
• Subjective
• Nausea / vomiting
• Colicky pain
• Drowsiness
• Thirst
• Aching
• Dry mucus membranes
• Intestinal spasms
• Malaise and fatigue

• Objective
• Vomiting
• Constipation
• Abd distention
• Borborugmi (gurgling)

7
Obstruction

• Symptoms for large bowel
• Subjective
• Constipation
• Colicky abd pain in spasms
• Hypogastric pain
• nausea

• Objective
• Constipation
• Leakage of liquid stool
• Intestinal spasms
• Fecal vomiting
• Severe abd pain

8
Obstruction

• Diagnostic tests
• HP
• Flat plate of abdomen
• UGI
• Barium enema
• E-lytes, CMP, amlyase

9
Obstruction

• Assessment
• Past medical history
• Abd tenderness and distention
• N/V
• BM history
• Skin turgor and moisture
• Vitals
• Rectal bleeding or drainage

10
Obstruction

• Medical treatment
• NG tube
• Labs
• IV
• Possible surgery

11
Obstruction

• Nursing interventions
• Pain control
• I/O
• Insert and care for NG
• Assess bowel sounds
• Monitor vitals
• Watch for rupture sudden sharp pain, rigidity,
  fever
• Watch respiratory function HOB , O2 if needed,
  watch for acidosis or alkalosis
• Prepare for surgery

12
Obstruction

• Surgical care
• TCDB
• NG care
• Monitor labs
• Pain RX
• IVs and antibiotics
• Early ambulation
• May have colostomy needs teaching

13
Abdominal Hernia

• Protrusion of an organ or structure through and
  abnormal opening
• Categories
• Reducible
• Irreducible
• Incarcerated
• Types
• Umbilical
• Inguinal
• Femoral
• Incisional

14
Abdominal Hernia

• Causes
• Congenital weakness in containing wall
• Weakness because of infections or aging
• Increased intra-abdominal pressure pregnancy,
  heavy lifting, obesity or straining
• Improper closing in the peritoneal sac in male
  clients

15
Abdominal Hernia

• Subjective symptoms
• Presence of abdominal mass after lifting,
  straining, etc.
• Possible pain
• Swelling relieved by lying down
• Sharp steady pain in groin
• Severe pain and nausea (strangulated)
• anorexia

16
Abdominal Hernia

• Objective symptoms
• Palpable mass in inguinal, femoral, or umbilical
  area
• Signs of obstruction
• Vomiting
• Irreducible mass
• Diminished bowel sounds
• Shock
• Increased temp
• Bloody stools
• Undescended testicle or hydrocele in infants

17
Abdominal Hernia

• Diagnosis
• History and physical
• Medical treatment
• Surgical repair lap or open
• Herniorrhaphy muscle repair
• Hernioplasty reinforcement with patch
• Truss if not able to have surgery

18
Abdominal Hernia

• Post- op care
• Routine
• Home care
• Restrict lifting for 6-8 weeks
• Prevent constipation
• Hold off on sexual activity