Nursing%20Care%20of%20Patients%20with%20Lower%20Gastrointestinal%20Disorders

1
Chapter 34

• Nursing Care of Patients with Lower
  Gastrointestinal Disorders

2
Lower Gastrointestinal System

• Small Intestines
• Large Intestines
• Rectum
• Anus

3
Constipation

• Fecal Mass Held In Rectum
• Feces Become Dry, Hard
• Many Causes
• Prevention High-fiber Diet, Fluids, Exercise
• Obstipation

4
Constipation (contd)

• Signs and Symptoms
• Abdominal Pain
• Distention
• Indigestion
• Rectal Pressure
• Incomplete Emptying

• Headache
• Fatigue
• Decreased Appetite

5
Constipation (contd)

• Complications
• Impaction
• Ulcers
• Straining
• Megacolon
• Chronic Laxative Abuse Fibrosis

6
Constipation (contd)

• Therapeutic Interventions
• High-fiber Diet, 2 to 3 L Fluid Daily
• Strengthen Abdominal Muscles
• Exercise
• Bulk-forming Agents
• Stool Softeners
• Education

7
Constipation (contd)

• Data Collection
• Establish Rapport
• History
• Auscultate Bowel Sounds
• Inspect/Palpate Abdomen

8
Constipation (contd)

• Nursing Diagnoses
• Constipation
• Anxiety
• Perceived Constipation
• Deficient Knowledge

9
Diarrhea

• Fecal Matter Passes Rapidly
• Decreased Absorption
• Causes
• Bacterial/Viral Infection
• Food Allergies
• Prevention

10
Diarrhea (contd)

• Signs And Symptoms
• Fever
• Foul Odor
• Abdominal Cramping
• Distention
• Anorexia
• Intestinal Rumbling

11
Diarrhea (contd)

• Therapeutic Interventions
• Identify Cause
• Replace Fluids/Electrolytes
• Increase Fiber/Bulk
• Diphenoxylate (Lomotil), Loperamide (Imodium)
• Lactinex Restores Normal Flora
• Antimicrobial Agents

12
Diarrhea (contd)

• Nursing Diagnoses
• Acute Pain
• Diarrhea
• Risk for Deficient Fluid Volume
• Risk for Infection
• Risk for Impaired Skin Integrity

13
Appendicitis

• Inflammation of the Appendix
• Fever, Nausea/Vomiting, Anorexia, Pain Right
  Lower Quadrant
• Increased White Blood Cells
• NPO, Surgery
• Postoperative Care

14
  McBurneys Point
15
Peritonitis

• Inflammation/Infection of Peritoneal Cavity
• Signs and Symptoms
• Abdominal Pain
• Abdominal Rigidity
• Nausea/Vomiting
• Fever

16
Peritonitis (contd)

• Therapeutic Interventions
• NPO
• Fluid/Electrolyte Replacement
• Naso/Orogastric Tube
• Antibiotics
• Surgery
• Pain Control

17
Peritonitis (contd)

• Complications
• Intestinal Obstruction
• Hypovolemia
• Septicemia

18
Peritonitis (contd)

• Nursing Diagnoses
• Acute Pain
• Deficient Fluid Volume
• Imbalanced Nutrition Less Than Body
• Requirements

19
Diverticulosis/Diverticulitis

• Diverticulum
• Outpouching of Bowel Mucous Membrane
• Diverticulosis
• Multiple Diverticula
• Diverticulitis
• Inflammation/Infection of Diverticulum

20
  Diverticulum
21
Diverticulosis/Diverticulitis(contd)

• Causes
• Chronic Constipation
• Decreased Intake of Dietary Fiber

22
Diverticulosis/Diverticulitis (contd)

• Therapeutic Interventions
• Prevent Constipation
• Intravenous Antibiotics
• Pain Control
• Surgery

23
Nursing Diagnoses Inflammatory or Infectious
Disorder

• Acute Pain
• Risk for Deficient Fluid Volume

24
Crohns Disease

• Inflammatory Bowel Disease
• Any Part of the Intestine
• Remissions and Exacerbations
• Cause Unknown
• Hereditary

25
Crohns Disease (contd)

• Signs and Symptoms
• Abdominal Pain or Cramping
• Weight Loss
• Diarrhea
• Fluid and Electrolyte Imbalance

26
Crohns Disease (contd)

• Complications
• Malnutrition
• Fissures
• Abscesses
• Fistulas

27
  Fistulas
28
Crohns Disease (contd)

• Diagnosis
• Laboratory Testing
• Endoscopy with Biopsy
• Ultrasound
• Multiphase CT Enterography
• Magnetic Resonance Enterography

29
Crohns Disease (contd)

• Therapeutic Interventions
• Medications
• Anti-inflammatories
• Antidiarrheal
• Antibiotics
• Biologics
• Corticosteriods
• Immunosuppressants

30
Crohns Disease (contd)

• Therapeutic Interventions (contd)
• Avoid Offending Foods
• Surgery if Necessary
• Elemental Formula or TPN if Required
• Support and Education

31
Ulcerative Colitis

• Inflammatory Bowel Disease
• Colon and Rectum
• Remissions and Exacerbations

32
Ulcerative Colitis (contd)

• Signs and Symptoms
• Abdominal Pain
• 5 to 20 Stools Daily
• Rectal Bleeding
• Fecal Urgency
• Anorexia

• Weight Loss
• Cramping
• Vomiting
• Fever
• Dehydration

33
Ulcerative Colitis (contd)

• Therapeutic Interventions
• Avoid Offending Foods
• Medications
• Anti-inflammatories
• Antidiarrheal
• Immunosuppressants
• Corticosteriods

34
Ulcerative Colitis (contd)

• Therapeutic Interventions (contd)
• Surgery if Necessary
• Elemental Formula or TPN if Required

35
Nursing Diagnoses Inflammatory Bowel Disease

• Acute Pain
• Diarrhea
• Deficient Fluid Volume
• Anxiety
• Impaired Skin Integrity

36
Nursing Diagnoses Inflammatory Bowel Disease
(contd)

• Ineffective Nutrition Less Than Body
  Requirements
• Ineffective Coping

37
Irritable Bowel Syndrome

• Altered Intestinal Motility/Increased Sensitivity
  to Visceral Sensations
• Bowel Mucosa Not Changed
• Psychological Stress/Food Intolerances
• More Common in Women

38
Irritable Bowel Syndrome (contd)

• Signs and Symptoms
• Gas
• Bloating
• Constipation
• Diarrhea
• Abdominal Pain
• Depression, Anxiety

39
Irritable Bowel Syndrome (contd)

• Diagnosis
• History
• Physical Examination

40
Irritable Bowel Syndrome (contd)

• Therapeutic Interventions
• High Fiber and Bran Diet
• Avoid Trigger Foods
• Smaller, Frequent Meals
• Stress Management

41
Irritable Bowel Syndrome (contd)

• Therapeutic Interventions (contd)
• Behavioral Therapy
• Exercise
• Medications

42
Irritable Bowel Syndrome (contd)

• Nursing Diagnoses
• Constipation
• Diarrhea
• Readiness for Enhanced Self-Health Management

43
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

44
Abdominal Hernias (contd)

• Types
• Inguinal
• Umbilical
• Ventral (Incisional)

45
Types of Hernias
46
Abdominal Hernias (contd)

• Signs and Symptoms
• None
• Bulging
• Complications
• Strangulated Incarcerated Hernia

47
Abdominal Hernias (contd)

• Therapeutic Interventions
• None
• Observation
• Support Devices
• Surgery
• Herniorrhaphy
• Hernioplasty

48
Abdominal Hernias (contd)

• Nursing Care
• Education
• Postoperative
• No Coughing
• Activity
• Education

49
Absorption Disorders

• Inability to Absorb One or More Major Nutrients
• Types
• Celiac Disease
• Lactose Intolerance

50
Absorption Disorders (contd)

• General Signs and Symptoms
• Weight Loss
• Weakness
• General Malaise

51
Absorption Disorders (contd)

• Therapeutic Interventions
• Celiac Disease
• High-calorie, High-protein, Gluten-free Diet
• Lactose Intolerance
• Avoid Lactose Foods Lactaid

52
Absorption Disorders (contd)

• Nursing Care
• Monitor Fluids, Electrolytes, Nutritional Status
• Daily Weight
• Intake and Output
• Education

53
Bowel Obstruction

• Flow of Intestinal Contents is Blocked
• Mechanical Blockage Occurs Within the Intestine
• Non-mechanical Peristalsis is Impaired
• Partial or Complete

54
Mechanical Bowel Obstructions
55
Bowel Obstruction (contd)

• 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

56
Bowel Obstruction (contd)

• Signs and Symptoms
• Abdominal Distention
• Fluid/Electrolyte Imbalance

57
Bowel Obstruction (contd)

• Diagnosis
• Abdominal X-Ray
• CT Scan
• CBC and Electrolytes

58
Bowel Obstruction (contd)

• Therapeutic Interventions
• NPO
• Frequent Mouth Care
• Nasogastric Tube
• Fluid and Electrolyte Replacement

59
Bowel Obstruction (contd)

• Therapeutic Interventions (contd)
• Medications
• Antibiotics
• Anti-emetics
• Analgesics
• Surgery

60
Bowel Obstruction (contd)

• Nursing Diagnoses
• Acute Pain
• Deficient Fluid Volume
• Deficient Knowledge

61
Anorectal Problems

• Hemorrhoids
• Anal Fissures
• Anorectal Abscess

62
Anorectal Problems (contd)

• Nursing Care
• Postoperative
• Pain Control
• Sitz Baths
• Dressing Changes
• Stool Softeners

63
Lower Gastrointestinal Bleeding Causes

• Diverticulitis
• Polyps
• Anal Fissures
• Hemorrhoids
• Inflammatory Bowel Disease
• Cancer

64
Lower Gastrointestinal Bleeding

• Occult Blood, Melena, Bright Red Stools
• Treat Cause

65
Lower Gastrointestinal Bleeding (contd)

• Nursing Care
• Monitor Stools, Bleeding
• Vital Signs
• Diagnostic Prep

66
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

67
Colorectal Cancer (contd)

• Major Cause Lack of Dietary Fiber
• Signs and Symptoms
• Anemia
• Obstruction

68
Colorectal Cancer (contd)

• Diagnosis
• Colonoscopy with Biopsy
• Sigmoidoscopy with Biopsy
• Proctosigmoidoscopy
• CT Scan

69
Colorectal Cancer (contd)

• Diagnosis (contd)
• Abdominal and Rectal Examination
• Immunological Tests
• Fecal Occult Blood
• CEA

70
Colorectal Cancer (contd)

• Therapeutic Interventions
• Surgery
• Resection
• Abdominoperineal Resection
• Colostomy

71
Colorectal Cancer (contd)

• Therapeutic Interventions (contd)
• Radiation
• Chemotherapy
• Monoclonal Antibody Therapy
• Analgesics
• TPN as Necessary

72
Colorectal Cancer (contd)

• Nursing Diagnoses
• Acute Pain
• Anxiety
• Imbalanced Nutrition Less Than Body Requirements
  

73
Colorectal Cancer (contd)

• Nursing Care
• Support and Education
• Postoperative Care

74
Ostomy Management

• Ostomy
• Surgically Created Opening Diverts Stool or Urine
  to Outside of Body
• Stoma
• Portion of Bowel Sutured onto Abdomen
• Abdominal Ostomies Ileostomy, Colostomy,
  Urostomy

75
Ileostomy

• Terminal Ileum to Abdominal Wall After Total
  Colectomy

76
Ileostomy Types

• Conventional Ileostomy
• Small Stoma Right Lower Quadrant
• Continuous Flow Liquid Effluent
• Continent Ileostomy
• Internal Reservoir with Nipple Valve
• Empty Reservoir 3 to 4 Times Daily

77
Continent Ileostomy
78
Ileostomy Types (contd)

• Ileoanal Anastomosis
• Ileorectal Anastomosis

79
 IlealAnal Anastomosis J Pouch
80
  Types of Stomas
81
Colostomy

• Effluent Becomes Less Liquid and More Solid as
  Location of Ostomy Becomes More Distal in Colon
• Types
• End Stoma
• Proximal Bowel End Brought to Abdominal Wall
• Loop Stoma
• Loop of Bowel Outside Abdomen with Bridge
• Under it

82
Colostomy Types

• Double-barrel Stoma
• Temporary Ostomy
• Both Ends of Colon Outside Abdominal Wall, Form
  Two Stomas
• Proximal Stoma is Functioning Stoma
• Distal Stoma is Mucous Fistula

83
Preoperative Ostomy Care

• Wound Ostomy Continence Nurse
• Marks Site
• Emotional, Physical Support
• Teaching
• Bowel Prep
• Antibiotics

84
Nursing Diagnoses

• Deficient Knowledge
• Appliance Change
• Daily Care and Hygiene
• Dietary Considerations

85
Nursing Diagnoses (contd)

• Body Image Disturbance
• Sexual Dysfunction
• Ineffective Therapeutic Regimen Management

86
Nursing Diagnoses (contd)

• Risk for Injury
• Peristomal Skin Irritation
• Peristomal Hernia
• Stomal Prolapse
• Stomal Necrosis
• Ileostomy Blockage

87
Postoperative Ostomy Care

• Data Collection
• Vital Signs
• Stoma
• Pink to Red, Moist Normal
• Bluish Inadequate Blood Supply
• Black Necrosis

88
Postoperative Ostomy Care (contd)

• Data Collection
• Skin Around Stoma Monitored for Irritation
• Stoma Shrinks Over Weeks
• Ostomy Care
• Appliance Change
• Teaching