Transcript GI 34

Nursing Care of Patients with Lower Gastrointestinal
Disorders
Constipation
 Fecal mass held in rectum, feces become dry, hard
 Causes include meds, narcotics, antacids c calcium, <
fiber and < water intake,< mobility,fatigue, chronic
laxative use
 Prevention: high fiber diet, fluids, exercise
Constipation (cont’d)
 Signs and Symptoms
 Abd pain,distention
 Indigestion
 Rectal pressure
 Intestinal rumbling
 HA, fatigue, < appetite
 Complications
 Impaction
 Ulcers
 Straining- valsalva’s
 Megacolon
 Bowel obstruction
Constipation (cont’d)
 Dx: patient c/o, H&P
 Therapeutic Interventions
 High Fiber Diet
 2-3 L Fluid Daily
 Exercise- Strengthen Abdominal Muscles
 Bulk-Forming Agents
 Stool softeners
 Education
Constipation (cont’d)
 Data Collection
 History- elimination patterns, diet
 Assessment- establish rapport
 Auscultate Bowel Sounds
 Inspect/Palpate Abdomen
Nsg Dx: Contipation, Anxiety, Knowledge dificient,
perceived constipation
Diarrhea
 Fecal matter passes rapidly, decreased absorption leads
to dehydration
 Causes- bacterial/viral Infection, food allergies
 S/S- fever, foul odor, abdominal cramping, distention,
anorexia, intestinal rumbling
Diarrhea (cont’d)
 Therapeutic Interventions
 Identify cause
 Replace fluids/electrolytes
 Increase fiber/bulk
 Diphenoxylate (Lomotil), Loperamide (Imodium)
 Lactinex restores normal flora
 Nsg Dx: pain, Risk for deficient fluid volume
Appendicitis
 Inflammation f the appendix
 Fever, nausea/vomiting, anorexia, pain right lower
quadrant
 Increased white blood cells
 NPO, Surgery
 Postop Care- NPO till GI function returns, control
pain,TCDB, early ambulation
Peritonitis
 Inflammation/infection of peritoneal cavity
 Signs and Symptoms
 Abdominal pain, abd rigidity, nausea/vomiting, fever
 Tx: NPO, fluid/electrolyte replacement, NG tube,
antibiotics, surgery, pain control
 Nsg Dx: Acute pain, Deficient fluid volume, imbalanced
nutrition: less than body requires
Diverticulosis/Diverticulitis
 Diverticulum- outpouching of bowel mucous
membrane caused by > pressure within the colon and
weakness in the bowel wall.
 Diverticulosis- multiple diverticula
 Diverticulitis-Inflammation/infection of diverticulum
Diverticulum
Diverticulosis/Diverticulitis
 Causes- chronic constipation or decreased intake
of dietary fiber
 s/s- Bowel changes, constipation to diarrhea,
cramping pain L lower quad, bleeding
 Treatment :
 Prevent constipation
 Intravenous antibiotics
 Pain control
 Surgery
Crohn’s Disease
 Inflammatory bowel disease in any part of the
intestine, has remissions and exacerbations, cause
unknown, may be hereditary.
 S/S- Abd pain or cramping, wt loss, diarrhea,
fluid/electrolyte imbalance
 Dx: Barium enema, colonscopy
 Complications: malnutrition, fistulas
Fistulas
Crohn’s Disease
Therapeutic Interventions
 Avoid Offending Foods
 Medications-antiinflammatory,antidiarrheal
antibiotics,corticosteriods
 Surgery if necessary
 Elemental formula or TPN if required
 Support and education
Ulcerative Colitis
 IBD of large colon and rectum, remissions and
exacerbations
 S/S- Abd pain, 5-20 stools daily, rectal bleeding, fecal
urgency, poor appetite, wt loss, cramping, vomiting,
fever, dehydration
 Dx: endoscopy, barium enema, ESR>, CBC, WBC>
Ulcerative Colitis
 Therapeutic Interventions
 Avoid Offending Foods
 Medications- antiinflammatory, antidiarrheal,
immunosuppressants, corticosteriods
 Surgery if necessary
 Elemental formula or TPN
 Support and education
Inflammatory Bowel Disease
Nursing Diagnoses
 Acute Pain
 Diarrhea
 Deficient Fluid Volume
 Anxiety
 Impaired Skin Integrity
 Ineffective nutrition: less than body requires
 Ineffective coping
Irritable Bowel Syndrome
 Altered intestinal motility, colon does not contract in a
normal pattern, bowel mucosa not changed
 Psychological Stress/Food Intolerances
 More Common in Women
 Dx: H&P, BE, UGI, signoidoscopy
Irritable Bowel Syndrome Signs
and Symptoms
 Gas, bloating, constipation, diarrhea, abd pain,
depression, anxiety
 Tx: High fiber and bran diet
 Avoid trigger foods
 Small frequent meals
 Stress management
 Exercise and medications
Abdominal Hernias
 Protrusion of organ or structure through weakness or
tear in wall of abdomen
 Inguinal- groin area where spermatic cord is in males
round ligaments in females
 Umbilical- failure of umbilical orifice to close
 Ventral- (incisional) result from weakness inabd wall
following surgery
Types of Hernias
Abdominal Hernias (cont’d)
 s/s- none or abnormal bulging in affected area (>
with straining or coughing)
 Complications
 Strangulated Incarcerated Hernia- when edema or
adhesions occur between the sac and its contents, can
become irreducible. The trapped loop of bowel becomes
stranguled and blood supply cut off. Will see pain at site,
n/v, and abd pain
Abdominal Hernias (cont’d)
 Tx includes observation and brief or binder to hold
hernia in place.
 Surgery
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Herniorrhaphy- incision into abd wall, replace contents of
hernia sac, sew weakened tissue and close opening
Hernioplasty- replace hernia in abd, reinforce muscle wall with
wire, fascia or mesh
Bowel Obstruction
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Flow of Intestinal Contents Blocked
Mechanical- blockage occurs within the intestine
Paralytic- peristalsis impaired
Can be partial or complete- severity depends on area of
affected bowel, amount of occlusion, and amount of
blood flow disturbance
Mechanical Bowel Obstructions
Bowel Obstruction (cont’d)
 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
 Abdominal distention
 Fluid/Electrolyte imbalance
Bowel Obstruction (cont’d)
 Dx: abd x-ray, CT, CBC & electrolytes
 Treatment
 NPO
 Frequent Mouth Care
 Nasogastric Tube
 Fluid and Electrolyte Replacement
 Medications: antibiotics, antiemetics, analgesic
 Surgery
Anorectal Problems
 Hemorrhoids- varicose veins in the anal canal.
Prevent constipation, avoid straining. Sitz bath,
antiinflammatory med, stool softeners,
sclerotherapy, or surgical removal
 Anal Fissures- cracks or ulcers in the lining of anal
canal. Stool softeners, sitz bath, anesthetic
suppositories
 Anorectal Abscess-pus pocket in rectal area.
Antibiotics,I&D
Lower Gastrointestinal Bleeding
Causes
 Causes: diverticulitis, polyps, anal fissures,
hemorrhoids, IBD, cancer
 Occult blood, melena, bright red stools
 Treat cause: monitor stools and bleeding, VS, diagnostic
preps
Colon 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
Colon Cancer (cont’d)
 Diagnosis
 Colon Care
 Colonoscopy with Biopsy
 Sigmoidoscopy with Biopsy
 Proctosigmoidoscopy
 Barium enema
 Abdominal and rectal exam
 Fecal occult blood
Colon Cancer (cont’d)
 Therapeutic Interventions
 Surgery- resection, possibly colostomy
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Radiation
Chemotherapy/radiation
Anagesics
TPN if necessary
Nursing Care: support and education
Nsg Dx: Pain, anxiety, imbalanced nutrition
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
Ileostomy Types
 Conventional Ileostomy
 Small Stoma Right Lower Quadrant
 Continuous Flow Liquid Effluent
 Continent Ileostomy
 Internal Reservoir with Nipple Valve
 Empty Reservoir 3-4 Times Daily
Types of Stomas
Colostomy
 stool 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
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
Preoperative Ostomy Care
 Wound Ostomy Continence Nurse
 Marks Site
 Emotional, Physical Support
 Teaching- appliance change, hygiene, dietary
considerations
 Bowel Prep
 Antibiotics
Postoperative Ostomy Care
 Data Collection
 Vital Signs
 Reinforce teaching
 Stoma- monitor skin for irritation
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Stoma shrinks over weeks
Pink To Red, Moist = Normal
Bluish = Inadequate Blood Supply
Black = Necrosis