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
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
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
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
Stoma shrinks over weeks
Pink To Red, Moist = Normal
Bluish = Inadequate Blood Supply
Black = Necrosis