1. Understanding Medical Surgical Nursing, 4th Edition Nursing Care of Patients with Lower Gastrointestinal Disorders

2. Understanding Medical Surgical Nursing, 4th Edition  Small Intestines  Large Intestines  Rectum  Anus

3. Understanding Medical Surgical Nursing, 4th Edition  Fecal Mass Held In Rectum  Feces Become Dry, Hard  Many Causes  Prevention: High-fiber Diet, Fluids, Exercise  Obstipation

4. Understanding Medical Surgical Nursing, 4th Edition  Signs and Symptoms ◦ Abdominal Pain ◦ Distention ◦ Indigestion ◦ Rectal Pressure ◦ Incomplete Emptying  Headache  Fatigue  Decreased Appetite

5. Understanding Medical Surgical Nursing, 4th Edition  Complications ◦ Impaction ◦ Ulcers ◦ Straining ◦ Megacolon ◦ Chronic Laxative Abuse – Fibrosis

6. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions ◦ High-fiber Diet, 2 to 3 L Fluid Daily ◦ Strengthen Abdominal Muscles ◦ Exercise ◦ Bulk-forming Agents ◦ Stool Softeners ◦ Education

7. Understanding Medical Surgical Nursing, 4th Edition  Data Collection ◦ Establish Rapport ◦ History ◦ Auscultate Bowel Sounds ◦ Inspect/Palpate Abdomen

8. Understanding Medical Surgical Nursing, 4th Edition  Nursing Diagnoses ◦ Constipation ◦ Anxiety ◦ Perceived Constipation ◦ Deficient Knowledge

9. Understanding Medical Surgical Nursing, 4th Edition  Fecal Matter Passes Rapidly  Decreased Absorption  Causes ◦ Bacterial/Viral Infection ◦ Food Allergies  Prevention

10. Understanding Medical Surgical Nursing, 4th Edition  Signs And Symptoms ◦ Fever ◦ Foul Odor ◦ Abdominal Cramping ◦ Distention ◦ Anorexia ◦ Intestinal Rumbling

11. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions ◦ Identify Cause ◦ Replace Fluids/Electrolytes ◦ Increase Fiber/Bulk ◦ Diphenoxylate (Lomotil), Loperamide (Imodium) ◦ Lactinex Restores Normal Flora ◦ Antimicrobial Agents

12. Understanding Medical Surgical Nursing, 4th Edition  Nursing Diagnoses ◦ Acute Pain ◦ Diarrhea ◦ Risk for Deficient Fluid Volume ◦ Risk for Infection ◦ Risk for Impaired Skin Integrity

13. Understanding Medical Surgical Nursing, 4th Edition  Inflammation of the Appendix  Fever, Nausea/Vomiting, Anorexia, Pain Right Lower Quadrant  Increased White Blood Cells  NPO, Surgery  Postoperative Care

14. Understanding Medical Surgical Nursing, 4th Edition

15.  Inflammation/Infection of Peritoneal Cavity  Signs and Symptoms ◦ Abdominal Pain ◦ Abdominal Rigidity ◦ Nausea/Vomiting ◦ Fever

16. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions ◦ NPO ◦ Fluid/Electrolyte Replacement ◦ Naso/Orogastric Tube ◦ Antibiotics ◦ Surgery ◦ Pain Control

17. Understanding Medical Surgical Nursing, 4th Edition  Complications ◦ Intestinal Obstruction ◦ Hypovolemia ◦ Septicemia

18. Understanding Medical Surgical Nursing, 4th Edition  Nursing Diagnoses ◦ Acute Pain ◦ Deficient Fluid Volume ◦ Imbalanced Nutrition: Less Than Body Requirements

19. Understanding Medical Surgical Nursing, 4th Edition  Diverticulum ◦ Outpouching of Bowel Mucous Membrane  Diverticulosis ◦ Multiple Diverticula  Diverticulitis ◦ Inflammation/Infection of Diverticulum

20. Understanding Medical Surgical Nursing, 4th Edition

21.  Causes ◦ Chronic Constipation ◦ Decreased Intake of Dietary Fiber

22. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions ◦ Prevent Constipation ◦ Intravenous Antibiotics ◦ Pain Control ◦ Surgery

23. Understanding Medical Surgical Nursing, 4th Edition  Acute Pain  Risk for Deficient Fluid Volume

24. Understanding Medical Surgical Nursing, 4th Edition  Inflammatory Bowel Disease  Any Part of the Intestine  Remissions and Exacerbations  Cause Unknown  Hereditary

25. Understanding Medical Surgical Nursing, 4th Edition  Signs and Symptoms ◦ Abdominal Pain or Cramping ◦ Weight Loss ◦ Diarrhea ◦ Fluid and Electrolyte Imbalance

26. Understanding Medical Surgical Nursing, 4th Edition  Complications ◦ Malnutrition ◦ Fissures ◦ Abscesses ◦ Fistulas

27. Understanding Medical Surgical Nursing, 4th Edition

28.  Diagnosis ◦ Laboratory Testing ◦ Endoscopy with Biopsy ◦ Ultrasound ◦ Multiphase CT Enterography ◦ Magnetic Resonance Enterography

29. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions ◦ Medications  Anti-inflammatories  Antidiarrheal  Antibiotics  Biologics  Corticosteriods  Immunosuppressants

30. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions (cont’d) ◦ Avoid Offending Foods ◦ Surgery if Necessary ◦ Elemental Formula or TPN if Required ◦ Support and Education

31. Understanding Medical Surgical Nursing, 4th Edition  Inflammatory Bowel Disease  Colon and Rectum  Remissions and Exacerbations

32. Understanding Medical Surgical Nursing, 4th Edition  Signs and Symptoms ◦ Abdominal Pain ◦ 5 to 20 Stools Daily ◦ Rectal Bleeding ◦ Fecal Urgency ◦ Anorexia ◦ Weight Loss ◦ Cramping ◦ Vomiting ◦ Fever ◦ Dehydration

33. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions ◦ Avoid Offending Foods ◦ Medications  Anti-inflammatories  Antidiarrheal  Immunosuppressants  Corticosteriods

34. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions (cont’d) ◦ Surgery if Necessary ◦ Elemental Formula or TPN if Required

35. Understanding Medical Surgical Nursing, 4th Edition  Acute Pain  Diarrhea  Deficient Fluid Volume  Anxiety  Impaired Skin Integrity

36. Understanding Medical Surgical Nursing, 4th Edition  Ineffective Nutrition: Less Than Body Requirements  Ineffective Coping

37. Understanding Medical Surgical Nursing, 4th Edition  Altered Intestinal Motility/Increased Sensitivity to Visceral Sensations  Bowel Mucosa Not Changed  Psychological Stress/Food Intolerances  More Common in Women

38. Understanding Medical Surgical Nursing, 4th Edition  Signs and Symptoms ◦ Gas ◦ Bloating ◦ Constipation ◦ Diarrhea ◦ Abdominal Pain ◦ Depression, Anxiety

39. Understanding Medical Surgical Nursing, 4th Edition  Diagnosis ◦ History ◦ Physical Examination

40. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions ◦ High Fiber and Bran Diet ◦ Avoid Trigger Foods ◦ Smaller, Frequent Meals ◦ Stress Management

41. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions (cont’d) ◦ Behavioral Therapy ◦ Exercise ◦ Medications

42. Understanding Medical Surgical Nursing, 4th Edition  Nursing Diagnoses ◦ Constipation ◦ Diarrhea ◦ Readiness for Enhanced Self-Health Management

43. Understanding Medical Surgical Nursing, 4th Edition  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. Understanding Medical Surgical Nursing, 4th Edition  Types ◦ Inguinal ◦ Umbilical ◦ Ventral (Incisional)

45. Understanding Medical Surgical Nursing, 4th Edition

46.  Signs and Symptoms ◦ None ◦ Bulging  Complications ◦ Strangulated Incarcerated Hernia

47. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions ◦ None ◦ Observation ◦ Support Devices ◦ Surgery  Herniorrhaphy  Hernioplasty

48. Understanding Medical Surgical Nursing, 4th Edition  Nursing Care ◦ Education ◦ Postoperative  No Coughing  Activity  Education

49. Understanding Medical Surgical Nursing, 4th Edition  Inability to Absorb One or More Major Nutrients  Types ◦ Celiac Disease ◦ Lactose Intolerance

50. Understanding Medical Surgical Nursing, 4th Edition  General Signs and Symptoms ◦ Weight Loss ◦ Weakness ◦ General Malaise

51. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions ◦ Celiac Disease  High-calorie, High-protein, Gluten-free Diet ◦ Lactose Intolerance  Avoid Lactose Foods; Lactaid

52. Understanding Medical Surgical Nursing, 4th Edition  Nursing Care ◦ Monitor Fluids, Electrolytes, Nutritional Status ◦ Daily Weight ◦ Intake and Output ◦ Education

53. Understanding Medical Surgical Nursing, 4th Edition  Flow of Intestinal Contents is Blocked  Mechanical: Blockage Occurs Within the Intestine  Non-mechanical: Peristalsis is Impaired  Partial or Complete

54. Understanding Medical Surgical Nursing, 4th Edition

55.  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. Understanding Medical Surgical Nursing, 4th Edition  Signs and Symptoms ◦ Abdominal Distention ◦ Fluid/Electrolyte Imbalance

57. Understanding Medical Surgical Nursing, 4th Edition  Diagnosis ◦ Abdominal X-Ray ◦ CT Scan ◦ CBC and Electrolytes

58. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions ◦ NPO ◦ Frequent Mouth Care ◦ Nasogastric Tube ◦ Fluid and Electrolyte Replacement

59. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions (cont’d) ◦ Medications  Antibiotics  Anti-emetics  Analgesics ◦ Surgery

60. Understanding Medical Surgical Nursing, 4th Edition  Nursing Diagnoses ◦ Acute Pain ◦ Deficient Fluid Volume ◦ Deficient Knowledge

61. Understanding Medical Surgical Nursing, 4th Edition  Hemorrhoids  Anal Fissures  Anorectal Abscess

62. Understanding Medical Surgical Nursing, 4th Edition  Nursing Care ◦ Postoperative  Pain Control  Sitz Baths  Dressing Changes  Stool Softeners

63. Understanding Medical Surgical Nursing, 4th Edition  Diverticulitis  Polyps  Anal Fissures  Hemorrhoids  Inflammatory Bowel Disease  Cancer

64. Understanding Medical Surgical Nursing, 4th Edition  Occult Blood, Melena, Bright Red Stools  Treat Cause

65. Understanding Medical Surgical Nursing, 4th Edition  Nursing Care ◦ Monitor Stools, Bleeding ◦ Vital Signs ◦ Diagnostic Prep

66. Understanding Medical Surgical Nursing, 4th Edition  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. Understanding Medical Surgical Nursing, 4th Edition  Major Cause: Lack of Dietary Fiber  Signs and Symptoms ◦ Anemia ◦ Obstruction

68. Understanding Medical Surgical Nursing, 4th Edition  Diagnosis ◦ Colonoscopy with Biopsy ◦ Sigmoidoscopy with Biopsy ◦ Proctosigmoidoscopy ◦ CT Scan

69. Understanding Medical Surgical Nursing, 4th Edition  Diagnosis (cont’d) ◦ Abdominal and Rectal Examination ◦ Immunological Tests ◦ Fecal Occult Blood ◦ CEA

70. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions ◦ Surgery  Resection  Abdominoperineal Resection  Colostomy

71. Understanding Medical Surgical Nursing, 4th Edition  Therapeutic Interventions (cont’d) ◦ Radiation ◦ Chemotherapy ◦ Monoclonal Antibody Therapy ◦ Analgesics ◦ TPN as Necessary

72. Understanding Medical Surgical Nursing, 4th Edition  Nursing Diagnoses ◦ Acute Pain ◦ Anxiety ◦ Imbalanced Nutrition: Less Than Body Requirements

73. Understanding Medical Surgical Nursing, 4th Edition  Nursing Care ◦ Support and Education ◦ Postoperative Care

74. Understanding Medical Surgical Nursing, 4th Edition  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. Understanding Medical Surgical Nursing, 4th Edition Terminal Ileum to Abdominal Wall After Total Colectomy

76. Understanding Medical Surgical Nursing, 4th Edition  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. Understanding Medical Surgical Nursing, 4th Edition

78.  Ileoanal Anastomosis  Ileorectal Anastomosis

79. Understanding Medical Surgical Nursing, 4th Edition

81.  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. Understanding Medical Surgical Nursing, 4th Edition  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. Understanding Medical Surgical Nursing, 4th Edition  Wound Ostomy Continence Nurse ◦ Marks Site ◦ Emotional, Physical Support  Teaching  Bowel Prep  Antibiotics

84. Understanding Medical Surgical Nursing, 4th Edition  Deficient Knowledge ◦ Appliance Change ◦ Daily Care and Hygiene ◦ Dietary Considerations

85. Understanding Medical Surgical Nursing, 4th Edition  Body Image Disturbance  Sexual Dysfunction  Ineffective Therapeutic Regimen Management

86. Understanding Medical Surgical Nursing, 4th Edition  Risk for Injury ◦ Peristomal Skin Irritation ◦ Peristomal Hernia ◦ Stomal Prolapse ◦ Stomal Necrosis ◦ Ileostomy Blockage

87. Understanding Medical Surgical Nursing, 4th Edition  Data Collection ◦ Vital Signs ◦ Stoma  Pink to Red, Moist = Normal  Bluish = Inadequate Blood Supply  Black = Necrosis

88. Understanding Medical Surgical Nursing, 4th Edition  Data Collection ◦ Skin Around Stoma Monitored for Irritation  Stoma Shrinks Over Weeks  Ostomy Care ◦ Appliance Change  Teaching