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Nursing Care of Patients with Lower Gastrointestinal Disorders
Chapter 34 Nursing Care of Patients with Lower Gastrointestinal Disorders
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Lower Gastrointestinal System
Small Intestines Large Intestines Rectum Anus
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Constipation Fecal Mass Held In Rectum Feces Become Dry, Hard
Many Causes Prevention: High-fiber Diet, Fluids, Exercise Obstipation
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Constipation (cont’d)
Signs and Symptoms Abdominal Pain Distention Indigestion Rectal Pressure Incomplete Emptying Headache Fatigue Decreased Appetite
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Constipation (cont’d)
Complications Impaction Ulcers Straining Megacolon Chronic Laxative Abuse – Fibrosis
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Constipation (cont’d)
Therapeutic Interventions High-fiber Diet, 2 to 3 L Fluid Daily Strengthen Abdominal Muscles Exercise Bulk-forming Agents Stool Softeners Education
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Constipation (cont’d)
Data Collection Establish Rapport History Auscultate Bowel Sounds Inspect/Palpate Abdomen
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Constipation (cont’d)
Nursing Diagnoses Constipation Anxiety Perceived Constipation Deficient Knowledge
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Diarrhea Fecal Matter Passes Rapidly Decreased Absorption Causes
Bacterial/Viral Infection Food Allergies Prevention
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Diarrhea (cont’d) Signs And Symptoms Fever Foul Odor
Abdominal Cramping Distention Anorexia Intestinal Rumbling
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Diarrhea (cont’d) Therapeutic Interventions Identify Cause
Replace Fluids/Electrolytes Increase Fiber/Bulk Diphenoxylate (Lomotil), Loperamide (Imodium) Lactinex Restores Normal Flora Antimicrobial Agents
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Diarrhea (cont’d) Nursing Diagnoses Acute Pain Diarrhea
Risk for Deficient Fluid Volume Risk for Infection Risk for Impaired Skin Integrity
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Appendicitis Inflammation of the Appendix
Fever, Nausea/Vomiting, Anorexia, Pain Right Lower Quadrant Increased White Blood Cells NPO, Surgery Postoperative Care
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McBurney’s Point
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Peritonitis Inflammation/Infection of Peritoneal Cavity
Signs and Symptoms Abdominal Pain Abdominal Rigidity Nausea/Vomiting Fever
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Peritonitis (cont’d) Therapeutic Interventions NPO
Fluid/Electrolyte Replacement Naso/Orogastric Tube Antibiotics Surgery Pain Control
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Peritonitis (cont’d) Complications Intestinal Obstruction Hypovolemia
Septicemia
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Peritonitis (cont’d) Nursing Diagnoses Acute Pain
Deficient Fluid Volume Imbalanced Nutrition: Less Than Body Requirements
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Diverticulosis/Diverticulitis
Diverticulum Outpouching of Bowel Mucous Membrane Diverticulosis Multiple Diverticula Diverticulitis Inflammation/Infection of Diverticulum
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Diverticulum
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Diverticulosis/Diverticulitis (cont’d)
Causes Chronic Constipation Decreased Intake of Dietary Fiber
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Diverticulosis/Diverticulitis (cont’d)
Therapeutic Interventions Prevent Constipation Intravenous Antibiotics Pain Control Surgery
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Nursing Diagnoses: Inflammatory or Infectious Disorder
Acute Pain Risk for Deficient Fluid Volume
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Crohn’s Disease Inflammatory Bowel Disease Any Part of the Intestine
Remissions and Exacerbations Cause Unknown Hereditary
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Crohn’s Disease (cont’d)
Signs and Symptoms Abdominal Pain or Cramping Weight Loss Diarrhea Fluid and Electrolyte Imbalance
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Crohn’s Disease (cont’d)
Complications Malnutrition Fissures Abscesses Fistulas
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Fistulas
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Crohn’s Disease (cont’d)
Diagnosis Laboratory Testing Endoscopy with Biopsy Ultrasound Multiphase CT Enterography Magnetic Resonance Enterography
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Crohn’s Disease (cont’d)
Therapeutic Interventions Medications Anti-inflammatories Antidiarrheal Antibiotics Biologics Corticosteriods Immunosuppressants
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Crohn’s Disease (cont’d)
Therapeutic Interventions (cont’d) Avoid Offending Foods Surgery if Necessary Elemental Formula or TPN if Required Support and Education
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Ulcerative Colitis Inflammatory Bowel Disease Colon and Rectum
Remissions and Exacerbations
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Ulcerative Colitis (cont’d)
Signs and Symptoms Abdominal Pain 5 to 20 Stools Daily Rectal Bleeding Fecal Urgency Anorexia Weight Loss Cramping Vomiting Fever Dehydration
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Ulcerative Colitis (cont’d)
Therapeutic Interventions Avoid Offending Foods Medications Anti-inflammatories Antidiarrheal Immunosuppressants Corticosteriods
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Ulcerative Colitis (cont’d)
Therapeutic Interventions (cont’d) Surgery if Necessary Elemental Formula or TPN if Required
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Nursing Diagnoses: Inflammatory Bowel Disease
Acute Pain Diarrhea Deficient Fluid Volume Anxiety Impaired Skin Integrity
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Nursing Diagnoses: Inflammatory Bowel Disease (cont’d)
Ineffective Nutrition: Less Than Body Requirements Ineffective Coping
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Irritable Bowel Syndrome
Altered Intestinal Motility/Increased Sensitivity to Visceral Sensations Bowel Mucosa Not Changed Psychological Stress/Food Intolerances More Common in Women
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Irritable Bowel Syndrome (cont’d)
Signs and Symptoms Gas Bloating Constipation Diarrhea Abdominal Pain Depression, Anxiety
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Irritable Bowel Syndrome (cont’d)
Diagnosis History Physical Examination
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Irritable Bowel Syndrome (cont’d)
Therapeutic Interventions High Fiber and Bran Diet Avoid Trigger Foods Smaller, Frequent Meals Stress Management
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Irritable Bowel Syndrome (cont’d)
Therapeutic Interventions (cont’d) Behavioral Therapy Exercise Medications
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Irritable Bowel Syndrome (cont’d)
Nursing Diagnoses Constipation Diarrhea Readiness for Enhanced Self-Health Management
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Abdominal Hernias Pathophysiology Etiology
Protrusion of Organ or Structure Through Weakness or Tear in Wall of Abdomen Etiology Weakness in Abdominal Wall with Increased Intra- abdominal Pressure
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Abdominal Hernias (cont’d)
Types Inguinal Umbilical Ventral (Incisional)
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Types of Hernias
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Abdominal Hernias (cont’d)
Signs and Symptoms None Bulging Complications Strangulated Incarcerated Hernia
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Abdominal Hernias (cont’d)
Therapeutic Interventions None Observation Support Devices Surgery Herniorrhaphy Hernioplasty
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Abdominal Hernias (cont’d)
Nursing Care Education Postoperative No Coughing Activity
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Absorption Disorders Inability to Absorb One or More Major Nutrients
Types Celiac Disease Lactose Intolerance
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Absorption Disorders (cont’d)
General Signs and Symptoms Weight Loss Weakness General Malaise
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Absorption Disorders (cont’d)
Therapeutic Interventions Celiac Disease High-calorie, High-protein, Gluten-free Diet Lactose Intolerance Avoid Lactose Foods; Lactaid
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Absorption Disorders (cont’d)
Nursing Care Monitor Fluids, Electrolytes, Nutritional Status Daily Weight Intake and Output Education
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Bowel Obstruction Flow of Intestinal Contents is Blocked
Mechanical: Blockage Occurs Within the Intestine Non-mechanical: Peristalsis is Impaired Partial or Complete
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Mechanical Bowel Obstructions
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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
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Bowel Obstruction (cont’d)
Signs and Symptoms Abdominal Distention Fluid/Electrolyte Imbalance
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Bowel Obstruction (cont’d)
Diagnosis Abdominal X-Ray CT Scan CBC and Electrolytes
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Bowel Obstruction (cont’d)
Therapeutic Interventions NPO Frequent Mouth Care Nasogastric Tube Fluid and Electrolyte Replacement
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Bowel Obstruction (cont’d)
Therapeutic Interventions (cont’d) Medications Antibiotics Anti-emetics Analgesics Surgery
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Bowel Obstruction (cont’d)
Nursing Diagnoses Acute Pain Deficient Fluid Volume Deficient Knowledge
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Anorectal Problems Hemorrhoids Anal Fissures Anorectal Abscess
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Anorectal Problems (cont’d)
Nursing Care Postoperative Pain Control Sitz Baths Dressing Changes Stool Softeners
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Lower Gastrointestinal Bleeding Causes
Diverticulitis Polyps Anal Fissures Hemorrhoids Inflammatory Bowel Disease Cancer
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Lower Gastrointestinal Bleeding
Occult Blood, Melena, Bright Red Stools Treat Cause
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Lower Gastrointestinal Bleeding (cont’d)
Nursing Care Monitor Stools, Bleeding Vital Signs Diagnostic Prep
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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
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Colorectal Cancer (cont’d)
Major Cause: Lack of Dietary Fiber Signs and Symptoms Anemia Obstruction
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Colorectal Cancer (cont’d)
Diagnosis Colonoscopy with Biopsy Sigmoidoscopy with Biopsy Proctosigmoidoscopy CT Scan
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Colorectal Cancer (cont’d)
Diagnosis (cont’d) Abdominal and Rectal Examination Immunological Tests Fecal Occult Blood CEA
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Colorectal Cancer (cont’d)
Therapeutic Interventions Surgery Resection Abdominoperineal Resection Colostomy
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Colorectal Cancer (cont’d)
Therapeutic Interventions (cont’d) Radiation Chemotherapy Monoclonal Antibody Therapy Analgesics TPN as Necessary
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Colorectal Cancer (cont’d)
Nursing Diagnoses Acute Pain Anxiety Imbalanced Nutrition: Less Than Body Requirements
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Colorectal Cancer (cont’d)
Nursing Care Support and Education Postoperative Care
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Ostomy Management Ostomy Stoma
Surgically Created Opening Diverts Stool or Urine to Outside of Body Stoma Portion of Bowel Sutured onto Abdomen Abdominal Ostomies: Ileostomy, Colostomy, Urostomy
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Ileostomy Terminal Ileum to Abdominal Wall After Total Colectomy
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Ileostomy Types Conventional Ileostomy Continent Ileostomy
Small Stoma Right Lower Quadrant Continuous Flow Liquid Effluent Continent Ileostomy Internal Reservoir with Nipple Valve Empty Reservoir 3 to 4 Times Daily
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Continent Ileostomy
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Ileostomy Types (cont’d)
Ileoanal Anastomosis Ileorectal Anastomosis
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Ileal–Anal Anastomosis J Pouch
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Types of Stomas
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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
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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
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Preoperative Ostomy Care
Wound Ostomy Continence Nurse Marks Site Emotional, Physical Support Teaching Bowel Prep Antibiotics
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Nursing Diagnoses Deficient Knowledge Appliance Change
Daily Care and Hygiene Dietary Considerations
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Nursing Diagnoses (cont’d)
Body Image Disturbance Sexual Dysfunction Ineffective Therapeutic Regimen Management
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Nursing Diagnoses (cont’d)
Risk for Injury Peristomal Skin Irritation Peristomal Hernia Stomal Prolapse Stomal Necrosis Ileostomy Blockage
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Postoperative Ostomy Care
Data Collection Vital Signs Stoma Pink to Red, Moist = Normal Bluish = Inadequate Blood Supply Black = Necrosis
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Postoperative Ostomy Care (cont’d)
Data Collection Skin Around Stoma Monitored for Irritation Stoma Shrinks Over Weeks Ostomy Care Appliance Change Teaching
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