1. Nursing Care & Interventions for Clients with Inflammatory Intestinal Disorders
Keith Rischer RN, MA, CEN

2. Today’s Objectives…
Describe commonalities in diseases of the gastro-intestinal tract.
Compare indicators for malignancy throughout the gastro-intestinal system.
Discuss relevance of diagnostic test results to the nursing plan of care.
Discuss the pathophysiology and assessment findings of ulcerative colitis and Crohn’s disease.
Consider nursing interventions for a client with a new ostomy.
Develop a teaching plan for a client integrating the use of medication and diet.

3. Chronic Inflammatory Bowel Disease
Ulcerative colitis is one of a group of bowel diseases of unknown etiology characterized by remissions and exacerbations (flare-ups).
Mucosal lining of the colon or rectum is affected.
Loose stools containing blood and mucus, poor absorption of vital nutrients, and thickening of the colon wall can result.

4. Assessment Physical assessment Clinical manifestations
Psychosocial assessment
Laboratory assessment
Radiographic assessment

5. Diarrhea Interventions:
Record the color, volume, frequency, and consistency of stools.
Identify factors that cause or contribute to diarrhea.
Eliminate gas-producing and spicy foods.

6. Diarrhea (Continued) Eliminate by trial foods containing lactose.
Eat a low-fiber, high-protein, high-calorie diet.
Use antidiarrheal medications.
Monitor skin.
Record weight regularly.
Rest the bowel.
S&P 6

7. Drug Therapy Salicylate compounds Corticosteroids
Immunosuppressive drugs
Antidiarrheal drugs
Other drugs

8. Total Colectomy with a Continent (Kock’s) Ileostomy
Internal ileal reservoir
Intra-abdominal pouch created from the terminal ileum by the surgeon
Stool stored in the pouch drained by catheter
Care of pouch
Effluent, or drainage, monitored

9. Total Colectomy with Ileoanal Anastomosis (J Pouch)
Removal of the colon and the rectum with the ileum sutured into the anal canal
Spares the rectal sphincter and need for an ostomy
Preoperative care
Operative procedure
Postoperative care

10. Acute Pain; Chronic Pain
Interventions include:
Pain management in ulcerative colitis
Comprehensive pain assessment
Evaluation of effectiveness of pain control measures used
Reduction or elimination of precipitating factors for pain.
Teach use of non-pharmacologic pain reducing measures.
S&P 10

11. Potential for Gastrointestinal Bleeding
Interventions include:
Monitoring for signs and symptoms of gastrointestinal bleeding
Monitoring all stools for blood, using both gross and occult examination
Monitoring hematocrit, hemoglobin, and electrolyte values
Monitoring vital signs
Preparing for possible blood administration

12. Crohn’s Disease
Idiopathic inflammatory disease of the small intestine and the colon, or both
All layers of the bowel involved, mostly terminal ileum
Bowel fistulas
Rare cancer of the small bowel and colon develop.
Malabsorption of vitamins and nutrients
S&P 12

13. Assessment Physical assessment Clinical manifestations
Psychosocial assessment
Diagnostic assessment

14. Nonsurgical Management
Drug therapy
Nutritional management
Complication management
Fluid and electrolyte therapy
Skin care
Prevention of infection
Complementary and alternative therapy

15. Surgical Management Laparoscopy
Small bowel resection and ileocecal resections
Stricturoplasty
Preoperative care
Operative procedure
Postoperative care

16. Diverticular Disease
Diverticulosis is the presence of many abnormal pouchlike herniations in the wall of the intestine.
Diverticulitis is the term used to describe an inflammation of one or more of the diverticula.

17. Assessments History Physical assessment Clinical manifestations
Diagnostic assessment

18. Nonsurgical Management
Drug therapy
Diet therapy
Rest
Intravenous fluids to correct dehydration
Intravenous antibiotics
Anticholinergics
Analgesics (

19. Nonsurgical Management
Avoid laxatives
Rest
Nothing by mouth in the hospital

20. Surgical Management Preoperative care Operative procedure
Postoperative care
Drain care
Care of the ostomy
Nothing by mouth followed by clear liquids

21. Anorectal Abscess
Localized induration and fluctuance due to the inflammation of the soft tissue near the rectum or anus
Rectal pain first symptom
Surgical incision and drainage
Nursing interventions focused on helping the client maintain comfort and optimal perineal hygiene
High-fiber diet
S&P 21