nursing care & interventions for clients with inflammatory intestinal disorders

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Keith Rischer RN, MA, CEN

Nursing Care & Interventions for Clients with Inflammatory

Intestinal Disorders

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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.

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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.

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Physical assessmentClinical manifestationsPsychosocial assessmentLaboratory assessmentRadiographic assessment

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Interventions:• Record the color,

volume, frequency, and consistency of stools.

• Identify factors that cause or contribute to diarrhea.

• Eliminate gas-producing and spicy foods.

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• 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.

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Salicylate compoundsCorticosteroidsImmunosuppressive drugsAntidiarrheal drugsOther drugs

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Internal ileal reservoirIntra-abdominal pouch created from the

terminal ileum by the surgeonStool stored in the pouch drained by

catheterCare of pouchEffluent, or drainage, monitored

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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 careOperative procedurePostoperative care

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Interventions include:• Pain management in

ulcerative colitisComprehensive pain

assessmentEvaluation of effectiveness

of pain control measures used

Reduction or elimination of precipitating factors for pain.

Teach use of non-pharmacologic pain reducing measures.

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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

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Idiopathic inflammatory disease of the small intestine and the colon, or both

All layers of the bowel involved, mostly terminal ileum

Bowel fistulasRare cancer of the small bowel and colon

develop.Malabsorption of vitamins and nutrients

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Physical assessmentClinical manifestationsPsychosocial assessmentDiagnostic assessment

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Drug therapyNutritional managementComplication managementFluid and electrolyte therapySkin carePrevention of infectionComplementary and alternative therapy

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LaparoscopySmall bowel resection and ileocecal

resectionsStricturoplastyPreoperative careOperative procedurePostoperative care

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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.

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HistoryPhysical

assessmentClinical

manifestationsDiagnostic

assessment

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Drug therapyDiet therapyRestIntravenous fluids to correct dehydrationIntravenous antibioticsAnticholinergicsAnalgesics

(

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Avoid laxativesRestNothing by mouth in the hospital

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Preoperative careOperative procedurePostoperative care

• Drain care• Care of the ostomy• Nothing by mouth followed by clear liquids

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Localized induration and fluctuance due to the inflammation of the soft tissue near the rectum or anus

Rectal pain first symptomSurgical incision and drainageNursing interventions focused on helping

the client maintain comfort and optimal perineal hygiene

High-fiber diet