Chapter 34 Nursing Care of Patients

with Lower Gastrointestinal

Disorders

Lower Gastrointestinal System

• Small Intestines

• Large Intestines

• Rectum

• Anus

https://www.youtube.com/watch?v=rvPD-OMZgQg

Constipation

• Fecal Mass Held In Rectum

• Feces Become Dry, Hard

• Many Causes

• Prevention: High-fiber Diet, Fluids, Exercise

• Obstipation

Constipation

• Signs and Symptoms – Abdominal Pain

– Distention

– Indigestion

– Rectal Pressure

– Incomplete emptying

– Headache

– Fatigue

– Decreased Appetite

Constipation

• Complications

– Impaction

– Ulcers

– Straining

– Megacolon

– Chronic Laxative Abuse – Fibrosis

Constipation

• Therapeutic Interventions

– High-fiber Diet, 2 to 3 L Fluid Daily

– Strengthen Abdominal Muscles

– Exercise

– Bulk-forming Agents

– Stool Softeners

– Education

Constipation (cont’d)

• Data Collection

– Establish Rapport

– History

– Auscultate Bowel Sounds

– Inspect/Palpate Abdomen

https://search.yahoo.com/search;_ylt=A0LEV1nSNwhVCfgACqNXNyoA;_ylc=X1MDMjc2NjY3OQRfcgMyBGZyA3lmcC10LTkwMQRncHJpZAMweWlwb1o2ZFRiS0o4ZG12cTZ2UV9BBG5fcnNsdAMwBG5fc3VnZwMxMARvcmlnaW4Dc2VhcmNoLnlhaG9vLmNvbQRwb3MDMARwcXN0cgMEcHFzdHJsAwRxc3RybAMxMwRxdWVyeQNvY2VhbnMgc291bmRzBHRfc3RtcAMxNDI2NjAyNDI5?p=oceans+sounds&fr2=sb-top-search&fr=yfp-t-901&fp=1

Diarrhea

• Fecal Matter Passes Rapidly

• Decreased Absorption

• Causes

– Bacterial/Viral Infection

– Food Allergies

• Prevention

Diarrhea

• Signs And Symptoms

– Fever

– Foul Odor

– Abdominal Cramping

– Distention

– Anorexia

– Intestinal Rumbling

Diarrhea

• Therapeutic Interventions

– Identify Cause

– Replace Fluids/Electrolytes

– Increase Fiber/Bulk

– Diphenoxylate (Lomotil), Loperamide (Imodium)

– Lactinex Restores Normal Flora

– Antimicrobial Agents

Appendicitis

• Inflammation of the Appendix

• Fever, Nausea/Vomiting, Anorexia, Pain Right Lower Quadrant

• Increased White Blood Cells

• NPO, Surgery

• Postoperative Care

McBurney’s Point

Peritonitis

• Inflammation/Infection of Peritoneal Cavity

• Signs and Symptoms

– Abdominal Pain

– Abdominal Rigidity

– Nausea/Vomiting

– Fever

Peritonitis

• Therapeutic Interventions

– NPO

– Fluid/Electrolyte Replacement

– Naso/Orogastric Tube

– Antibiotics

– Surgery

– Pain Control

Peritonitis

• Complications

Diverticulosis/Diverticulitis

• Diverticulum

– Outpouching of Bowel Mucous Membrane

• Diverticulosis

– Multiple Diverticula

• Diverticulitis

– Inflammation/Infection of Diverticulum

Diverticulum

Diverticulosis/Diverticulitis

• Causes

– Chronic Constipation

– Decreased Intake of Dietary Fiber

• Therapeutic Interventions

– Prevent Constipation

– Intravenous Antibiotics

– Pain Control

– Surgery

Crohn’s Disease

• Inflammatory Bowel Disease

• Any Part of the Intestine

• Remissions and Exacerbations

• Cause Unknown

• Hereditary

Crohn’s Disease

• Signs and Symptoms

– Abdominal Pain or Cramping

– Weight Loss

– Diarrhea

– Fluid and Electrolyte Imbalance

Crohn’s Disease

• Complications

– Malnutrition

– Fissures

– Abscesses

– Fistulas

Fistulas

Crohn’s Disease

• Diagnosis

– Laboratory Testing

– Endoscopy with Biopsy

– Ultrasound

– Multiphase CT Enterography

– Magnetic Resonance Enterography

Crohn’s Disease

• Therapeutic Interventions – Medications

• Aminosalicylates: Azulfidine (sulfasalazine) • Antidiarrheal • Biologic: Humira (adalimumab) • Corticosteriods • Immunomodulators: Imuran (azathioprine)

– Avoid Offending Foods – Surgery if Necessary – Elemental Formula or PN if Required – Support and Education

Ulcerative Colitis

• Inflammatory Bowel Disease

• Colon and Rectum

• Remissions and Exacerbations

Ulcerative Colitis • Signs and Symptoms

– Abdominal Pain

– 5 to 20 Stools Daily

– Rectal Bleeding

– Fecal Urgency

– Anorexia

– Weight Loss

– Cramping

– Vomiting

– Fever

– Dehydration

Ulcerative Colitis

• Therapeutic Interventions – Avoid Offending Foods

– Medications • Aminosalicylates: Azulfidine (sulfasalazine)

• Antidiarrheal

• Biologic: Humira (adalimumab)

• Corticosteriods

• Immunomodulators: Imuran (azathioprine)

– Surgery if Necessary

– Elemental Formula or PN if Required

Restorative proctocolectomy

Irritable Bowel Syndrome (IBS)

• Altered Intestinal Motility/Increased Sensitivity to Visceral Sensations

• Bowel Mucosa Not Changed

• Psychological Stress/Food Intolerances

• More Common in Women

Irritable Bowel Syndrome

• Signs and Symptoms

– Gas

– Bloating

– Constipation

– Diarrhea

– Abdominal Pain

– Depression, Anxiety

Irritable Bowel Syndrome

• Diagnosis

– History

– Physical Examination

Irritable Bowel Syndrome

• Therapeutic Interventions – Low FODMAP Diet

– High Fiber and Bran Diet

– Avoid Trigger Foods

– Smaller, Frequent Meals

– Stress Management

– Behavioral Therapy

– Exercise

– Medications Depend on Type of IBS

Abdominal Hernias

• Pathophysiology

– Protrusion of Organ or Structure Through Weakness or Tear in Wall of Abdomen

• Etiology

– Weakness in Abdominal Wall with Increased Intra-abdominal Pressure

Abdominal Hernias

• Types

– Inguinal

– Umbilical

– Ventral (Incisional)

Types of Hernias

Abdominal Hernias

• Signs and Symptoms

– None

– Bulging

• Complications

– Strangulated Incarcerated Hernia

Abdominal Hernias

• Therapeutic Interventions

– None

– Observation

– Support Devices

– Surgery

• Herniorrhaphy

• Hernioplasty

Abdominal Hernias

• Nursing Care

– Education

– Postoperative

• No Coughing

• Activity

• Education

Absorption Disorders

• Inability to Absorb One or More Major Nutrients

• Types

– Celiac Disease

– Lactose Intolerance

Absorption Disorders

• General Signs and Symptoms

– Weight Loss

– Weakness

– General Malaise

Absorption Disorders

• Therapeutic Interventions

– Celiac Disease

• High-calorie, High-protein, Gluten-free Diet

– Lactose Intolerance

• Avoid Lactose Foods; Lactaid

Absorption Disorders

• Nursing Care

– Monitor Fluids, Electrolytes, Nutritional Status

– Daily Weight

– Intake and Output

– Education

Mechanical Bowel Obstructions

Bowel Obstruction

• Flow of Intestinal Contents is Blocked

• Mechanical

– Blockage Occurs Within the Intestine

• Non-mechanical

– Peristalsis is Impaired

– Partial or Complete

Bowel Obstruction

• 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

Bowel Obstruction

• Signs and Symptoms

– Abdominal Distention

– Fluid/Electrolyte Imbalance

• Diagnosis

– Abdominal X-Ray

– CT Scan

– CBC and Electrolytes

Bowel Obstruction

• Therapeutic Interventions – NPO

– Frequent Mouth Care

– Nasogastric Tube

– Fluid and Electrolyte Replacement

– Medications • Antibiotics

• Anti-emetics

• Analgesics

– Surgery

Anorectal Problems

• Hemorrhoids

• Anal Fissures

• Anorectal Abscess

Anorectal Problems

• Nursing Care

– Postoperative

• Pain Control

• Sitz Baths

• Dressing Changes

• Stool Softeners

Lower Gastrointestinal Bleeding

• Causes

– Diverticulitis

– Polyps

– Anal Fissures

– Hemorrhoids

– Inflammatory Bowel Disease

– Cancer

Lower Gastrointestinal Bleeding

• Occult Blood, Melena, Bright Red Stools

• Treat Cause

• Nursing Care

– Monitor Stools, Bleeding

– Vital Signs

– Diagnostic Prep

Colorectal Cancer

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

Colorectal Cancer

• Diagnosis – Colonoscopy with Biopsy

– Sigmoidoscopy with Biopsy

– Proctosigmoidoscopy

– CT Scan

– Abdominal and Rectal Examination

– Immunological Tests

– Fecal Occult Blood

– CEA

Colorectal Cancer

• Therapeutic Interventions – Surgery

• Resection

• Abdominoperineal Resection

• Colostomy

– Radiation

– Chemotherapy

– Monoclonal Antibody Therapy

– Analgesics

– PN as Necessary

Colorectal Cancer

• Nursing Care

– Support and Education

– Postoperative Care