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1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 38 Digestive Tract Disorders.

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1 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 38 Digestive Tract Disorders

2 2Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Learning Objectives Identify the nursing responsibilities in the care of patients undergoing diagnostic tests and procedures for disorders of the digestive tract. List the data to be included in the nursing assessment of the patient with a digestive disorder. Describe the nursing care of patients with gastrointestinal intubation and decompression, tube feedings, total parenteral nutrition, digestive tract surgery, and drug therapy for digestive disorders. Describe the pathophysiology, signs and symptoms, complications, and medical treatment of selected digestive disorders. Assist in developing nursing care plans for patients receiving treatment for digestive disorders.

3 3Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anatomy and Physiology of the Digestive Tract Mouth Where teeth, tongue, and salivary glands begin food digestion Pharynx Muscular structure shared by the digestive and respiratory tracts It joins the mouth and nasal passages to the esophagus Esophagus Long muscular tube that passes through the diaphragm into the stomach Stomach Churns and mixes food with gastric secretions until a semiliquid mass called chyme

4 4Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anatomy and Physiology of the Digestive Tract Small intestine Chemical digestion and absorption of nutrients take place Approximately 20 feet long and consists of three sections: the duodenum, the jejunum, and the ileum Liver and pancreatic secretions enter the digestive tract in the duodenum

5 5Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anatomy and Physiology of the Digestive Tract Large intestine and anus The first section of the large intestine is the cecum Ascending colon goes up right side of the abdomen Transverse colon crosses abdomen just below waist Descending colon goes down left side of abdomen The last 6 to 8 inches of the large intestine is the rectum, which ends at the anus, where wastes leave the body

6 6Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-1

7 7Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Age-Related Changes Teeth are mechanically worn down with age The jaw may be affected by osteoarthritis A significant loss of taste buds with age Xerostomia (dry mouth) is common Walls of esophagus and stomach thin with aging, and secretions lessen Production of hydrochloric acid and digestive enzymes decreases Gastric motor activity slows Movement of contents through the colon is slower Anal sphincter tone and strength decrease

8 8Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Health History Chief complaint and history of present illness A detailed description of the present illness Complaints include weight changes, problems with food ingestion, symptoms of digestive disturbances, or changes in bowel elimination

9 9Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Health History Past medical history Recent surgery, trauma, burns, or infections Serious illnesses, such as diabetes, hepatitis, anemia, peptic ulcers, gallbladder disease, and cancer Alternative methods of feeding or fecal diversion Prescription and over-the-counter medications Food allergy or intolerance

10 10Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Health History Review of systems Description of the patients general health state Changes in skin: dryness, bruising, and pruritus Whether the patient has any mouth problems Document if the patient has dentures, partial plates, or natural teeth, and record the last dental examination Problems with chewing or swallowing Changes in appetite, food intake, and weight Nausea, vomiting, dyspepsia, heartburn, flatus, abdominal distention, or pain Assessment of elimination

11 11Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Health History Functional assessment Information about general dietary habits should include the daily pattern of food intake Attitudes and beliefs about food, and changes in dietary habits related to health problems Effects of chief complaint on usual functioning Note whether the patient is able to obtain and prepare food, and eat independently

12 12Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Physical Examination Head and neck Inspect the mouth Abdomen Inspection Auscultation Percussion Palpation Rectum and anus Palpate for lumps and tenderness in the rectum

13 13Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-2

14 14Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diagnostic Tests and Procedures Radiographic studies Upper gastrointestinal (UGI or GI) series Small bowel series Barium enema examination

15 15Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diagnostic Tests and Procedures Endoscopic examinations Upper GI Esophagoscopy, gastroscopy, gastroduodenoscopy, esophagogastroduodenoscopy, endoscopic retrograde cholangiography Lower GI Colonoscopy, proctoscopy, and sigmoidoscopy

16 16Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diagnostic Tests and Procedures Laboratory studies Gastric analysis Occult blood test Stool examination

17 17Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-3

18 18Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-4

19 19Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Therapeutic Measures

20 20Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gastrointestinal Intubation Tube feedings Delivered by gravity flow or by infusion pump Gastrointestinal decompression For the relief or prevention of distention Levin and gastric sump tubes

21 21Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Total Parenteral Nutrition Bypasses digestive tract by delivering nutrients directly to the bloodstream

22 22Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-5

23 23Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-6

24 24Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-7

25 25Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-9

26 26Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gastrointestinal Surgery Preoperative nursing care The digestive tract is usually cleansed Magnesium citrate or large-volume cathartic (laxative) solutions; enemas Diet limited to liquids 24 hours before surgery Intravenous fluids Oral antibiotics Nasogastric tube inserted and attached to suction

27 27Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gastrointestinal Surgery Postoperative nursing care Be sure gastrointestinal suction is draining Inspect, describe, and measure the drainage Abdomen for distention and bowel sounds Administer intravenous fluids Keep strict intake and output records Drug therapy Emetics, antiemetics, laxatives, cathartics, antidiarrheals, antacids, anticholinergics, mucosal barriers, histamine-2 (H 2 )-receptor blockers, prostaglandins, and antibiotics

28 28Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Disorders of the Digestive Tract

29 29Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anorexia Causes Nausea, decreased sense of taste or smell, mouth disorders, and medications Emotional problems such as anxiety, depression, or disturbing thoughts

30 30Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anorexia Medical diagnosis Physician assesses for malnutrition Weight may be monitored over several weeks Complete history and physical examination Serum hemoglobin, iron, total iron-binding capacity, transferrin, calcium, folate, B 12, zinc Thyroid function tests

31 31Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anorexia Medical treatment Correctable causes of anorexia are treated, but sometimes no physical cause is found Nutritional supplements

32 32Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anorexia Assessment Record chronic and recent illnesses, hospitalizations, medications, and allergies Female patients obstetric history Symptoms: pain, nausea, dyspnea, extreme fatigue The functional assessment reveals patterns of activity and rest, usual dietary patterns, current stressors, and coping strategiesall can affect appetite

33 33Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anorexia Interventions Assist with oral hygiene before and after meals Teach proper oral hygiene; refer for dental care Relieve nausea before presenting a meal tray Before serving meal tray, remove bedpans/emesis basins from sight, conceal drains and drainage collection devices, deodorize room if necessary Socialization during mealtime Respect food likes and dislikes Position patient comfortably with easy access to food

34 34Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Feeding Problems Patients with paralysis, arthritis, neuromuscular disorders, confusion, weakness, or visual impairment are likely to need assistance Medical diagnosis and treatment Identifying problems, prescribing treatment Patients often referred to physical therapy and occupational therapy

35 35Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Feeding Problems Assessment Assess each patients ability to feed self Determine nature of patients difficulty and identify remaining abilities Assess visual acuity, range of motion and muscle strength in both arms, and range of motion and grip strength in both hands; ability to follow instructions

36 36Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Feeding Problems Interventions Proper positioning and arrangement of the meal tray Provide assistive devices Open milk cartons, cut meat, butter bread, and season food

37 37Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Stomatitis A general term for inflammation of the oral mucosa Medical treatment is directed toward determining the cause and eliminating it; a soft, bland diet may be ordered

38 38Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Vincents Infection Bacterial infection that causes a metallic taste and bleeding ulcers in the mouth, foul breath, and increased salivation Topical antibiotics and mouthwashes to treat infection; rest, a nutritious diet, and good oral hygiene

39 39Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Herpes Simplex Caused by the herpes simplex virus, type 1 Ulcers and vesicles in mouth and on lips Occur with upper respiratory tract infections, excessive sun exposure, or stress Spirits of camphor, topical steroids, and antiviral agents as treatment

40 40Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Aphthous Stomatitis (Canker Sore) May be caused by a virus Characterized by ulcers of the lips and mouth that recur at intervals Topical or systemic steroids may be used

41 41Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Candida albicans Yeastlike fungus causes the oral condition known as thrush or candidiasis Bluish white lesions on the mucous membranes Patients at high risk include those on steroid or long-term antibiotic therapy Treated with oral or topical antifungal agents; vaginal nystatin tablets can be used like lozenges and allowed to dissolve in the mouth

42 42Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Care Assessment Pain location, onset, and precipitating factors Record any known illnesses and treatments, including drugs and radiation therapy Describe habits, including diet, oral care practices, alcohol intake, and use of tobacco Assess patients stress level Inspect lips and oral cavity for redness, swelling, and lesions

43 43Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Care Interventions Gentle oral hygiene, prescribed mouthwashes The teeth and tongue can be cleansed with a soft- bristle toothbrush, sponge, or cotton-tipped applicator Medications must be given as ordered

44 44Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Dental Caries A destructive process of tooth decay The only treatment for dental caries is removal of the decayed part of the tooth, followed by filling the cavity with a restorative material

45 45Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Periodontal Disease Begins with gingivitis; progresses to involve the other structures that support the teeth Gums red, swollen, painful, and bleed easily Primarily from inadequate oral hygiene Treatment in early stage: dental care for teeth cleaning and correction of contributing problems Untreated, abscesses develop around the roots, the teeth loosen, and extraction is necessary

46 46Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-10

47 47Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Care Assessment Observe condition of teeth and gums Document missing or broken teeth, caries, redness or lesions of the gums, and gum recession

48 48Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Care Interventions Most patients are treated for dental and gum conditions in dentists offices Interventions directed at minimizing pain until the problem can be corrected by a dentist Provide oral care for patients who cannot do it themselves

49 49Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Oral Cancer Squamous cell carcinoma and basal cell carcinoma Risk factors Cancer of the lip related to prolonged exposure to irritants, including sun, wind, and pipe smoking Factors that increase the risk of cancers inside the mouth include tobacco and alcohol use, poor nutritional status, and chronic irritation

50 50Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Oral Cancer Signs and symptoms Tongue irritation, loose teeth, and pain in the tongue or ear Malignant lesions may appear as ulcerations, thickened or rough areas, or sore spots Leukoplakia: hard, white patches in the mouth; premalignant

51 51Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Oral Cancer Medical diagnosis and treatment A biopsy of suspicious lesions Treatment includes surgery, radiation, or chemotherapy, or a combination of these

52 52Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Oral Cancer Assessment History of prolonged sun exposure, tobacco use, or alcohol consumption Assess for difficulty swallowing or chewing, decreased appetite, weight loss, change in t of dentures, and hemoptysis The physical examination should focus on examination of the mouth for lesions Assess the neck for limitation of movement and enlarged lymph nodes

53 53Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-11

54 54Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Oral Cancer Interventions Impaired Oral Mucous Membrane Ineffective Breathing Pattern Pain Imbalanced Nutrition: Less Than Body Requirements Impaired Verbal Communication Disturbed Body Image Risk for Infection Ineffective Tissue Perfusion

55 55Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Parotitis Inflammation of the parotid glands Causes painful swelling of the salivary glands below the ear next to the lower jaw; pain increases during eating Treated with antibiotics, mouthwashes, and warm compresses; surgical drainage or removal may be necessary

56 56Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Achalasia Progressively worsening dysphagia Failure of the lower esophageal muscles and sphincter to relax during swallowing Thought to be a neuromuscular defect affecting the esophageal muscles Treatment includes drug therapy, dilation, and surgical measures

57 57Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Esophageal Cancer Pathophysiology No known cause, but predisposing factors are cigarette smoking, excessive alcohol intake, chronic trauma, poor oral hygiene, and eating spicy foods Signs and symptoms Progressive dysphagia

58 58Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Esophageal Cancer Medical diagnosis Barium swallow, computed tomography, esophagoscopy, and endoscopic ultrasonography Medical and surgical treatment Surgery, radiation, chemotherapy, or various combinations

59 59Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-12

60 60Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Esophageal Cancer Assessment Dysphagia, pain, and choking Hoarseness, cough, anorexia, weight loss, and regurgitation The functional assessment documents the use of alcohol and tobacco and dietary practices

61 61Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Esophageal Cancer Interventions Pain Imbalanced Nutrition: Less Than Body Requirements Anxiety Risk for Injury Impaired Gas Exchange Deficient Knowledge

62 62Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nausea and Vomiting Nausea: sometimes referred to as queasiness Vomiting: forceful expulsion of stomach contents through the mouth Complications Significant losses of fluids and electrolytes Aspiration Medical treatment Antiemetics Intravenous fluids Oral fluids may be limited to clear liquids or withheld Nasogastric tube

63 63Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nausea and Vomiting Assessment Onset, frequency, and duration of present illness Conditions under which nausea and vomiting occur Amount, color, odor, and contents of the vomitus Surgeries, chronic illnesses, allergies, and medications General appearance; record vital signs, height/weight Assess pulse and blood pressure, tissue turgor, mental status, and muscle tone Inspect, auscultate, and palpate the abdomen for distention, bowel sounds, and tenderness

64 64Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nausea and Vomiting Interventions Imbalanced Nutrition and Deficient Fluid Volume Risk for Aspiration

65 65Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hiatal Hernia Pathophysiology Protrusion of lower esophagus and stomach up through the diaphragm and into the chest Causes Weakness of diaphragm muscles where esophagus and stomach join, but exact cause is not known Factors are excessive intra-abdominal pressure, trauma, and long-term bed rest in a reclining position

66 66Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hiatal Hernia Signs and symptoms Many people have no symptoms at all; others report feelings of fullness, dysphagia, eructation, regurgitation, and heartburn

67 67Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-13

68 68Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hiatal Hernia Medical diagnosis Barium swallow examination with fluoroscopy Esophagoscopy Esophageal manometry Medical treatment Drug therapy, diet, and measures to avoid increased intra-abdominal pressure Surgery: fundoplication and placement of the synthetic Angelchik prosthesis

69 69Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-14

70 70Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-15

71 71Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hiatal Hernia Assessment Document symptoms Record factors that trigger symptoms as well as measures that aggravate or relieve them Patients dietary habits, use of alcohol and tobacco, and medication history Interventions Chronic Pain Risk for Aspiration Imbalanced Nutrition: Less Than Body Requirements

72 72Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hiatal Hernia Postoperative care Turning, coughing, and deep breathing Patient might have nasogastric tube in place and connected to suction for a day or two Until bowel function returns, the patient is given only intravenous fluids Tell the patient to expect mild dysphagia for several weeks

73 73Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. GERD Backward flow of gastric contents from the stomach into the esophagus Pathophysiology Abnormalities around the LES, gastric or duodenal ulcer, gastric or esophageal surgery, prolonged vomiting, and prolonged gastric intubation Eventually causes esophagitis Signs and symptoms Painful burning sensation that moves up and down, commonly occurs after meals, and is relieved by antacids

74 74Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. GERD Medical diagnosis Suggested by the signs and symptoms Endoscopy, biopsy, gastric analysis, esophageal manometry, 24-hour monitoring of esophageal pH, and acid perfusion tests Medical treatment and nursing care Like those described earlier for hiatal hernia Drug therapy may include H 2 -receptor blockers, prokinetic agents, and proton pump inhibitors If medical care unsuccessful, surgical fundoplication

75 75Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gastritis Pathophysiology Inflammation of the lining of the stomach Mucosal barrier that normally protects the stomach from autodigestion breaks down Hydrochloric acid, histamine, and pepsin cause tissue edema, increased capillary permeability, possible hemorrhage Helicobacter pylori thought to be prime culprit Signs and symptoms Nausea, vomiting, anorexia, a feeling of fullness, and pain in the stomach area

76 76Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gastritis Medical diagnosis Gastroscopy Laboratory studies to detect occult blood in the feces, low blood hemoglobin and hematocrit, and low serum gastrin levels; H. pylori can be confirmed by breath, urine, stool, or serum tests, or by gastric tissue biopsy

77 77Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gastritis Medical treatment Oral fluids and foods withheld until the acute symptoms subside; IV fluids administered Medications to reduce gastric acidity and relieve nausea Analgesics for pain relief and antibiotics for H. pylori Surgical intervention may be needed

78 78Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gastritis Assessment Patients present illness Pain, indigestion, nausea, and vomiting Determine the onset, duration, and location of pain Note factors that trigger or relieve the symptoms Diet, use of alcohol and tobacco, activity/rest patterns Patients general appearance for signs of distress Compare vital signs, height, weight to previous readings Note the skin color and check turgor Inspect abdomen for distention; palpate for tenderness Auscultate abdomen for increased bowel sounds

79 79Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gastritis Interventions Pain Imbalanced Nutrition: Less Than Body Requirements Deficient Fluid Volume Ineffective Coping

80 80Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Peptic Ulcer Pathophysiology Loss of tissue from lining of the digestive tract Classified as gastric or duodenal Causes Contributing factors: drugs, infection, stress Most ulcers are caused by the microorganism H. pylori

81 81Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Peptic Ulcer Signs and symptoms Burning pain Nausea, anorexia, weight loss Complications Hemorrhage, perforation, or pyloric obstruction

82 82Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Peptic Ulcer Medical diagnosis Barium swallow examination, gastroscopy, and esophagogastroduodenoscopy H. pylori can be detected by antibodies in the blood or stool, and by a breath test Medical treatment Drug therapy Diet therapy Managing complications

83 83Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Peptic Ulcer Care of the patient managed medically Assessment Pain, including location, aggravating factors, and measures that bring relief; relationship between pain and food intake Recent serious illnesses, previous peptic ulcer disease, and a medication history Functional assessment: patients usual diet, use of alcohol and tobacco, activities, sleep patterns, and stressors Vital signs; height and weight; skin and mucous membranes for turgor and moisture Inspect abdomen for distention and palpate for tenderness Auscultate for bowel sounds

84 84Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Peptic Ulcer Care of the patient managed medically Interventions Pain Imbalanced Nutrition: Less Than Body Requirements Risk for Injury Ineffective Coping

85 85Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Peptic Ulcer Care of the patient managed surgically Assessment Pain, nausea, and vomiting Measure vital signs at frequent intervals Note the amount and type of IV fluids, and check the infusion site for swelling or redness Document patency of the nasogastric tube as well as the color and amount of drainage Breath sounds; inspect the wound dressing for bleeding Inspect abdomen for distention and auscultate for bowel sounds Monitor urine output and palpate for bladder distention

86 86Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Peptic Ulcer Care of the patient managed surgically Interventions Risk for Injury Imbalanced Nutrition: Less Than Body Requirements Decreased Cardiac Output

87 87Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Stomach Cancer Pathophysiology Begins in the mucous membranes, invades the gastric wall, and spreads to the regional lymphatics, liver, pancreas, and colon No specific signs or symptoms in the early stages Late signs and symptoms are vomiting, ascites, liver enlargement, and an abdominal mass

88 88Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Stomach Cancer Risk factors H. pylori infection, pernicious anemia, chronic atrophic gastritis, and achlorhydria, type A blood, and a family history Cigarette smoking, alcohol abuse, and a diet high in starch, salt, pickled foods, salted meats, and nitrates

89 89Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Stomach Cancer Medical diagnosis Gastroscopy, endoscopic ultrasound, upper GI series, CT, PET scan, MRI, laparoscopy Laboratory studies include hemoglobin and hematocrit, serum albumin, liver function tests, and carcinoembryonic antigen Medical treatment Surgery, chemotherapy, and radiation therapy

90 90Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-16

91 91Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Stomach Cancer Preoperative care of the patient with stomach cancer Inform about the nasogastric tube and IV fluids; teach coughing, deep breathing, and leg exercises Identify/support patients coping methods Include sources of support, such as family members or a spiritual counselor, in the preoperative care

92 92Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Stomach Cancer Postoperative care of the patient with stomach cancer Assessment Comfort, appetite, and nausea and vomiting Monitor weight changes and determine dietary preferences Identify the patients support system and coping strategies Interventions Pain Imbalanced Nutrition: Less Than Body Requirements Ineffective Coping

93 93Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Obesity Increased weight caused by excessive body fat Causes Heredity, body build/metabolism, psychosocial factors Basic problem: caloric intake exceeds metabolic demands Complications Cardiovascular and respiratory problems, polycythemia, diabetes mellitus, cholelithiasis (gallstones), infertility, endometrial cancer, and fatty liver infiltration

94 94Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Obesity Medical diagnosis Standard weight tables Measuring skinfold thickness Endocrine function tests Medical and surgical treatment Weight reduction diet accompanied by a planned exercise program Drug therapy Bariatric surgery

95 95Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Obesity Assessment Identify factors that contribute to obesity Ask about usual dietary practices Identify factors that trigger overeating and reactions to overeating Collect data about previous efforts to lose weight and current interest in losing weight

96 96Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Obesity Interventions for the obese patient managed nonsurgically Imbalanced Nutrition: More Than Body Requirements Ineffective Tissue Perfusion Ineffective Breathing Pattern Disturbed Body Image

97 97Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Obesity Interventions after bariatric surgery Impaired Gas Exchange Impaired Tissue Perfusion Impaired Skin Integrity Imbalanced Nutrition: Less Than Body Requirements

98 98Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Malabsorption One or more nutrients are not digested or absorbed Many causes: bacteria, deficiencies of bile salts or digestive enzymes, alterations in the intestinal mucosa, and absence of all or part of the stomach or intestines

99 99Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Malabsorption Signs and symptoms Steatorrhea Weight loss, fatigue, decreased libido, easy bruising, edema, anemia, and bone pain Bloating, cramping, abdominal cramps, and diarrhea are symptoms of lactase deficiency

100 100Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Malabsorption Medical diagnosis Sprue: based on laboratory studies, endoscopy with biopsy, and radiologic imaging studies Lactase deficiency: based on the health history, the lactose tolerance test, a breath test for abnormal hydrogen levels, and if necessary, biopsy of the intestinal

101 101Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Malabsorption Medical treatment Sprue: diet and drug therapy; foods that aggravate symptoms eliminated from the diet Celiac disease: avoid products that contain gluten Tropical sprue: antibiotics, oral folate, and vitamin B 12 injections Lactase deficiency: eliminate milk and milk products

102 102Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Malabsorption Nursing care Document the patients symptoms Note stool characteristics In the case of celiac sprue, teach the patient how to eliminate gluten from the diet Give antibiotics as ordered for tropical sprue If folic acid therapy continued, instruct patient in self-medication The effect of therapy is evaluated by the return of normal stool consistency Advise the patient with lactase deficiency of dietary restrictions and alternative products

103 103Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diarrhea The passage of loose, liquid stools with increased frequency May have cramps, abdominal pain, and a feeling of urgency before bowel movements

104 104Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diarrhea Causes Spoiled foods, allergies, infections, diverticulosis, malabsorption, cancer, stress, fecal impactions, and tube feedings Adverse effect of some medications Complications Dehydration, electrolyte imbalances, and metabolic acidosis Malnutrition and anemia

105 105Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diarrhea Medical treatment Acute diarrhea usually treated by resting the digestive tract and giving antidiarrheal drugs Severe, persistent diarrhea may require TPN

106 106Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diarrhea Assessment Diarrhea and onset, severity, precipitating factors, and measures that bring relief Ask about stool characteristics, including amount, color, odor, and unusual contents, such as blood, mucus, or undigested food Functional assessment focuses on usual diet, dietary changes, recent and current medications, recent travel to a foreign country

107 107Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diarrhea Interventions Deficient Fluid Volume and Imbalanced Nutrition: Less Than Body Requirements Impaired Skin Integrity Pain Self-Care Deficit

108 108Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Constipation Hard, dry, infrequent stools that are passed with difficulty

109 109Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Constipation Causes Frequently ignoring the urge to defecate Frequent use of laxatives or enemas Inactivity Inadequate water intake Diet low in fiber and high in cheese, lean meat, pasta Drugs that slow intestinal motility/increase urine output Diseases of the colon or rectum, as well as brain or spinal cord injury; abdominal surgery

110 110Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Constipation Complications Valsalva maneuver The rapid changes in blood flow can be fatal to a patient with heart disease Hemorrhoids Fecal impaction Medical treatment Laxatives, suppositories, enemas, or combination for prompt results Stool softeners

111 111Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Constipation Assessment Usual pattern of bowel elimination, including frequency, amount, color, unusual contents, and pain associated with defecation Information about diet, exercise, and drug therapy Any aids to elimination; type and frequency of use Examine abdomen for distention or visible peristalsis Auscultate for bowel sounds in all four quadrants of the abdomen

112 112Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Constipation Interventions Maintained with diet, fluids, exercise, and regular toilet habits Megacolon Regular enemas for bowel cleansing Fecal impaction Assess for impaction by inserting a gloved, lubricated finger into the rectum Remove impaction following agency protocol or specific physicians orders

113 113Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Intestinal Obstruction Causes Strangulated hernia, tumor, paralytic ileus, stricture, volvulus (twisting of the bowel), intussusception (telescoping of the bowel into itself), and postoperative adhesions Signs and symptoms Vomiting (possibly projectile), abdominal pain, and constipation Blood or purulent drainage passed rectally Abdominal distention, especially with colon obstruction

114 114Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Intestinal Obstruction Complications Fluid and electrolyte imbalances and metabolic alkalosis Gangrene and perforation of the bowel

115 115Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-17

116 116Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Intestinal Obstruction Medical diagnosis History, physical examination, and laboratory studies; confirmed by radiologic studies Medical treatment Gastrointestinal decompression; intravenous fluids; and surgical intervention

117 117Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Intestinal Obstruction Assessment Symptoms, including pain and nausea Onset and progression of symptoms Hernia, cancer of the digestive tract, and abdominal surgeries Ask when the patients last bowel movement was and if the characteristics were normal

118 118Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Intestinal Obstruction Interventions Acute Pain Deficient Fluid Volume Risk for Infection Ineffective Breathing Pattern Anxiety

119 119Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Appendicitis Pathophysiology Inflammation of the appendix A ruptured appendix allows digestive contents to enter the abdominal cavity, causing peritonitis

120 120Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Appendicitis Signs and symptoms Pain at McBurneys point, midway between the umbilicus and the iliac crest Temperature elevation, nausea, and vomiting Elevated WBC count (10,000-15,000/mm 3 ) Peritonitis: absence of bowel sounds, severe abdominal distention, increased pulse and temperature, nausea/vomiting; rigid abdomen

121 121Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-18

122 122Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Appendicitis Medical treatment Nothing by mouth A cold pack to the abdomen may be ordered Laxatives and heat applications should never be used for undiagnosed abdominal pain Immediate surgical treatment indicated Ruptured appendix: surgery may be delayed 6-8 hours while antibiotics and IV fluids given

123 123Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Appendicitis Assessment Location, severity, onset, duration, precipitating factors, and alleviating measures in relation to the pain Previous abdominal distress, chronic illnesses, surgeries; record allergies and medications Temperature; abdominal pain, distention, and tenderness; presence and characteristics of bowel sounds

124 124Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Appendicitis Preoperative interventions Semi-Fowler or side-lying position with the hips flexed Until physician determines the diagnosis, analgesics may be withheld If rupture suspected, elevate patients head to localize the infection

125 125Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Appendicitis Postoperative interventions Administer antibiotics, intravenous fluids, and possibly gastrointestinal decompression Assist the patient in turning, coughing, and deep breathing; incentive spirometry Splint the incision during deep breathing Early ambulation Assess abdominal wound for redness, swelling, and foul drainage Wound care as ordered or according to agency policy

126 126Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Peritonitis Pathophysiology Inflammation of peritoneum caused by chemical or bacterial contamination of the peritoneal cavity Signs and symptoms Pain over affected area, rebound tenderness, abdominal rigidity and distention, fever, tachycardia, tachypnea, nausea, and vomiting

127 127Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Peritonitis Medical diagnosis History and physical Complete blood cell count, serum electrolyte measurements, abdominal radiography, computed tomography, and ultrasound Paracentesis

128 128Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Peritonitis Medical treatment Gastrointestinal decompression, intravenous fluids, antibiotics, and analgesics Surgery to close a ruptured structure and remove foreign material and fluid from the peritoneal cavity

129 129Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Peritonitis Assessment Onset, location, and severity of the pain and any related symptoms Record a history of abdominal trauma, including surgery Take and record vital signs Inspect abdomen for distention and auscultate for the presence of bowel sounds

130 130Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Peritonitis Interventions Acute Pain Decreased Cardiac Output Imbalanced Nutrition: Less Than Body Requirements Anxiety

131 131Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Abdominal Hernia Pathophysiology Weakness in the abdominal wall that allows a portion of the large intestine to push through Weak locations include the umbilicus and the lower inguinal areas of the abdomen; may also develop at the site of a surgical incision Classified as reducible or irreducible

132 132Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Abdominal Hernia Signs and symptoms A smooth lump on the abdomen With incarceration, the patient has severe abdominal pain and distention, vomiting, and cramps

133 133Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-19

134 134Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Abdominal Hernia Medical diagnosis Health history and physical examination Medical treatment Surgical repair Herniorrhaphy Hernioplasty

135 135Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Abdominal Hernia Assessment Chief complaint Ask about pain and vomiting Inspect for abnormalities, and listen for bowel sounds in all four abdominal quadrants

136 136Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Abdominal Hernia Preoperative interventions Risk for Injury Impaired Skin Integrity Postoperative interventions Impaired Urinary Elimination Constipation Acute Pain Risk for Injury

137 137Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Inflammatory Bowel Disease Pathophysiology Ulcerative colitis and Crohns disease Inflammation and ulceration of intestinal tract lining Exact cause is unknown Possible causes: infectious agents, autoimmune reactions, allergies, heredity, and foreign substances

138 138Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Inflammatory Bowel Disease Signs and symptoms Ulcerative colitis Diarrhea with frequent bloody stools, abdominal cramping Crohns disease If the stomach and duodenum are involved, symptoms include nausea, vomiting, and epigastric pain Involvement of the small intestine produces pain and abdominal tenderness and cramping An inflamed colon typically causes abdominal pain, cramping, rectal bleeding, and diarrhea Systemic signs and symptoms include fever, night sweats, malaise, and joint pain

139 139Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Inflammatory Bowel Disease Complications Hemorrhage, obstruction, perforation (rupture), abscesses in the anus or rectum, fistulas, and megacolon

140 140Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Inflammatory Bowel Disease Medical diagnosis History and physical examination Abdominal radiography Barium enema examination with air contrast; colonoscopy with biopsy, ultrasonography, CT, and cell studies Video capsule Medical treatment Drug therapy, diet, and rest

141 141Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Inflammatory Bowel Disease Assessment Onset, location, severity, and duration of pain Note factors that contribute to the onset of pain Onset and duration of diarrhea; presence of blood Vital signs, height and weight, measures of hydration Inspect perianal area for irritation or ulceration Maintain accurate intake and output records Measure diarrhea stools if possible and count as output

142 142Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Inflammatory Bowel Disease Interventions Acute Pain Diarrhea Deficient Fluid Volume Imbalanced Nutrition: Less Than Body Requirements Ineffective Coping Risk for Injury

143 143Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diverticulosis Pathophysiology Small saclike pouches in intestinal wall: diverticula Weak areas of the intestinal wall allow segments of the mucous membrane to herniate outward Risk factors Lack of dietary residue Age, constipation, obesity, emotional tension

144 144Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diverticulosis Signs and symptoms Often asymptomatic, but many people report constipation, diarrhea, or periodic bouts of each Rectal bleeding, pain in left lower abdomen, nausea and vomiting, and urinary problems

145 145Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-20

146 146Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diverticulosis Complications Diverticulitis Bleeding, obstruction, perforation (rupture), peritonitis, and fistula formation Medical diagnosis Symptoms Abdominal CT and barium enema examination

147 147Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diverticulosis Medical treatment High-residue diet without spicy foods Stool softeners or bulk-forming laxatives; antidiarrheals; broad-spectrum antibiotics; anticholinergics Surgical intervention may be necessary

148 148Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diverticulosis Assessment Assess patients comfort and stool characteristics; note nausea and vomiting Monitor patients temperature Assess abdomen for distention and tenderness

149 149Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diverticulosis Interventions Fluids as permitted; monitor intake and output Antiemetics, analgesics, anticholinergics as ordered Be alert for signs of perforation Teach patient about diverticulosis, including the pathophysiology, treatment, and symptoms of inflammation

150 150Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Colorectal Cancer Pathophysiology Cancer of the large intestine People at greater risk for colorectal cancer are those with histories of inflammatory bowel disease, or family histories of colorectal cancer or multiple intestinal polyps High-fat, low-fiber diet and inadequate intake of fruits and vegetables also contribute to development Can develop anywhere in the large intestine Three fourths of all colorectal cancers are located in the rectum or lower sigmoid colon

151 151Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-21

152 152Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Colorectal Cancer Signs and symptoms Right side of the abdomen Vague cramping until the disease is advanced Unexplained anemia, weakness, and fatigue related to blood loss may be the only early symptoms Left side or in the rectum Diarrhea or constipation and may notice blood in the stool Stools may become very narrow, causing them to be described as pencil-like Feeling of fullness or pressure in the abdomen or rectum

153 153Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Colorectal Cancer Medical and surgical treatment Usually treated surgically Combination chemotherapy postoperatively if tumor extends through the bowel wall or if lymph nodes involved Early stage rectal cancer sometimes treated with radiation and surgery

154 154Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Colorectal Cancer Assessment Vital signs, intake and output, breath sounds, bowel sounds, and pain Appearance of wounds and wound drainage If there is a colostomy, measure and describe the fecal drainage

155 155Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Colorectal Cancer Interventions Risk for Injury Ineffective Tissue Perfusion Acute Pain Sexual Dysfunction Ineffective Coping

156 156Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Polyps Small growths in the intestine Most benign but can become malignant Inherited syndromes: familial polyposis and Gardners syndrome Usually asymptomatic; found on routine testing Complications are bleeding and obstruction Diagnosed by barium enema or endoscopic exam Colectomy for familial polyposis or Gardners syndrome because of the high risk of malignancy

157 157Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hemorrhoids Internal or external dilated veins in the rectum Thrombosed Blood clots form in external hemorrhoids; become inflamed and very painful Risk factors Constipation, pregnancy, prolonged sitting or standing Signs and symptoms Rectal pain and itching Bleeding with defecation External hemorrhoids easy to see; appear red/bluish

158 158Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 38-22

159 159Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hemorrhoids Medical diagnosis and treatment Diagnosed by visual inspection Nonsurgical treatment Topical creams, lotions, or suppositories soothe and shrink inflamed tissue Sitz baths often comforting The physician may order heat or cold applications Outpatient procedures: ligation, sclerotherapy. Thermocoagulation/electrocoagulation, laser surgery Hemorrhoidectomy The surgical excision (removal) of hemorrhoids

160 160Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hemorrhoids Assessment After hemorrhoidectomy, monitor vital signs, intake and output, and breath sounds. Assess the perianal area for bleeding and drainage Interventions Acute Pain Impaired Skin Integrity Constipation

161 161Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anorectal Abscess An infection in the tissue around the rectum Signs and symptoms are rectal pain, swelling, redness, and tenderness Treated with antibiotics followed by incision and drainage Preoperatively, pain is treated with ice packs, sitz baths, and topical agents as ordered

162 162Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anorectal Abscess Postoperatively, pain treated with opioid analgesics Patient teaching emphasizes importance of thorough cleansing after each bowel movement Advise patient to consume adequate fluids and a high-fiber diet to promote soft stools

163 163Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anal Fissure Laceration between the anal canal and the perianal skin May be related to constipation, diarrhea, Crohns disease, tuberculosis, leukemia, trauma, or childbirth Signs and symptoms include pain before and after defecation and bleeding on the stool or tissue If fissure chronic, the patient may experience pruritus, urinary frequency or retention, and dysuria Usually heal spontaneously, but can become chronic Conservative treatment: sitz baths, stool softeners, and analgesics Surgical excision may be necessary

164 164Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anal Fistula Abnormal opening between anal canal and perianal skin Develops from anorectal abscesses or related to inflammatory bowel disease or tuberculosis Patient typically complains of pruritus and discharge Sitz baths provide some comfort Surgical treatment is excision of fistula and surrounding tissue Sometimes a temporary colostomy to allow the surgical site to heal Postoperative care: analgesics and sitz baths for pain

165 165Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Pilonidal Cyst Located in the sacrococcygeal area Results from an infolding of skin, causing a sinus that is easily infected because of its closeness to the anus Once infected, it is painful and swollen and may form an abscess Surgical excision usually recommended Care is similar to that for the patient having a hemorrhoidectomy

166 166Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Patient Education to Promote Normal Bowel Function Good hand washing and proper food handling People who recognize that stress affects their gastrointestinal function may benefit from relaxation techniques and stress management training Signs and symptoms of digestive problems should be reported for prompt diagnosis and treatment if indicated Teaching patients what is normal, how to promote normal function, and how to detect problems can help to avoid serious gastrointestinal dysfunction


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