1. Nursing Care of Patients with Lower Gastrointestinal Disorders

2. Constipation Fecal mass held in rectum, feces become dry, hard Causes include meds, narcotics, antacids c calcium, < fiber and < water intake,< mobility,fatigue, chronic laxative use Prevention: high fiber diet, fluids, exercise

3. Constipation (cont’d) Signs and Symptoms Abd pain,distention Indigestion Rectal pressure Intestinal rumbling HA, fatigue, < appetite Complications Impaction Ulcers Straining- valsalva’s Megacolon Bowel obstruction

4. Constipation (cont’d) Dx: patient c/o, H&P Therapeutic Interventions High Fiber Diet 2-3 L Fluid Daily Exercise- Strengthen Abdominal Muscles Bulk-Forming Agents Stool softeners Education

5. Constipation (cont’d) Data Collection History- elimination patterns, diet Assessment- establish rapport Auscultate Bowel Sounds Inspect/Palpate Abdomen Nsg Dx: Contipation, Anxiety, Knowledge dificient, perceived constipation

6. Diarrhea Fecal matter passes rapidly, decreased absorption leads to dehydration Causes- bacterial/viral Infection, food allergies S/S- fever, foul odor, abdominal cramping, distention, anorexia, intestinal rumbling

7. Diarrhea (cont’d) Therapeutic Interventions Identify cause Replace fluids/electrolytes Increase fiber/bulk Diphenoxylate (Lomotil), Loperamide (Imodium) Lactinex restores normal flora Nsg Dx: pain, Risk for deficient fluid volume

8. Appendicitis Inflammation f the appendix Fever, nausea/vomiting, anorexia, pain right lower quadrant Increased white blood cells NPO, Surgery Postop Care- NPO till GI function returns, control pain,TCDB, early ambulation

9. Peritonitis Inflammation/infection of peritoneal cavity Signs and Symptoms Abdominal pain, abd rigidity, nausea/vomiting, fever Tx: NPO, fluid/electrolyte replacement, NG tube, antibiotics, surgery, pain control Nsg Dx: Acute pain, Deficient fluid volume, imbalanced nutrition: less than body requires

10. Diverticulosis/Diverticulitis Diverticulum- outpouching of bowel mucous membrane caused by > pressure within the colon and weakness in the bowel wall. Diverticulosis- multiple diverticula Diverticulitis-Inflammation/infection of diverticulum

11. Diverticulum

12. Diverticulosis/Diverticulitis Causes- chronic constipation or decreased intake of dietary fiber s/s- Bowel changes, constipation to diarrhea, cramping pain L lower quad, bleeding Treatment : Prevent constipation Intravenous antibiotics Pain control Surgery

13. Crohn’s Disease Inflammatory bowel disease in any part of the intestine, has remissions and exacerbations, cause unknown, may be hereditary. S/S- Abd pain or cramping, wt loss, diarrhea, fluid/electrolyte imbalance Dx: Barium enema, colonscopy Complications: malnutrition, fistulas

14. Fistulas

15. Crohn’s Disease Therapeutic Interventions Avoid Offending Foods Medications-antiinflammatory,antidiarrheal antibiotics,corticosteriods Surgery if necessary Elemental formula or TPN if required Support and education

16. Ulcerative Colitis IBD of large colon and rectum, remissions and exacerbations S/S- Abd pain, 5-20 stools daily, rectal bleeding, fecal urgency, poor appetite, wt loss, cramping, vomiting, fever, dehydration Dx: endoscopy, barium enema, ESR>, CBC, WBC>

17. Ulcerative Colitis Therapeutic Interventions Avoid Offending Foods Medications- antiinflammatory, antidiarrheal, immunosuppressants, corticosteriods Surgery if necessary Elemental formula or TPN Support and education

18. Inflammatory Bowel Disease Nursing Diagnoses Acute Pain Diarrhea Deficient Fluid Volume Anxiety Impaired Skin Integrity Ineffective nutrition: less than body requires Ineffective coping

19. Irritable Bowel Syndrome Altered intestinal motility, colon does not contract in a normal pattern, bowel mucosa not changed Psychological Stress/Food Intolerances More Common in Women Dx: H&P, BE, UGI, signoidoscopy

20. Irritable Bowel Syndrome Signs and Symptoms Gas, bloating, constipation, diarrhea, abd pain, depression, anxiety Tx: High fiber and bran diet Avoid trigger foods Small frequent meals Stress management Exercise and medications

21. Abdominal Hernias Protrusion of organ or structure through weakness or tear in wall of abdomen Inguinal- groin area where spermatic cord is in males round ligaments in females Umbilical- failure of umbilical orifice to close Ventral- (incisional) result from weakness inabd wall following surgery

22. Types of Hernias

23. Abdominal Hernias (cont’d) s/s- none or abnormal bulging in affected area (> with straining or coughing) Complications Strangulated Incarcerated Hernia- when edema or adhesions occur between the sac and its contents, can become irreducible. The trapped loop of bowel becomes stranguled and blood supply cut off. Will see pain at site, n/v, and abd pain

24. Abdominal Hernias (cont’d) Tx includes observation and brief or binder to hold hernia in place. Surgery Herniorrhaphy- incision into abd wall, replace contents of hernia sac, sew weakened tissue and close opening Hernioplasty- replace hernia in abd, reinforce muscle wall with wire, fascia or mesh

25. Bowel Obstruction Flow of Intestinal Contents Blocked Mechanical- blockage occurs within the intestine Paralytic- peristalsis impaired Can be partial or complete- severity depends on area of affected bowel, amount of occlusion, and amount of blood flow disturbance

26. Mechanical Bowel Obstructions

27. 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 Abdominal distention Fluid/Electrolyte imbalance

28. Bowel Obstruction (cont’d) Dx: abd x-ray, CT, CBC & electrolytes Treatment NPO Frequent Mouth Care Nasogastric Tube Fluid and Electrolyte Replacement Medications: antibiotics, antiemetics, analgesic Surgery

29. Anorectal Problems Hemorrhoids- varicose veins in the anal canal. Prevent constipation, avoid straining. Sitz bath, antiinflammatory med, stool softeners, sclerotherapy, or surgical removal Anal Fissures- cracks or ulcers in the lining of anal canal. Stool softeners, sitz bath, anesthetic suppositories Anorectal Abscess-pus pocket in rectal area. Antibiotics,I&D

30. Lower Gastrointestinal Bleeding Causes Causes: diverticulitis, polyps, anal fissures, hemorrhoids, IBD, cancer Occult blood, melena, bright red stools Treat cause: monitor stools and bleeding, VS, diagnostic preps

31. Colon 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

32. Colon Cancer (cont’d) Diagnosis Colon Care Colonoscopy with Biopsy Sigmoidoscopy with Biopsy Proctosigmoidoscopy Barium enema Abdominal and rectal exam Fecal occult blood

33. Colon Cancer (cont’d) Therapeutic Interventions Surgery- resection, possibly colostomy Radiation Chemotherapy/radiation Anagesics TPN if necessary Nursing Care: support and education Nsg Dx: Pain, anxiety, imbalanced nutrition

34. Ostomy Management Ostomy: surgically created opening diverts stool or urine to outside of body Stoma: portion of bowel sutured onto abdomen Abdominal Ostomies: Ileostomy, Colostomy, Urostomy

35. Ileostomy Types Conventional Ileostomy Small Stoma Right Lower Quadrant Continuous Flow Liquid Effluent Continent Ileostomy Internal Reservoir with Nipple Valve Empty Reservoir 3-4 Times Daily

36. Types of Stomas

37. Colostomy stool 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

38. 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

39. Preoperative Ostomy Care Wound Ostomy Continence Nurse Marks Site Emotional, Physical Support Teaching- appliance change, hygiene, dietary considerations Bowel Prep Antibiotics

40. Postoperative Ostomy Care Data Collection Vital Signs Reinforce teaching Stoma- monitor skin for irritation Stoma shrinks over weeks Pink To Red, Moist = Normal Bluish = Inadequate Blood Supply Black = Necrosis