Chapter 45 Care of the Patient with a Gastrointestinal Disorder

Chapter 45 Care of the Patient with a Gastrointestinal Disorder
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Overview of Anatomy and Physiology
Digestive system Organs and their functions Mouth: Beginning of digestion Teeth: Bite, crush, and grind food Salivary glands: Secrete saliva Esophagus: Moves food from mouth to stomach Stomach: Churn and mix contents with gastric juices Small intestine: Most digestion occurs here Large intestine: Forms and expels feces Rectum: Expels feces It is a well understood fact that the digestive system functions to process the foods and nutrients taken into the body. Along its journey, the food becomes involved with a group of supportive organs known as accessory organs. What function do accessory organs serve for the digestive system?

Location of digestive organs.
Figure 45-1 The digestive process begins in the mouth. From the time the food enters the mouth, the chemical digestive process begins. Review the chemicals and enzymes secreted in the process of digestion. Where do these substances enter the alimentary canal? What is their source? The fundamental purpose of dietary intake is to nourish the body. At what point do the nutritional sources begin to be absorbed by the body? What processes facilitate this to occur? (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.) Location of digestive organs.

Overview of Anatomy and Physiology
Accessory organs of digestion Organs and their functions Liver: Produces bile; stores it in the gallbladder Pancreas: Produces pancreatic juice Regulation of food intake Hypothalamus One center stimulates eating and another signals to stop eating Discuss the sequence of the digestive process. Be sure to note the function of each of the organs in the steps.

Laboratory and Diagnostic Examinations
Upper GI series Gastric analysis Esophagogastroduodenoscopy (EGD) Barium swallow Bernstein test Stool for occult blood Sigmoidoscopy Barium enema Colonoscopy Stool culture and sensitivity; stool for ova and parasites Flat plate of the abdomen The majority of diagnostic exams associated with the digestive system are used to visualize the areas of concern. When a patient is scheduled for a diagnostic exam, what are the responsibilities of the nurse? What responsibilities are associated with the physician? How do these scopes of practice/responsibility differ? For each of the diagnostic tests listed, what preparation is required? Review the documentation that is necessary concerning the preparation. What are the nursing responsibilities after each of the procedures?

Disorders of the Mouth Dental plaque and caries
Etiology/pathophysiology Erosive process that results from the action of bacteria on carbohydrates in the mouth, which produces acids that dissolve tooth enamel Medical management/nursing interventions Remove affected area and replace with dental material Dental decay is a phenomenon having a profound impact on the health of Americans. It is estimated 95% of Americans will experience dental decay during their lives. What factors are associated with dental decay? Identify steps to prevent dental decay. What is the impact of dental decay on the patient’s health status?

Disorders of the Mouth Candidiasis Etiology/pathophysiology
Infection caused by a species of Candida, usually Candida albicans Fungus normally present in the mouth, intestine, and vagina, and on the skin Also referred to as thrush and moniliasis Clinical manifestations/assessment Small white patches on the mucous membrane of the mouth Thick white discharge from the vagina Candidiasis is a fungal infection. List factors that can contribute to the development of a candidiasis infection.

Disorders of the Mouth Candidiasis (continued)
Medical management/nursing interventions Pharmacological management Nystatin Ketoconazole oral tablets Half-strength hydrogen peroxide/saline mouthwash Meticulous handwashing Comfort measures When caring for a patient having a candidiasis infection, what are the nursing responsibilities? Please include care, assessment, and health teaching.

Disorders of the Mouth Carcinoma of the oral cavity
Etiology/pathophysiology Malignant lesions on the lips, oral cavity, tongue, or pharynx Usually squamous cell epitheliomas Clinical manifestations/assessment Leukoplakia Roughened area on the tongue Difficulty chewing, swallowing, or speaking Edema, numbness, or loss of feeling in the mouth Earache, face ache, and toothache In the United States, 2% to 4% of cancers are oral in nature. Unfortunately, the number of young people suffering from oral cancers continues to grow. What factors can be attributed to this occurrence? The mortality rate of oral cancers involves the high degree of metastasis seen in them. Discuss the causes associated with the mortality rates of oral cancer. Differentiate between early and late signs and symptoms associated with oral cancer.

Disorders of the Mouth Carcinoma of the oral cavity (continued)
Diagnostic tests Indirect laryngoscopy Excisional biopsy Medical management/nursing interventions Stage I: Surgery or radiation Stage II & III: Both surgery and radiation Stage IV: Palliative Expound on the manner in which the diagnostic examinations differ with the type of suspected oral malignancy being evaluated. Identify factors that determine what type of medical management options will be utilized.

Disorders of the Esophagus
Gastroesophageal reflux disease Etiology/pathophysiology Backward flow of stomach acid into the esophagus Clinical manifestations/assessment Heartburn (pyrosis) 20 min to 2 hours after eating Regurgitation Dysphagia or odynophagia Eructation Gastroesophageal reflux disease is commonly referred to as GERD. GERD is the reflux of stomach acid into the esophagus. What factors are associated with the development of this manifestation? Discuss attributes that impact the severity of the disorder.

Gastroesophageal reflux disease (continued) Diagnostic tests Esophageal motility and Bernstein tests Barium swallow Endoscopy Medical management/nursing interventions Pharmacological management Antacids or acid-blocking medications Dietary recommendations Lifestyle recommendations Comfort measures Surgery Discuss the rationale for the prescribed nursing actions. Are there any dietary modifications that can be used to alleviate symptoms? Outline the mode of action for the medications commonly used to manage GERD.

Carcinoma of the esophagus Etiology/pathophysiology Malignant epithelial neoplasm that has invaded the esophagus 90% are squamous cell carcinoma associated with alcohol intake and tobacco use 6% are adenocarcinomas associated with reflux esophagitis Clinical manifestations/assessment Progressive dysphagia over a 6-month period Sensation of food sticking in throat Review risk factors for the development of carcinoma of the esophagus.

Carcinoma of the esophagus (continued) Medical management/nursing interventions Radiation: May be curative or palliative Surgery: May be palliative, increase longevity, or curative Types of surgical procedures Esophagogastrectomy Esophagogastrostomy Esophagoenterostomy Gastrostomy The patient having oral or esophageal cancer has both psychological and physiological needs. What are the nursing responsibilities in the plan of care for these patients?

Achalasia Etiology/pathophysiology Cardiac sphincter of the stomach cannot relax Possible causes: Nerve degeneration, esophageal dilation, and hypertrophy Clinical manifestations/assessment Dysphagia Regurgitation of food Substernal chest pain Loss of weight; weakness Poor skin turgor What are the results of achalasia? What is the underlying cause of the disorder? Review at-risk populations. Explain the reason for the signs and symptoms that occur with the disorder. Separate and identify the early and late clinical manifestations.

Achalasia (continued) Diagnostic tests Radiologic studies; esophagoscopy Medical management/nursing interventions Pharmacological management Anticholinergics, nitrates, and calcium channel blockers Dilation of cardiac sphincter Surgery Cardiomyectomy The chief diagnostic studies used for achalasia involve radiologic studies or esophagoscopy. What findings are indicative of this condition?

Disorders of the Stomach
Acute gastritis Etiology/pathophysiology Inflammation of the lining of the stomach May be associated with alcoholism, smoking, and stressful physical problems Clinical manifestations/assessment Fever; headache Epigastric pain; nausea and vomiting Coating of the tongue Loss of appetite

Acute gastritis (continued) Diagnostic tests Stool for occult blood; WBC; electrolytes Medical management/nursing interventions Pharmacological management Antiemetics Antacids Antibiotics IV fluids NG tube and administration of blood, if bleeding NPO until signs and symptoms subside Monitor intake and output Review the common names of medications commonly used in the management of acute gastritis. Develop appropriate nursing diagnoses for the patient with acute gastritis.

Gastric ulcers and duodenal ulcers Ulcerations of the mucous membrane or deeper structures of the GI tract Most commonly occur in the stomach and duodenum Result of acid and pepsin imbalances H. pylori Bacterium found in 70% of patients with gastric ulcers and 95% of patients with duodenal ulcers What variables are implicated in the development of a gastric ulcer? H. pylori has been associated with gastric ulcer occurrence. What is H. pylori? How do individuals become infected with the bacterium?

Gastric ulcers (continued) Etiology/pathophysiology Gastric mucosa are damaged, acid is secreted, mucosal erosion occurs, and an ulcer develops Duodenal ulcers (continued) Excessive production or release of gastrin, increased sensitivity to gastrin, or decreased ability to buffer the acid secretions Discuss stress ulcers. How do they develop?

Gastric and duodenal ulcers (continued) Clinical manifestations/assessment Pain: Dull, burning, boring, or gnawing, epigastric Dyspepsia Hematemesis Melena Diagnostic tests Esophagogastroduodenoscopy (EGD) Breath test for H. pylori Explain the underlying cause for the signs and symptoms experienced by the patient suffering from a gastric ulcer.

Fiberoptic endoscopy of the stomach.
Figure 45-5 Discuss the use of fiberoptic endoscopy of the stomach to diagnose gastrointestinal disorders. (from Monahan, F.D., et al. [2007]. Phipps’ medical-surgical nursing: health and illness perspectives. [8th ed.]. St. Louis: Mosby.) Fiberoptic endoscopy of the stomach.

Gastric and duodenal ulcers (continued) Medical management/nursing interventions Pharmacological management Antacids Histamine H2 receptor blockers Proton pump inhibitor Mucosal healing agents Antibiotics Dietary recommendations High in fat and carbohydrates; low in protein and milk products; small frequent meals; limit coffee, tobacco, alcohol, and aspirin use Develop teaching plans for the patient with a gastric or duodenal ulcer. What are the nursing responsibilities for the patient with an ulcer? What are the goals of treatment for patients experiencing gastric and duodenal ulcers?

Gastric and duodenal ulcers (continued) Medical management/nursing interventions Surgery Antrectomy Gastroduodenostomy (Billroth I) Gastrojejunostomy (Billroth II) Total gastrectomy Vagotomy Pyloroplasty Surgical intervention is needed for approximately 20% of patients having ulcers. The decision to perform surgery is determined by the patient’s unique health status. What events may necessitate a patient having surgery to treat gastric ulcers? Outline the differences between the surgical procedures that might be used in the treatment of patients diagnosed with ulcers.

Figure 45-7 Types of gastric resections with anastomoses.
A, Billroth I. B, Billroth II.

Gastric and duodenal ulcers (continued) Complications after gastric surgery Dumping syndrome Pernicious anemia Iron deficiency anemia At what point in the postoperative process are the complications of dumping syndrome, pernicious anemia, and iron deficiency most likely to occur? What impact do these complications have on the patient’s health status? How are the potential complications prevented and managed?

Cancer of the stomach Etiology/pathophysiology Most commonly adenocarcinoma Primary location is the pyloric area Risk factors: History of polyps Pernicious anemia Hypochlorhydria Gastrectomy; chronic gastritis; gastric ulcer Diet high in salt, preservatives, and carbohydrates Diet low in fresh fruits and vegetables Although the rates of gastric cancer are declining in the United States, it still remains a cause of concern. Studies have identified risk factors for the development of gastric cancer. Why do patients experiencing these circumstances have a higher risk of gastric cancer development?

Cancer of the stomach (continued) Clinical manifestations/assessment Early stages may be asymptomatic Vague epigastric discomfort or indigestion Postprandial fullness Ulcer-like pain that does not respond to therapy Anorexia; weight loss Weakness Blood in stools; hematemesis Vomiting after fluids and meals The patient suffering from gastric cancer may be asymptomatic initially. What signs and symptoms are seen early in the development of the disease? What signs and symptoms are considered late? Anemia can also accompany gastric cancer. Why does the patient experience anemia?

Cancer of the stomach (continued) Diagnostic tests GI series Endoscopic/gastroscopic examination Stool for occult blood RBC, hemoglobin, and hematocrit Medical management/nursing interventions Surgery Partial or total gastric resection Chemotherapy and/or radiation What findings are typically found to support a diagnosis of gastric cancer? After a diagnosis of gastric cancer is found, what treatment options are available? What is the role of the nurse when caring for the patient experiencing gastric cancer?

Disorders of the Intestines
Infection Etiology/pathophysiology Invasion of the alimentary canal by pathogenic microorganisms Most commonly enters through the mouth in food or water Person-to-person contact Fecal-oral transmission Long-term antibiotic therapy can cause an overgrowth of the normal intestinal flora (C. difficile) There are numerous means for the intestinal tract to be exposed to infectious matter. With so many available avenues to become infected, how does the body resist these infections? List some of the potential pathogens that can affect the intestinal tract.

Infection (continued) Clinical manifestations/assessment Diarrhea Rectal urgency Tenesmus Nausea and vomiting Abdominal cramping Fever The typical patient experiencing an intestinal infection will present with complaints of nausea, vomiting, and diarrhea. These symptoms are common and might accompany other disorders. To aid the physician in making a diagnosis, what additional data should the nurse attempt to collect from the patient?

Infection (continued) Diagnostic tests Stool culture Medical management/nursing interventions Antibiotics Fluid and electrolyte replacement Kaopectate Pepto-Bismol When collecting a stool specimen, what education should be given to the patient? How should the stool be handled after collection? What are the nursing responsibilities/implications in the treatment plan?

Irritable bowel syndrome Etiology/pathophysiology Episodes of alteration in bowel function Spastic and uncoordinated muscle contractions of the colon Clinical manifestations/assessment Abdominal pain Frequent bowel movements Sense of incomplete evacuation Flatulence, constipation, and/or diarrhea Irritable bowel syndrome (IBS) is a common disorder possibly affecting 20% of the population. What causes IBS?

Irritable bowel syndrome (continued) Diagnostic tests History and physical examination Medical management/nursing interventions Pharmacological management Anticholinergics Milk of magnesia Mineral oil Opioids Antianxiety agents Dietary recommendations Bulking agents The diagnosis of IBS is often made by taking a history and performing a physical examination. What elements in the patient’s health history should be reviewed? Treatment for IBS includes diet and bulking agents. Review the dietary recommendations for the patient diagnosed with IBS. What effect do bulking agents have on the bowel? Review the desired mode of action and desired outcomes for the classifications of medications prescribed to treat IBS. In addition to the traditional medication therapy, alternative therapies are being used to treat the disorder. Discuss their use.

Ulcerative colitis Etiology/pathophysiology Ulceration of the mucosa and submucosa of the colon Tiny abscesses form that produce purulent drainage, slough the mucosa, and ulcerations occur Clinical manifestations/assessment Diarrhea—pus and blood; 15 to 20 stools per day Abdominal cramping Involuntary leakage of stool Ulcerative colitis is a chronic inflammatory bowel disease. What portion of the bowel is involved in ulcerative colitis? Discuss the progression of the disease.

Ulcerative colitis (continued) Diagnostic tests Barium studies, colonoscopy, stool for occult blood Medical management/nursing interventions Pharmacological management Azulfidine, Dipentum, Rowasa, corticosteroids, Imodium Dietary recommendations: No milk products or spicy foods; high-protein, high-calorie; total parenteral nutrition Stress control Assist patient to find coping mechanisms Review the factors that are utilized to determine the course of treatment. Medications prescribed for the management of ulcerative colitis include sulfasalazine, non-sulfa drugs, corticosteroids, and antidiarrheal agents. How do these medications work?

Ulcerative colitis (continued) Medical management/nursing interventions Surgical interventions Colon resection Ileostomy Ileoanal anastomosis Proctocolectomy Kock pouch Surgical interventions might be used to manage ulcerative colitis if the condition does not respond to traditional therapies. Review the surgical interventions that could be used to treat ulcerative colitis. What are the nursing assessment responsibilities during the postoperative phase?

Kock pouch (Kock continent ileostomy).
Figure 45-9 Kock pouch (Kock continent ileostomy).

Ileostomy with absence of resected bowel.
Figure 45-10 Ileostomy with absence of resected bowel.

Crohn’s disease Etiology/pathophysiology Inflammation, fibrosis, scarring, and thickening of the bowel wall Clinical manifestations/assessment Weakness; loss of appetite Diarrhea: 3 to 4 daily; contain mucus and pus Right lower abdominal pain Steatorrhea Anal fissures and/or fistulas Crohn’s disease is an inflammatory bowel disease with an increasing incidence in the United States. What factors might be associated with this increase? Identify the population affected most by Crohn’s disease. Review the progression of the disease. The disease is associated with significant changes in bowel habits. What type of bowel function is characteristic of Crohn’s disease?

Crohn’s disease (continued) Medical management/nursing interventions Pharmacological management Corticosteroids Azulfidine Antibiotics Antidiarrheals; antispasmodics Enteric-coated fish oil capsules B12 replacement Once a diagnosis of Crohn’s disease is made, a plan of treatment is devised. What factors play a role in the determination of the plan of care? Medications are used to treat Crohn’s disease. What mode of action does each of medication classification have?

Crohn’s disease (continued) Medical management/nursing interventions Dietary recommendations High-protein Elemental Hyperalimentation Avoid Lactose-containing foods, brassica vegetables, caffeine, beer, monosodium glutamate, highly seasoned foods, carbonated beverages, fatty foods Surgery Segmental resection of diseased bowel Dietary management is a central part of the patient’s treatment plan. Review the dietary modifications that might be recommended to the patient with Crohn’s disease. What role does each of the elements of the dietary plan have in the management of this condition?

Appendicitis Etiology/pathophysiology Inflammation of the vermiform appendix Lumen of the appendix becomes obstructed, the E. coli multiplies, and an infection develops Clinical manifestations/assessment Rebound tenderness over the right lower quadrant of the abdomen (McBurney’s point) Vomiting Low-grade fever Elevated WBC Appendicitis occurs when the vermiform appendix becomes inflamed. What is the vermiform appendix? What is its physiological purpose? Where is it located? How should the assessment be performed for the patient who is suspected of having appendicitis?

Appendicitis (continued) Diagnostic tests WBC Roentgenogram Ultrasound Laparoscopy Medical management/nursing interventions Appendectomy Once a patient presents with the clinical signs and symptoms indicative of appendicitis, diagnostic tests are performed to establish additional supportive data. What findings on the white blood cell count will support a diagnosis of appendicitis? When a diagnosis of appendicitis is confirmed, surgery will be performed. What measures/interventions are contraindicated? Why?

Diverticular disease Etiology/pathophysiology Diverticulosis Pouch-like herniations through the muscular layer of the colon Diverticulitis Inflammation of one or more diverticula Review the clinical process that accompanies diverticulosis/diverticulitis.

Figure 45-11 Diverticulosis.

Diverticular disease (continued) Clinical manifestations/assessment Diverticulosis May have few, if any, symptoms Constipation, diarrhea, and/or flatulence Pain in the left lower quadrant Diverticulitis Mild to severe pain in the left lower quadrant Elevated WBC; low-grade fever Abdominal distention Vomiting Blood in stool Differing symptoms are associated with diverticulosis and diverticulitis. Why do these clinical presentations differ?

Diverticular disease (continued) Medical management/nursing interventions Diverticulosis with muscular atrophy Low-residue diet; stool softeners Bed rest Diverticulosis with increased intracolonic pressure and muscle thickening High-fiber diet Sulfa drugs Antibiotics; analgesics The treatment of diverticulosis and diverticulitis can include medication, dietary modification, and surgery. Review factors that could be used to determine the best course of treatment.

Diverticular disease (continued) Medical management/nursing interventions (continued) Surgery Hartmann’s pouch Double-barrel transverse colostomy Transverse loop colostomy What nursing diagnoses can be utilized in the plan of care for the patient diagnosed with diverticulosis or diverticulitis?

Peritonitis Etiology/pathophysiology Inflammation of the abdominal peritoneum Bacterial contamination of the peritoneal cavity from fecal matter or chemical irritation Clinical manifestations/assessment Severe abdominal pain; nausea and vomiting Abdomen is tympanic; absence of bowel sounds Chills; weakness Weak rapid pulse; fever; hypotension Peritonitis is a serious infection in the abdominal peritoneum. What factors might be associated with the development of this condition?

Peritonitis (continued) Diagnostic tests Flat plate of the abdomen CBE Medical management/nursing interventions Pharmacological management Parenteral antibiotics Analgesics IV fluids Position patient in semi-Fowler’s position Surgery Repair cause of fecal contamination Removal of chemical irritant NG tube to prevent GI distention The treatment of peritonitis is aggressive. What patient teaching should be provided concerning the disease, its management, and its prognosis?

External hernias Etiology/pathophysiology Congenital or acquired weakness of the abdominal wall or postoperative defect Abdominal Femoral or inguinal Umbilical The protrusion of a viscus through an abdominal opening, or weakened area in which it is usually contained, results in a hernia. Identify populations at risk for the development of hernias. Which of their attributes place them at increased risk?

External hernias (continued) Clinical manifestations/assessment Protruding mass or bulge around the umbilicus, in the inguinal area, or near an incision Incarceration Strangulation Diagnostic tests Radiographs Palpation Define reducible, incarcerated, and strangulated hernias. What medical concerns accompany incarcerated and strangulated hernias?

External hernias (continued) Medical management/nursing interventions If no discomfort, hernia is left unrepaired, unless it becomes strangulated or obstruction occurs Truss Surgery Synthetic mesh is applied to weakened area of the abdominal wall Discuss assessment of the patient presenting with a hernia. Review the signs and symptoms signaling a complication with the hernia.

Hiatal hernia Etiology/pathophysiology Protrusion of the stomach and other abdominal viscera through an opening in the membrane or tissue of the diaphragm Contributing factors: obesity, trauma, aging Clinical manifestations/assessment Most people display few, if any, symptoms Gastroesophageal reflux What complications may result with a hiatal hernia?

Hiatal hernia. A, Sliding hernia. B, Rolling hernia.
Figure 45-15 A hiatal hernia could be sliding or rolling. How do they differ? Hiatal hernia. A, Sliding hernia. B, Rolling hernia.

Hiatal hernia (continued) Medical management/nursing interventions Head of bed should be slightly elevated when lying down Surgery Posterior gastropexy Transabdominal fundoplication (Nissen) What nursing diagnoses would be appropriate for inclusion in a care plan for the patient diagnosed with a hiatal hernia? When caring for the patient with a hiatal hernia, what should be included in the teaching plan for the patient?

Intestinal obstruction Etiology/pathophysiology Intestinal contents cannot pass through the GI tract Partial or complete Mechanical Non-mechanical Clinical manifestations/assessment Vomiting; dehydration Abdominal tenderness and distention Constipation Intestinal obstruction is a serious medical complication. It could be mechanical or non-mechanical. What are possible causes of mechanical obstructions? Non-mechanical obstructions? Why is the development of an intestinal obstruction serious? What are the clinical implications associated with an intestinal obstruction? The clinical manifestations of an intestinal obstruction vary with location and onset. What are early signs and symptoms associated with an intestinal obstruction?

Intestinal obstructions. A, Adhesions. B, Volvulus.
Figure 45-17 Intestinal obstructions. A, Adhesions. B, Volvulus.

Intestinal obstruction (continued) Diagnostic tests Radiographic examinations BUN, sodium, potassium, hemoglobin, and hematocrit Medical management/nursing interventions Evacuation of intestine NG tube to decompress the bowel Nasointestinal tube with mercury weight Surgery Required for mechanical obstructions Radiographic studies provide a visualization of the abdomen and bowel. What findings are present with x-ray studies that support a diagnosis of intestinal obstruction? How are electrolyte levels impacted when an intestinal obstruction is located? What nursing assessments are required when caring for the patient with an intestinal obstruction?

Colorectal cancer Etiology/pathophysiology Malignant neoplasm that invades the epithelium and surrounding tissue of the colon and rectum Second most prevalent internal cancer in the United States Clinical manifestations/assessment Change in bowel habits; rectal bleeding Abdominal pain, distention, and/or ascites Nausea Cachexia Colon cancer equally affects men and women. An estimated 70% of colon cancers are found in the sigmoid, rectal, cecum, and ascending colon. Studies have pinpointed risk factors associated with the development of colon cancer. Review the risk factors. Review the signs and symptoms of colon cancer. Differentiate between early and late manifestations.

Cancer of the colon (continued) Diagnostic tests Proctosigmoidoscopy with biopsy Colonoscopy Stool for occult blood Medical management/nursing interventions Radiation Chemotherapy Early diagnosis of colon cancer is key in preventing death. What preventative tests are available to detect colon cancer? Review the medical recommendations for preventive screening. In the event colon cancer is suspected, what diagnostic test findings are indicative of the disease?

Cancer of the colon (continued) Medical management/nursing interventions (continued) Surgery Obstruction One-stage or two-stage resection Two-stage resection Colorectal cancer Right or left hemicolectomy Anterior rectosigmoid resection When the medical management of colon cancer includes surgical intervention, a number of options are available. Compare and contrast the surgical interventions used in the treatment plan. What are the nursing responsibilities during the postoperative period? What is the prognosis for colon cancer? What determines the patient’s prognosis?

Hemorrhoids Etiology/pathophysiology Varicosities (dilated veins) External or internal Contributing factors Straining with defecation, diarrhea, pregnancy, CHF, portal hypertension, prolonged sitting and standing Clinical manifestations/assessment Varicosities in rectal area Bright red bleeding with defecation Pruritus Severe pain when thrombosed

Hemorrhoids (continued) Medical management/nursing interventions Pharmacological management Bulk stool softeners Hydrocortisone cream Topical analgesics Sitz baths Ligation Sclerotherapy; cryotherapy Infrared photocoagulation Laser excision Hemorrhoidectomy In most cases, hemorrhoids respond to conservative management. Discuss the desired outcomes of each of the treatment options.

Anal fissure Linear ulceration or laceration of the skin of the anus Usually caused by trauma Lesions usually heal spontaneously May be excised surgically Anal fistula Abnormal opening on the surface near the anus Usually from a local abscess Common in Crohn’s disease Treated by a fistulectomy or fistulotomy What are examples of patients who have fissures?

Nursing Process Nursing diagnoses Activity intolerance Anxiety
Body image, disturbed Constipation Coping, ineffective Diarrhea Fear Fluid volume, deficient, risk for Home management, impaired Management of therapeutic regimen, ineffective Nutrition, imbalanced: less than body requirements Pain, chronic/acute Skin integrity, risk for impaired Sleep pattern, disturbed Social isolation Tissue perfusion, ineffective Disorders of the digestive system are often invasive and far-reaching. There is immeasurable impact on the patients affected. Review the provided nursing diagnoses. Which of the digestive disorders do they most pertain to?

Fecal incontinence Potential causes Medical management/nursing interventions Biofeedback training Bowel training Patient education Dietary recommendations Discuss the steps that should be included in a bowel training plan.

Chapter 45 Care of the Patient with a Gastrointestinal Disorder

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