1. Medical-Surgical Nursing
3rd edition
Chapter 29
Care of Patients with Disorders of the Lower Gastrointestinal System
Copyright © 2017, Elsevier Inc. All rights reserved.

2. Abdominal and Inguinal Hernia
Etiology and pathophysiology
Reducible and irreducible
Incarcerated
Strangulated
Indirect and direct inguinal hernia
Signs and symptoms

4. Types of Hernias
See Figure 29-3 on p. 677.

5. Diagnosis and Treatment of Abdominal and Inguinal Hernias
Herniorrhaphy
Nursing management
Care after hernia repair is directed at pain control and preventing recurrence of the hernia.
The patient is cautioned not to do heavy lifting, pulling, or pushing that increases intra-abdominal pressure.

6. Irritable Bowel Syndrome
Etiology
Pathophysiology
Signs and symptoms
Alteration in bowel elimination (either constipation or diarrhea or both)
Abdominal pain and bloating
Absence of detectable organic disease

7. Diagnosis of Irritable Bowel Syndrome
Diagnostic criteria include
Abdominal pain or discomfort characterized by
Relieved by defecation
Associated with a change in stool frequency or consistency
Other symptoms
Mucorrhea (mucus in the stool)
Abdominal bloating

8. Treatment and Nursing Management of Irritable Bowel Syndrome
General health assessment
Bulk-forming agents, antidiarrheals, antispasmodics, antidepressants, anticholinergics/sedatives, and mild analgesics to relieve discomfort
High-fiber diet
Patient teaching and reassurance
Complementary and alternative therapies

9. Diverticula Etiology Pathophysiology Signs, symptoms, and diagnosis
Treatment
Nursing management
Meperidine toxicity
Diet for diverticular disease

10. Intestinal Obstruction
Etiology and pathophysiology
Mechanical obstructions including volvulus and intussusception
Nonmechanical obstruction, including paralytic ileus

11. Intestinal Obstruction (cont.)
Signs and symptoms
Diagnosis and treatment
Diagnostic radiography
Surgery
Nursing management

13. Bowel Ischemia Etiology and pathophysiology Signs and symptoms
Diagnosis
Treatment
Nursing management

14. Ulcerative Colitis and Crohn’s Disease
Etiology
Pathophysiology
Signs and symptoms
Attacks of diarrhea that may be bloody and contain mucus, abdominal pain with cramping, malaise, fever, and weight loss
Bouts often are precipitated by undue physical or emotional stress.

15. Ulcerative Colitis and Crohn’s Disease (cont.)
Diagnosis
Colonoscopy
Flexible sigmoidoscopy
Mucosal biopsy
Barium enema
Stool analysis
Treatment
Medications
Diet modifications
Evidence-based therapies
Surgery
Nursing management

16. Comparison of Ulcerative Colitis and Crohn’s Disease
Area affected
Characteristics
Signs and symptoms
Complications
See Table 29-2 on p. 678.

17. Comparison of Ulcerative Colitis and Crohn’s Disease (Cont.)
See Figure 29-4 on p. 679.

18. Treatment for Ulcerative Colitis or Crohn’s Disease
Varies according to severity of symptoms and chronicity
Conservative approaches
Low-fat, low-fiber, high-protein diet
Small, frequent feedings
Avoid lactose
Corticosteroids
Fluid replacement or blood transfusions, as needed

20. Expected Outcomes
Patient’s pain will be controlled with analgesia within 8 hours.
Patient will regain fluid balance within 36 hours.
Patient will experience decreased number of diarrhea bowel movements within 24 hours.
Long-term goals may be concerned with helping the patient adhere to the prescribed regimen, encouraging effective coping mechanisms, and participating in prescribed psychotherapy.

21. Appendicitis Etiology and pathophysiology Signs and symptoms Diagnosis
Pain in the lower right side, halfway between the umbilicus and the crest of the ileum at McBurney’s point, is the best-known symptom of appendicitis.
Diagnosis
Treatment
Nursing management

23. Peritonitis Etiology Pathophysiology Signs and symptoms
Diagnosis and treatment
Nursing management

24. Malabsorption Etiology and pathophysiology
Lactose intolerance
Signs, symptoms, and diagnosis
Steatorrhea (passage of stool that is bulky, frothy, and foul smelling and that usually floats in the toilet)
Treatment
Nursing management

25. Cancer of the Colon Etiology
Most at risk include those with disorders of the intestinal tract, especially ulcerative colitis and familial polyposis.
Other risk factors: smoking, alcohol consumption, physical inactivity, obesity, diet high in saturated fat or red meat, and inadequate intake of fruits and vegetables

26. Cancer of the Colon (cont.)
Pathophysiology
Signs and symptoms
Any change in bowel habits, either diarrhea or constipation, could be a sign of colon cancer.
Diagnosis
Screening tests
Colonoscopy
Transrectal ultrasound
Carcinoembryonic antigen

27. Cancer of the Colon (Cont.)
Treatment
Surgical removal of the affected portion of the intestine
Colectomy or hemicolectomy
Abdominoperineal resection
Adjunctive treatment—preoperative, intraoperative, or postoperative radiation and chemotherapy
Nursing management

28. Ostomy Surgery and Care
Colostomy
Loop colostomy
Double-barreled colostomy
Single-barreled or end colostomy

29. First Stage of Loop Transverse Colostomy
See Figure 29-5 on p A segment of transverse colon is brought out through the abdominal wall and supported by a bridge. A slit in the bowel allows feces to drain from proximal colon. Support is removed 5 to 7 days after surgery or when the bowel adheres to the abdominal wall.

30. Types of Ostomies and Intestinal Diversions
See Figure 29-6 on p. 684.

31. Ostomy Surgery and Care
Colostomy locations
Ileostomy

32. Ileoanal Reservoirs
See Figure 29-7 on p. 685.
From deWit SC: Fundamental concepts and skills for nursing, ed. 2, Philadelphia, 2005, Saunders.

33. Preoperative Nursing Care
Low-residue diet as early as 7 to 10 days before surgery. The last 24 to 72 hours before surgery, the diet is changed to liquids only.
Vitamins and minerals may be given to supplement these restricted diets.
Antibiotics may be given as prophylaxis against infection of the operative site.
Laxatives and enemas
Nasogastric (NG) tube and Miller-Abbott tube

34. Nursing Management of Ostomies
Immediate postoperative care
Psychosocial assessment
Care of the stoma
A noticeable lightening or blanching of the stoma
Signs of edema
Fecal output
Dressing

35. Care of the Stoma Measurement of intake and output
Evacuation and irrigation
Cultural issues for ostomy patients
Periostomal skin care
Cleanliness
Provision of a protective barrier
Changing the collection device
Psychosocial concerns

36. Patient Teaching
Preventing intestinal blockage for the ileostomy patient
What to do when there is a blockage in the intestine or the ostomy

37. Hemorrhoids Etiology and pathophysiology
Signs, symptoms, and diagnosis
Treatment
Nursing management

38. Pilonidal Sinus (Pilonidal Cyst)
Etiology
Pathophysiology
Signs and symptoms
Diagnosis
Treatment
Nursing management

39. Ostomy Collection Appliance
See Figure 29-8 on p. 688.
From deWit SC, O’Neill P: Fundamental concepts and skills for nursing, ed. 4, St. Louis, 2013, Saunders.

40. Anorectal Abscess and Fistula
Etiology
Pathophysiology
Signs and symptoms
Diagnosis
Treatment
Nursing management