1. Care of Patients with Noninflammatory Intestinal Disorders
Chapter 59
Care of Patients with Noninflammatory Intestinal Disorders
Spastic contractions of the colon as they occur with irritable bowel syndrome.

3. Lower GI Bleed
Common causes of lower GI bleeding.

4. Noninflammatory Intestinal Disorders
2 types of intestinal disorders: Inflammatory & Noninflammatory
Noninflammatory often cause:
Rectal bleeding
Changing bowel patterns
Abdominal pain
If not managed, they can lead to inadequate absorption of vital nutrients

5. Student Group Activity
Divide into groups of 4 or 5 and map common concepts for acute versus chronic inflammatory bowel disorders.

6. Irritable Bowel Syndrome (IBS)
Chronic disorder characterized by:
Chronic or recurrent diarrhea
Constipation
And/or abdominal pain & bloating
Etiology
Unclear, possibly:
Combination of environmental, immunologic, genetic, hormonal, and/or stress factors
Assessment
Variable, sometimes pain in the LLQ

8. Medication for IBS Anti-diarrheals Bile acid binding agents
Diphenoxylate (Lomotil)
Loperamide (Imodium)
Bile acid binding agents
Cholestyramine (Prevalite)
Antispasmodic/Anticholinergic
Dicyclomine (bentyl)
Probiotics
Stool Softeners
Fiber
Laxatives
Antidepressants (to inhibit nerve fibers that cause pain)

10. Question What is a hernia? How are they classified? Why do they occur?
How are they managed?
Surgically
Non-Surgically
Classifications: Reducible (contents of hernia sac can be placed back into cavity with gentle pressure)
Irreducible (incarcerated: Requires immediate surgical eval)
Strangulated: blood supply is cut off by hernial ring & ischemia occurs
Why: congenital or acquired muscle weakness and increased intra-abdominal pressure for pregnancy, obesity, lifting heaving objects, defects in the muscle wall from prior surgeries, etc.
Management: Non-surgical: truss (pad made with firm material) applied to area after physician has reduced the hernia; Surgical Repair is usually best and can be done many times by laparoscopy: Herniorrhaphy (minimally invasive); hernioplasty: reinforced with mesh

11. Common Abdominal Hernias
Types of abdominal hernias.

12. Colorectal Cancer (CRC)
Colorectal – refers to colon and rectum, which together make up large intestine
Most CRCs are adenocarcinomas
Etiology:
Age >50 yr
Genetic predisposition
Personal/family history of cancer
Familial adenomatous polyposis

13. Staging American Joint Committee on Cancer
Stage I—tumor invades up to muscle layer
Stage II—tumor invades up to other organs or perforates peritoneum
Stage III—any level of tumor invasion, up to 4 regional lymph nodes
Stage IV—any level of tumor invasion; many lymph nodes affected with distant metastasis

14. Colostomies
Different locations of colostomies in the colon.

15. Colostomy Care Normal appearance of stoma
Signs and symptoms of complications
Measurement of stoma
Choice, use, care, application of appropriate appliance to cover stoma
Measures to protect skin
Dietary measures to control gas and odor
Resumption of normal activities

16. Student discussion
What is the relationship between inflammatory bowel diseases and CRC?

17. Bowel Obstruction Videos: http://www.youtube.com/watch?v=swgfBC0MEMg

18. Mechanical Obstruction
Two types of mechanical obstruction.

19. Class Discussion Preoperative: Surgical: Postoperative:
What are the priorities when caring for a patient having colorectal surgery for cancer? (Divide class into 3 groups)
Preoperative:
Surgical:
Postoperative:

20. What is a Polyp?
Small growths covered with mucosa and attached to the surface of the intestine.
Most are benign & are identified by their tissue type
What is the relationship of polyps to the later development of CRC?
Villous adenomas pose a greater cancer risk.
Polyps

21. Polyps
Pedunculated and sessile polyps. Pedunculated polyps, such as tubular adenomas, are stalk-like. Sessile polyps, such as villous adenomas, are broad based.

22. What is a Hemorrhoid?
Swollen or distended veins in the anorectal region
Caused by increased abdominal pressure
Eventually they can separate from the smooth muscle surrounding them and prolapse.
Can be internal or external
Not significant unless they cause pain or bleeding.

23. 2 Groups: Compare/Contrast
Hemorrhoids to Polyps
Pathophysiology
Management
Nursing care for patients requiring treatment
Nonsurgical treatments?
Surgical treatments?

24. NCLEX Review Questions
Chapter 59
NCLEX Review Questions 24

25. Question 1
What symptom does the nurse expect the patient with intussusception to exhibit?
Decrease in pulse
Extremely elevated body temperature
Singultus (hiccups)
Frequent bloody stools
Answer: C
Rationale: Intussusception is a telescoping of the intestine within itself. Singultus (hiccups) is common with all types of intestinal obstruction. The vagus and phrenic nerves stimulate the hiccup reflex. Intestinal obstruction can increase the intraabdominal pressure, causing pressure on the phrenic nerve and the symptom of singultus (hiccups).

26. Answer
Answer: C
Rationale: Intussusception is a telescoping of the intestine within itself. Singultus (hiccups) is common with all types of intestinal obstruction. The vagus and phrenic nerves stimulate the hiccup reflex. Intestinal obstruction can increase the intraabdominal pressure, causing pressure on the phrenic nerve and the symptom of singultus (hiccups).

27. Question 2
True or False: Emotional stress is a risk factor for irritable bowel syndrome (IBS).
True
False
Answer: B (False)
Rationale: Emotional stress does not cause IBS, but people with IBS may have their bowels react more to stress. So, if a patient already has IBS, stress can make the symptoms worse. Learning to reduce stress can help with IBS. With less stress, patients may have less cramping, pain, and better symptom relief.
(Source: Accessed August 13, 2011, from

28. Answer Answer: B (False)
Rationale: Emotional stress does not cause IBS, but people with IBS may have their bowels react more to stress. So, if a patient already has IBS, stress can make the symptoms worse. Learning to reduce stress can help with IBS. With less stress, patients may have less cramping, pain, and better symptom relief.

29. Question 3
Which ethnic group has a higher incidence of colorectal cancer?
Hispanic/Latino
Asian
Caucasian
African-American
Answer: D
Rationale: African-American men and women are diagnosed with and die from colorectal cancer at higher rates than men and women of any other United States racial or ethnic group. The reason for this is not yet understood.
(Source: Accessed August 13, 2011, from and

30. Answer
Answer: D
Rationale: African-American men and women are diagnosed with and die from colorectal cancer at higher rates than men and women of any other United States racial or ethnic group. The reason for this is not yet understood.

31. Question 4
An older patient has a nasogastric tube (NGT) connected to low continuous suction to treat an intestinal obstruction from fecal impaction. The nurse observes that the tube has stopped draining. What is the nurse’s best action?
Remove the NGT because it is not working.
Document the finding, and monitor closely.
Notify the health care provider immediately.
Irrigate the tube with 30 mL saline.

32. Answer
Ans: D
Rationale: Irrigating the NGT every 4 hours or as needed will maintain patency.