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Med Surg Ch 34

Nursing Care of Patients with Lower Gastrointestinal Disorders

Obstipation prolonged constipation
Causes of constipation meds; rectal or anal problems; metabolic or neurologic conditions; colon cancer; diet; lifestyle; age
Meds that can cause constipation narcotics, tranquilizers, antacids that contain aluminum
Rectal or anal problems that can lead to constipation hemorrhoids and fissures
Metabolic or neurologic conditions that can lead to constipation diabetes, MS, lupus, scleroderma
Diet that can lead to constipation low intake of fiber and fluids
Lifestyle that can lead to constipation low exercise, low mobility, chronic laxative use
Age-related factors that lead to constipation weakness, weakened muscles needed for defecation, fatigue
Fecal impaction stool so dry and hard it cannot be passed
Ulcers From pressure on the colon mucosa
Incontinence small amounts of liquid stool ooze around the fecal mass
Constipation and straining Valsalva’s maneuver; can result in cardiac, neurologic, and respiratory complications
In patients with history of HTN, heart failure, or recent MI what can straining cause cardiac rupture and death
Megacolon Grossly dilated loops of bowel develop proximal to the dry fecal mass and obstruction can occur
Chronic Laxative Abuse Colonic mucosal atrophy, muscle thickening, and fibrosis; can lead to perforation and need for emergency colectomy
Constipation therapeutic Interventions high-fiber diet, 2 to 3 L fluid daily; setting a daily defecation schedule and responding promptly to the urge to defecate
Constipation Nursing Goal patient will pass soft, formed stool every 1-3 days
Nursing interventions for Constipation bowel history; specific time for defecation; footstool; high-fiber, high-residue diet; increase fluid intake to 2-3 liter/day, if not contraindicated; increase daily activity and abdominal exercises
High-fiber and high-residue diet includes fresh fruits, vegetables, and whole grains with 2 gm. of bran added
Criteria for regular bowel function regular time of soft and formed defecation every 1 to 3 days; regular exercise; avoidance of laxative; 2-3 L of water; high-fiber and high-residue foods added to diet
Most common cause of acute diarrhea bacterial or viral infection
Prevention of acute diarrhea Proper food handling, storage and preparation; hand washing; kitchen cleanliness; adequate refrigeration
Diagnostic tests for diarrhea lab exam and visual inspection of stool
Priority therapeutic intervention for diarrhea replace fluids/electrolytes
Patient teaching to prevent spread of infection with diarrhea good hand washing, identify potentially infected persons or foods
Prevention of skin breakdown with diarrhea keep skin clean and dry; protect with moisture barrier cream, vaseline, or medicated ointment; use of a fecal incontinence device to protect perianal skin
Classic finding for appendicitis localized pain in the RLQ of abdomen at McBurney’s point, midway between umbilicus and right iliac crest is a classic finding for appendicitis
Appencicitis: finding from a physical exam slight abdominal muscular rigidity, normal bowel sounds, and local rebound tenderness in the RLQ
Appendicitis post op care assess for s/s of peritonitis
Appendicitis complications perforation; abscess of appendix; peritonitis
s/s of peritonitis extreme tenderness over the area; aggravation of pain with movement; rebound tenderness; abdominal rigidity
Diverticulum outpouching of bowel mucous membrane caused by increased pressure within the colon and weakness of the bowel wall
Diverticulitis complication when food or bacteria become trapped in a diverticula, inflammation and infection develop
Diverticulosis/Diverticulitis causes chronic constipation; decreased intake of dietary fiber
Diverticulosis/Diverticulitis prevention increase dietary fiber; prevent constipation
Crohn’s Disease: skip lesions inflamed areas alternate between areas of healthy tissue
Chrohn’s disease complication fluid and electrolyte imbalance
Chrohn’s Disease medication: Budesonide (enterocort EC) synthetic anti-inflammatory corticosteroid; acts locally rather than systemically; administer in the morning; take the pill whole; do not take with grapefruit juice
Ulcerative colitis inflammatory bowel disease similar to Crohn’s but only occurs in the colon and rectum
Ulcerative colitis and surgery pouching can be done; surgery does cure ulcerative colitis
IBS therapeutic interventions high-fiber and high bran diet may help but may cause other symptoms to worsen in some people; avoid trigger foods; avoid foods that cause distress or gas formation
Foods that cause distress or gas formation fresh fruits and vegetable; spices; milk; coffee; carbonated beverages; alcohol
Abdominal hernia complications strangulated incarcerated hernia
Strangulated incarcerated hernia an irreducible hernia in which the blood supply is cut off to the hernia contents causing ischemia, and possibly gangrene and bowel perforation
Celiac disease (gluten enteropathy) intervention avoid foods that contain gluten, wheat, rye, barley; oats may be contaminated in processing plants so it is avoided
Steatorrhea stools are gray in color with high fat content
Velvulus bowel twists causing obstruction
Intussusception peristalsis causes the intestine to telescope into itself
Paralytic ileus intestinal peristalsis decreases or stops because of vascular or neuromuscular pathologic condition
Bowel obstruction symptom progression symptoms progress as obstruction worsens or becomes complete
Bowel obstruction, what may occur fecal vomiting and pain and abdominal distention
What is done to decompress the bowel in bowel obstruction NG tube
Lower GI Bleeding nursing care baseline vital signs
Report what finding with lower GI bleeding changes from baseline that determine bleeding and shock; also decreased BP and rising HR
Higher risk people for colorectal cancer with personal or family history of ulcerative colitis, colon cancer, polyps of the rectum or large intestine
Major causative factor of colorectal cancer lack of dietary fiber; Prolonged fecal transit prolongs exposure to carcinogens; bacterial flora is altered by excess fat which converts steroids into compounds having carcinogenic properties
Other causative factors for colorectal cancer obesity, smoking, alcohol intake, large intake of red meats
Ileostomy end stoma formed by bringing the terminal ileum to abdominal wall after total colectomy
Conventional ileostomy small stoma RLQ; continuous flow liquid effluent
Continent ileostomy internal reservoir with nipple valve; empty reservoir 3 to 4 times daily to prevent pouch rupture
Colostomy and effluent type of effluent depends on location; effluent becomes less liquid and more solid as location of ostomy is more distal in colon
Postoperative ostomy care normal stoma is pink to red, and moist; blue or black stoma is reported immediately
What to monitor on stoma during ostomy care irritation
Nursing care to prevent skin problems on stoma hole in the water of the appliance is cut to size of the base of the stoma; stoma shrinks over weeks, adjust size of opening in water
Postop ostomy care appliance change change every 3 days or 10-14 days depending on type of appliance; empty appliance when it is 1/3 to ½ full
What can be placed in appliance to control odor spray deodorants or chlorophyll tablets
Ostomy care and bathing may bathe or shower with appliance on but check seal after and retape or change it if it is loosened
Ostomy care teaching and skin barrier stomahesive
Ostomy care teaching for gas a descending or sigmoid colostomy can be regulated; don’t poke holes in the appliance to relieve gas
Ostomy care teaching about foods teach foods to avoid that can cause ileostomy blockage
Foods that can cause ileostomy blockage cole slaw,celery, corn, popcorn, coconut, mushrooms, nuts, Chinese veggies; green, leafy veggies; spinach, collards, mustards, foods with nondigestable peels, dried fruits, and meats with casings
Foods with nondigestable peels apples, grapes, potatoes
Dried fruits raisins, figs, apricots
Meats with casings sausage, hot dogs, bologna
What to report with stomas dusky or blue color
S/s of ileostomy blockage absent stool, abdominal cramping, edematous stoma, stoma color that pale or dusky
Treatment for ileostomy blockage have patient get into tub of warm water, assume knee-chest position and soak, drink warm fluids; if ineffective, medical treatment should be sought
Created by: laotracuata