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Med Surg Ch 34
Nursing Care of Patients with Lower Gastrointestinal Disorders
| Question | Answer |
|---|---|
| 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 |
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