Nursing Care of Patients with Lower Gastrointestinal Disorders
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| Obstipation | prolonged constipation
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| Causes of constipation | meds; rectal or anal problems; metabolic or neurologic conditions; colon cancer; diet; lifestyle; age
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| Meds that can cause constipation | narcotics, tranquilizers, antacids that contain aluminum
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| Rectal or anal problems that can lead to constipation | hemorrhoids and fissures
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| Metabolic or neurologic conditions that can lead to constipation | diabetes, MS, lupus, scleroderma
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| Diet that can lead to constipation | low intake of fiber and fluids
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| Lifestyle that can lead to constipation | low exercise, low mobility, chronic laxative use
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| Age-related factors that lead to constipation | weakness, weakened muscles needed for defecation, fatigue
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| Fecal impaction | stool so dry and hard it cannot be passed
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| Ulcers | From pressure on the colon mucosa
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| Incontinence | small amounts of liquid stool ooze around the fecal mass
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| Constipation and straining | Valsalva’s maneuver; can result in cardiac, neurologic, and respiratory complications
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| In patients with history of HTN, heart failure, or recent MI what can straining cause | cardiac rupture and death
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| Megacolon | Grossly dilated loops of bowel develop proximal to the dry fecal mass and obstruction can occur
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| Chronic Laxative Abuse | Colonic mucosal atrophy, muscle thickening, and fibrosis; can lead to perforation and need for emergency colectomy
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| 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
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| Constipation Nursing Goal | patient will pass soft, formed stool every 1-3 days
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| 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
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| High-fiber and high-residue diet | includes fresh fruits, vegetables, and whole grains with 2 gm. of bran added
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| 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
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| Most common cause of acute diarrhea | bacterial or viral infection
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| Prevention of acute diarrhea | Proper food handling, storage and preparation; hand washing; kitchen cleanliness; adequate refrigeration
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| Diagnostic tests for diarrhea | lab exam and visual inspection of stool
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| Priority therapeutic intervention for diarrhea | replace fluids/electrolytes
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| Patient teaching to prevent spread of infection with diarrhea | good hand washing, identify potentially infected persons or foods
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| 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
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| 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
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| Appencicitis: finding from a physical exam | slight abdominal muscular rigidity, normal bowel sounds, and local rebound tenderness in the RLQ
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| Appendicitis post op care | assess for s/s of peritonitis
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| Appendicitis complications | perforation; abscess of appendix; peritonitis
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| s/s of peritonitis | extreme tenderness over the area; aggravation of pain with movement; rebound tenderness; abdominal rigidity
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| Diverticulum | outpouching of bowel mucous membrane caused by increased pressure within the colon and weakness of the bowel wall
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| Diverticulitis complication | when food or bacteria become trapped in a diverticula, inflammation and infection develop
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| Diverticulosis/Diverticulitis causes | chronic constipation; decreased intake of dietary fiber
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| Diverticulosis/Diverticulitis prevention | increase dietary fiber; prevent constipation
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| Crohn’s Disease: skip lesions | inflamed areas alternate between areas of healthy tissue
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| Chrohn’s disease complication | fluid and electrolyte imbalance
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| 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
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| Ulcerative colitis | inflammatory bowel disease similar to Crohn’s but only occurs in the colon and rectum
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| Ulcerative colitis and surgery | pouching can be done; surgery does cure ulcerative colitis
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| 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
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| Foods that cause distress or gas formation | fresh fruits and vegetable; spices; milk; coffee; carbonated beverages; alcohol
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| Abdominal hernia complications | strangulated incarcerated hernia
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| 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
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| Celiac disease (gluten enteropathy) intervention | avoid foods that contain gluten, wheat, rye, barley; oats may be contaminated in processing plants so it is avoided
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| Steatorrhea | stools are gray in color with high fat content
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| Velvulus | bowel twists causing obstruction
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| Intussusception | peristalsis causes the intestine to telescope into itself
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| Paralytic ileus | intestinal peristalsis decreases or stops because of vascular or neuromuscular pathologic condition
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| Bowel obstruction symptom progression | symptoms progress as obstruction worsens or becomes complete
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| Bowel obstruction, what may occur | fecal vomiting and pain and abdominal distention
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| What is done to decompress the bowel in bowel obstruction | NG tube
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| Lower GI Bleeding nursing care | baseline vital signs
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| Report what finding with lower GI bleeding | changes from baseline that determine bleeding and shock; also decreased BP and rising HR
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| Higher risk people for colorectal cancer | with personal or family history of ulcerative colitis, colon cancer, polyps of the rectum or large intestine
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| 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
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| Other causative factors for colorectal cancer | obesity, smoking, alcohol intake, large intake of red meats
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| Ileostomy | end stoma formed by bringing the terminal ileum to abdominal wall after total colectomy
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| Conventional ileostomy | small stoma RLQ; continuous flow liquid effluent
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| Continent ileostomy | internal reservoir with nipple valve; empty reservoir 3 to 4 times daily to prevent pouch rupture
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| 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
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| Postoperative ostomy care | normal stoma is pink to red, and moist; blue or black stoma is reported immediately
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| What to monitor on stoma during ostomy care | irritation
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| 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
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| 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
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| What can be placed in appliance to control odor | spray deodorants or chlorophyll tablets
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| Ostomy care and bathing | may bathe or shower with appliance on but check seal after and retape or change it if it is loosened
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| Ostomy care teaching and skin barrier | stomahesive
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| Ostomy care teaching for gas | a descending or sigmoid colostomy can be regulated; don’t poke holes in the appliance to relieve gas
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| Ostomy care teaching about foods | teach foods to avoid that can cause ileostomy blockage
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| 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
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| Foods with nondigestable peels | apples, grapes, potatoes
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| Dried fruits | raisins, figs, apricots
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| Meats with casings | sausage, hot dogs, bologna
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| What to report with stomas | dusky or blue color
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| S/s of ileostomy blockage | absent stool, abdominal cramping, edematous stoma, stoma color that pale or dusky
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| 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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