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Understanding Medical Surgical Nursing, 4th Edition Chapter 34 Nursing Care of Patients with Lower Gastrointestinal Disorders Understanding Medical Surgical Nursing, 4th Edition Lower Gastrointestinal System Small Intestines Large Intestines Rectum Anus Understanding Medical Surgical Nursing, 4th Edition Constipation Fecal Mass Held In Rectum Feces Become Dry, Hard Many Causes Prevention: High-fiber Diet, Fluids, Exercise Obstipation Understanding Medical Surgical Nursing, 4th Edition Constipation (cont’d) Signs and Symptoms ◦ ◦ ◦ ◦ ◦ Abdominal Pain Distention Indigestion Rectal Pressure Incomplete Emptying Headache Fatigue Decreased Appetite Understanding Medical Surgical Nursing, 4th Edition Constipation (cont’d) Complications ◦ ◦ ◦ ◦ ◦ Impaction Ulcers Straining Megacolon Chronic Laxative Abuse – Fibrosis Understanding Medical Surgical Nursing, 4th Edition Constipation (cont’d) Therapeutic Interventions ◦ ◦ ◦ ◦ ◦ ◦ High-fiber Diet, 2 to 3 L Fluid Daily Strengthen Abdominal Muscles Exercise Bulk-forming Agents Stool Softeners Education Understanding Medical Surgical Nursing, 4th Edition Constipation (cont’d) Data Collection ◦ ◦ ◦ ◦ Establish Rapport History Auscultate Bowel Sounds Inspect/Palpate Abdomen Understanding Medical Surgical Nursing, 4th Edition Constipation (cont’d) Nursing Diagnoses ◦ ◦ ◦ ◦ Constipation Anxiety Perceived Constipation Deficient Knowledge Understanding Medical Surgical Nursing, 4th Edition Diarrhea Fecal Matter Passes Rapidly Decreased Absorption Causes ◦ Bacterial/Viral Infection ◦ Food Allergies Prevention Understanding Medical Surgical Nursing, 4th Edition Diarrhea (cont’d) Signs And Symptoms ◦ ◦ ◦ ◦ ◦ ◦ Fever Foul Odor Abdominal Cramping Distention Anorexia Intestinal Rumbling Understanding Medical Surgical Nursing, 4th Edition Diarrhea (cont’d) Therapeutic Interventions ◦ ◦ ◦ ◦ ◦ ◦ Identify Cause Replace Fluids/Electrolytes Increase Fiber/Bulk Diphenoxylate (Lomotil), Loperamide (Imodium) Lactinex Restores Normal Flora Antimicrobial Agents Understanding Medical Surgical Nursing, 4th Edition Diarrhea (cont’d) Nursing Diagnoses ◦ ◦ ◦ ◦ ◦ Acute Pain Diarrhea Risk for Deficient Fluid Volume Risk for Infection Risk for Impaired Skin Integrity Understanding Medical Surgical Nursing, 4th Edition Appendicitis Inflammation of the Appendix Fever, Nausea/Vomiting, Anorexia, Pain Right Lower Quadrant Increased White Blood Cells NPO, Surgery Postoperative Care Understanding Medical Surgical Nursing, 4th Edition McBurney’s Point Understanding Medical Surgical Nursing, 4th Edition Peritonitis Inflammation/Infection of Peritoneal Cavity Signs and Symptoms ◦ ◦ ◦ ◦ Abdominal Pain Abdominal Rigidity Nausea/Vomiting Fever Understanding Medical Surgical Nursing, 4th Edition Peritonitis (cont’d) Therapeutic Interventions ◦ ◦ ◦ ◦ ◦ ◦ NPO Fluid/Electrolyte Replacement Naso/Orogastric Tube Antibiotics Surgery Pain Control Understanding Medical Surgical Nursing, 4th Edition Peritonitis (cont’d) Complications ◦ Intestinal Obstruction ◦ Hypovolemia ◦ Septicemia Understanding Medical Surgical Nursing, 4th Edition Peritonitis (cont’d) Nursing Diagnoses ◦ Acute Pain ◦ Deficient Fluid Volume ◦ Imbalanced Nutrition: Less Than Body Requirements Understanding Medical Surgical Nursing, 4th Edition Diverticulosis/Diverticulitis Diverticulum ◦ Outpouching of Bowel Mucous Membrane Diverticulosis ◦ Multiple Diverticula Diverticulitis ◦ Inflammation/Infection of Diverticulum Understanding Medical Surgical Nursing, 4th Edition Diverticulum Understanding Medical Surgical Nursing, 4th Edition Diverticulosis/Diverticulitis (cont’d) Causes ◦ Chronic Constipation ◦ Decreased Intake of Dietary Fiber Understanding Medical Surgical Nursing, 4th Edition Diverticulosis/Diverticulitis (cont’d) Therapeutic Interventions ◦ ◦ ◦ ◦ Prevent Constipation Intravenous Antibiotics Pain Control Surgery Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Inflammatory or Infectious Disorder Acute Pain Risk for Deficient Fluid Volume Understanding Medical Surgical Nursing, 4th Edition Crohn’s Disease Inflammatory Bowel Disease Any Part of the Intestine Remissions and Exacerbations Cause Unknown Hereditary Understanding Medical Surgical Nursing, 4th Edition Crohn’s Disease (cont’d) Signs and Symptoms ◦ ◦ ◦ ◦ Abdominal Pain or Cramping Weight Loss Diarrhea Fluid and Electrolyte Imbalance Understanding Medical Surgical Nursing, 4th Edition Crohn’s Disease (cont’d) Complications ◦ ◦ ◦ ◦ Malnutrition Fissures Abscesses Fistulas Understanding Medical Surgical Nursing, 4th Edition Fistulas Understanding Medical Surgical Nursing, 4th Edition Crohn’s Disease (cont’d) Diagnosis ◦ ◦ ◦ ◦ ◦ Laboratory Testing Endoscopy with Biopsy Ultrasound Multiphase CT Enterography Magnetic Resonance Enterography Understanding Medical Surgical Nursing, 4th Edition Crohn’s Disease (cont’d) Therapeutic Interventions ◦ Medications Anti-inflammatories Antidiarrheal Antibiotics Biologics Corticosteriods Immunosuppressants Understanding Medical Surgical Nursing, 4th Edition Crohn’s Disease (cont’d) Therapeutic Interventions (cont’d) ◦ ◦ ◦ ◦ Avoid Offending Foods Surgery if Necessary Elemental Formula or TPN if Required Support and Education Understanding Medical Surgical Nursing, 4th Edition Ulcerative Colitis Inflammatory Bowel Disease Colon and Rectum Remissions and Exacerbations Understanding Medical Surgical Nursing, 4th Edition Ulcerative Colitis (cont’d) Signs and Symptoms ◦ ◦ ◦ ◦ ◦ Abdominal Pain 5 to 20 Stools Daily Rectal Bleeding Fecal Urgency Anorexia ◦ ◦ ◦ ◦ ◦ Weight Loss Cramping Vomiting Fever Dehydration Understanding Medical Surgical Nursing, 4th Edition Ulcerative Colitis (cont’d) Therapeutic Interventions ◦ Avoid Offending Foods ◦ Medications Anti-inflammatories Antidiarrheal Immunosuppressants Corticosteriods Understanding Medical Surgical Nursing, 4th Edition Ulcerative Colitis (cont’d) Therapeutic Interventions (cont’d) ◦ Surgery if Necessary ◦ Elemental Formula or TPN if Required Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Inflammatory Bowel Disease Acute Pain Diarrhea Deficient Fluid Volume Anxiety Impaired Skin Integrity Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Inflammatory Bowel Disease (cont’d) Ineffective Nutrition: Less Than Body Requirements Ineffective Coping Understanding Medical Surgical Nursing, 4th Edition Irritable Bowel Syndrome Altered Intestinal Motility/Increased Sensitivity to Visceral Sensations Bowel Mucosa Not Changed Psychological Stress/Food Intolerances More Common in Women Understanding Medical Surgical Nursing, 4th Edition Irritable Bowel Syndrome (cont’d) Signs and Symptoms ◦ ◦ ◦ ◦ ◦ ◦ Gas Bloating Constipation Diarrhea Abdominal Pain Depression, Anxiety Understanding Medical Surgical Nursing, 4th Edition Irritable Bowel Syndrome (cont’d) Diagnosis ◦ History ◦ Physical Examination Understanding Medical Surgical Nursing, 4th Edition Irritable Bowel Syndrome (cont’d) Therapeutic Interventions ◦ ◦ ◦ ◦ High Fiber and Bran Diet Avoid Trigger Foods Smaller, Frequent Meals Stress Management Understanding Medical Surgical Nursing, 4th Edition Irritable Bowel Syndrome (cont’d) Therapeutic Interventions (cont’d) ◦ Behavioral Therapy ◦ Exercise ◦ Medications Understanding Medical Surgical Nursing, 4th Edition Irritable Bowel Syndrome (cont’d) Nursing Diagnoses ◦ Constipation ◦ Diarrhea ◦ Readiness for Enhanced Self-Health Management Understanding Medical Surgical Nursing, 4th Edition Abdominal Hernias Pathophysiology ◦ Protrusion of Organ or Structure Through Weakness or Tear in Wall of Abdomen Etiology ◦ Weakness in Abdominal Wall with Increased Intraabdominal Pressure Understanding Medical Surgical Nursing, 4th Edition Abdominal Hernias (cont’d) Types ◦ Inguinal ◦ Umbilical ◦ Ventral (Incisional) Understanding Medical Surgical Nursing, 4th Edition Types of Hernias Understanding Medical Surgical Nursing, 4th Edition Abdominal Hernias (cont’d) Signs and Symptoms ◦ None ◦ Bulging Complications ◦ Strangulated Incarcerated Hernia Understanding Medical Surgical Nursing, 4th Edition Abdominal Hernias (cont’d) Therapeutic Interventions ◦ ◦ ◦ ◦ None Observation Support Devices Surgery Herniorrhaphy Hernioplasty Understanding Medical Surgical Nursing, 4th Edition Abdominal Hernias (cont’d) Nursing Care ◦ Education ◦ Postoperative No Coughing Activity Education Understanding Medical Surgical Nursing, 4th Edition Absorption Disorders Inability to Absorb One or More Major Nutrients Types ◦ Celiac Disease ◦ Lactose Intolerance Understanding Medical Surgical Nursing, 4th Edition Absorption Disorders (cont’d) General Signs and Symptoms ◦ Weight Loss ◦ Weakness ◦ General Malaise Understanding Medical Surgical Nursing, 4th Edition Absorption Disorders (cont’d) Therapeutic Interventions ◦ Celiac Disease High-calorie, High-protein, Gluten-free Diet ◦ Lactose Intolerance Avoid Lactose Foods; Lactaid Understanding Medical Surgical Nursing, 4th Edition Absorption Disorders (cont’d) Nursing Care ◦ ◦ ◦ ◦ Monitor Fluids, Electrolytes, Nutritional Status Daily Weight Intake and Output Education Understanding Medical Surgical Nursing, 4th Edition Bowel Obstruction Flow of Intestinal Contents is Blocked Mechanical: Blockage Occurs Within the Intestine Non-mechanical: Peristalsis is Impaired Partial or Complete Understanding Medical Surgical Nursing, 4th Edition Mechanical Bowel Obstructions Understanding Medical Surgical Nursing, 4th Edition Bowel Obstruction (cont’d) Signs and Symptoms ◦ ◦ ◦ ◦ ◦ Abdominal Pain Blood and Mucus per Rectum Feces and Flatus Cease Fecal Vomiting May Occur Bowel Sounds High-pitched/Tinkling or Absent Understanding Medical Surgical Nursing, 4th Edition Bowel Obstruction (cont’d) Signs and Symptoms ◦ Abdominal Distention ◦ Fluid/Electrolyte Imbalance Understanding Medical Surgical Nursing, 4th Edition Bowel Obstruction (cont’d) Diagnosis ◦ Abdominal X-Ray ◦ CT Scan ◦ CBC and Electrolytes Understanding Medical Surgical Nursing, 4th Edition Bowel Obstruction (cont’d) Therapeutic Interventions ◦ ◦ ◦ ◦ NPO Frequent Mouth Care Nasogastric Tube Fluid and Electrolyte Replacement Understanding Medical Surgical Nursing, 4th Edition Bowel Obstruction (cont’d) Therapeutic Interventions (cont’d) ◦ Medications Antibiotics Anti-emetics Analgesics ◦ Surgery Understanding Medical Surgical Nursing, 4th Edition Bowel Obstruction (cont’d) Nursing Diagnoses ◦ Acute Pain ◦ Deficient Fluid Volume ◦ Deficient Knowledge Understanding Medical Surgical Nursing, 4th Edition Anorectal Problems Hemorrhoids Anal Fissures Anorectal Abscess Understanding Medical Surgical Nursing, 4th Edition Anorectal Problems (cont’d) Nursing Care ◦ Postoperative Pain Control Sitz Baths Dressing Changes Stool Softeners Understanding Medical Surgical Nursing, 4th Edition Lower Gastrointestinal Bleeding Causes Diverticulitis Polyps Anal Fissures Hemorrhoids Inflammatory Bowel Disease Cancer Understanding Medical Surgical Nursing, 4th Edition Lower Gastrointestinal Bleeding Occult Blood, Melena, Bright Red Stools Treat Cause Understanding Medical Surgical Nursing, 4th Edition Lower Gastrointestinal Bleeding (cont’d) Nursing Care ◦ Monitor Stools, Bleeding ◦ Vital Signs ◦ Diagnostic Prep Understanding Medical Surgical Nursing, 4th Edition Colorectal Cancer Major Cause: Lack of Dietary Fiber Signs and Symptoms ◦ ◦ ◦ ◦ ◦ ◦ Change in Bowel Habits Blood or Mucus In Stools Abdominal or Rectal Pain Weight Loss Anemia Obstruction Understanding Medical Surgical Nursing, 4th Edition Colorectal Cancer (cont’d) Major Cause: Lack of Dietary Fiber Signs and Symptoms ◦ Anemia ◦ Obstruction Understanding Medical Surgical Nursing, 4th Edition Colorectal Cancer (cont’d) Diagnosis ◦ ◦ ◦ ◦ Colonoscopy with Biopsy Sigmoidoscopy with Biopsy Proctosigmoidoscopy CT Scan Understanding Medical Surgical Nursing, 4th Edition Colorectal Cancer (cont’d) Diagnosis (cont’d) ◦ ◦ ◦ ◦ Abdominal and Rectal Examination Immunological Tests Fecal Occult Blood CEA Understanding Medical Surgical Nursing, 4th Edition Colorectal Cancer (cont’d) Therapeutic Interventions ◦ Surgery Resection Abdominoperineal Resection Colostomy Understanding Medical Surgical Nursing, 4th Edition Colorectal Cancer (cont’d) Therapeutic Interventions (cont’d) ◦ ◦ ◦ ◦ ◦ Radiation Chemotherapy Monoclonal Antibody Therapy Analgesics TPN as Necessary Understanding Medical Surgical Nursing, 4th Edition Colorectal Cancer (cont’d) Nursing Diagnoses ◦ Acute Pain ◦ Anxiety ◦ Imbalanced Nutrition: Less Than Body Requirements Understanding Medical Surgical Nursing, 4th Edition Colorectal Cancer (cont’d) Nursing Care ◦ Support and Education ◦ Postoperative Care Understanding Medical Surgical Nursing, 4th Edition Ostomy Management Ostomy ◦ Surgically Created Opening Diverts Stool or Urine to Outside of Body Stoma ◦ Portion of Bowel Sutured onto Abdomen Abdominal Ostomies: Ileostomy, Colostomy, Urostomy Understanding Medical Surgical Nursing, 4th Edition Ileostomy Terminal Ileum to Abdominal Wall After Total Colectomy Understanding Medical Surgical Nursing, 4th Edition Ileostomy Types Conventional Ileostomy ◦ Small Stoma Right Lower Quadrant ◦ Continuous Flow Liquid Effluent Continent Ileostomy ◦ Internal Reservoir with Nipple Valve ◦ Empty Reservoir 3 to 4 Times Daily Understanding Medical Surgical Nursing, 4th Edition Continent Ileostomy Understanding Medical Surgical Nursing, 4th Edition Ileostomy Types (cont’d) Ileoanal Anastomosis Ileorectal Anastomosis Understanding Medical Surgical Nursing, 4th Edition Ileal–Anal Anastomosis J Pouch Understanding Medical Surgical Nursing, 4th Edition Types of Stomas Understanding Medical Surgical Nursing, 4th Edition Colostomy Effluent Becomes Less Liquid and More Solid as Location of Ostomy Becomes More Distal in Colon Types ◦ End Stoma Proximal Bowel End Brought to Abdominal Wall ◦ Loop Stoma Loop of Bowel Outside Abdomen with Bridge Under it Understanding Medical Surgical Nursing, 4th Edition Colostomy Types Double-barrel Stoma ◦ Temporary Ostomy ◦ Both Ends of Colon Outside Abdominal Wall, Form Two Stomas ◦ Proximal Stoma is Functioning Stoma ◦ Distal Stoma is Mucous Fistula Understanding Medical Surgical Nursing, 4th Edition Preoperative Ostomy Care Wound Ostomy Continence Nurse ◦ Marks Site ◦ Emotional, Physical Support Teaching Bowel Prep Antibiotics Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses Deficient Knowledge ◦ Appliance Change ◦ Daily Care and Hygiene ◦ Dietary Considerations Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses (cont’d) Body Image Disturbance Sexual Dysfunction Ineffective Therapeutic Regimen Management Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses (cont’d) Risk for Injury ◦ ◦ ◦ ◦ ◦ Peristomal Skin Irritation Peristomal Hernia Stomal Prolapse Stomal Necrosis Ileostomy Blockage Understanding Medical Surgical Nursing, 4th Edition Postoperative Ostomy Care Data Collection ◦ Vital Signs ◦ Stoma Pink to Red, Moist = Normal Bluish = Inadequate Blood Supply Black = Necrosis Understanding Medical Surgical Nursing, 4th Edition Postoperative Ostomy Care (cont’d) Data Collection ◦ Skin Around Stoma Monitored for Irritation Stoma Shrinks Over Weeks Ostomy Care ◦ Appliance Change Teaching
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