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Nursing Care & Interventions
for Clients with Inflammatory
Intestinal Disorders
Keith Rischer RN, MA, CEN
1
Today’s Objectives…
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Describe commonalities in diseases of the gastrointestinal tract.
Compare indicators for malignancy throughout the
gastro-intestinal system.
Discuss relevance of diagnostic test results to the
nursing plan of care.
Discuss the pathophysiology and assessment findings
of ulcerative colitis and Crohn’s disease.
Consider nursing interventions for a client with a new
ostomy.
Develop a teaching plan for a client integrating the use
of medication and diet.
2
 Ulcerative
colitis is one of a group of
bowel diseases of unknown etiology
characterized by remissions and
exacerbations (flare-ups).
 Mucosal lining of the colon or rectum is
affected.
 Loose stools containing blood and mucus,
poor absorption of vital nutrients, and
thickening of the colon wall can result.
3
 Physical
assessment
 Clinical manifestations
 Psychosocial assessment
 Laboratory assessment
 Radiographic assessment
4
 Interventions:
•
•
•
Record the color,
volume, frequency,
and consistency of
stools.
Identify factors that
cause or contribute
to diarrhea.
Eliminate gasproducing and spicy
foods.
5
•
•
•
•
•
•
Eliminate by trial foods containing lactose.
Eat a low-fiber, high-protein, high-calorie diet.
Use antidiarrheal medications.
Monitor skin.
Record weight regularly.
Rest the bowel.
6
 Salicylate
compounds
 Corticosteroids
 Immunosuppressive drugs
 Antidiarrheal drugs
 Other drugs
7
Surgical Care
Total proctocolectomy with a
permanent ileostomy
Preoperative care
Operative procedure
Postoperative care
Loose, dark green liquid, with
some blood in stool
Pouch system worn at all
times
Skin care
8
 Internal
ileal reservoir
 Intra-abdominal pouch created from the
terminal ileum by the surgeon
 Stool stored in the pouch drained by
catheter
 Care of pouch
 Effluent, or drainage, monitored
9
 Removal
of the colon and the rectum with
the ileum sutured into the anal canal
 Spares the rectal sphincter and need for
an ostomy
 Preoperative care
 Operative procedure
 Postoperative care
10
 Interventions
include:
• Pain management in
ulcerative colitis
Comprehensive
pain
assessment
Evaluation of
effectiveness of pain
control measures
used
Reduction or
elimination of
precipitating factors
for pain.
Teach use of non-
11
 Interventions
•
•
•
•
•
include:
Monitoring for signs and symptoms of
gastrointestinal bleeding
Monitoring all stools for blood, using both
gross and occult examination
Monitoring hematocrit, hemoglobin, and
electrolyte values
Monitoring vital signs
Preparing for possible blood administration
12
 Idiopathic
inflammatory disease of the
small intestine and the colon, or both
 All layers of the bowel involved, mostly
terminal ileum
 Bowel fistulas
 Rare cancer of the small bowel and colon
develop.
 Malabsorption of vitamins and nutrients
13
 Physical
assessment
 Clinical manifestations
 Psychosocial assessment
 Diagnostic assessment
14
 Drug
therapy
 Nutritional management
 Complication management
 Fluid and electrolyte therapy
 Skin care
 Prevention of infection
 Complementary and alternative therapy
15
 Laparoscopy
 Small
bowel resection and ileocecal
resections
 Stricturoplasty
 Preoperative care
 Operative procedure
 Postoperative care
16
 Diverticulosis
is the presence of many
abnormal pouchlike herniations in the wall
of the intestine.
 Diverticulitis is the term used to describe
an inflammation of one or more of the
diverticula.
17
 History
 Physical
assessment
 Clinical
manifestations
 Diagnostic
assessment
18
 Drug
therapy
 Diet therapy
 Rest
 Intravenous fluids to correct dehydration
 Intravenous antibiotics
 Anticholinergics
 Analgesics
(
19
 Avoid
laxatives
 Rest
 Nothing
by mouth in the hospital
20
 Preoperative
care
 Operative procedure
 Postoperative care
• Drain care
• Care of the ostomy
• Nothing by mouth
followed by clear
liquids
21
 Localized
induration and fluctuance due to
the inflammation of the soft tissue near the
rectum or anus
 Rectal pain first symptom
 Surgical incision and drainage
 Nursing interventions focused on helping
the client maintain comfort and optimal
perineal hygiene
 High-fiber diet
22