Nursing%20Care%20of%20Patients%20with%20Lower%20Gastrointestinal%20Disorders - PowerPoint PPT Presentation

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Nursing%20Care%20of%20Patients%20with%20Lower%20Gastrointestinal%20Disorders

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Title: Nursing%20Care%20of%20Patients%20with%20Lower%20Gastrointestinal%20Disorders


1
Chapter 34
  • Nursing Care of Patients with Lower
    Gastrointestinal Disorders

2
Lower Gastrointestinal System
  • Small Intestines
  • Large Intestines
  • Rectum
  • Anus

3
Constipation
  • Fecal Mass Held In Rectum
  • Feces Become Dry, Hard
  • Many Causes
  • Prevention High-fiber Diet, Fluids, Exercise
  • Obstipation

4
Constipation (contd)
  • Signs and Symptoms
  • Abdominal Pain
  • Distention
  • Indigestion
  • Rectal Pressure
  • Incomplete Emptying
  • Headache
  • Fatigue
  • Decreased Appetite

5
Constipation (contd)
  • Complications
  • Impaction
  • Ulcers
  • Straining
  • Megacolon
  • Chronic Laxative Abuse Fibrosis

6
Constipation (contd)
  • Therapeutic Interventions
  • High-fiber Diet, 2 to 3 L Fluid Daily
  • Strengthen Abdominal Muscles
  • Exercise
  • Bulk-forming Agents
  • Stool Softeners
  • Education

7
Constipation (contd)
  • Data Collection
  • Establish Rapport
  • History
  • Auscultate Bowel Sounds
  • Inspect/Palpate Abdomen

8
Constipation (contd)
  • Nursing Diagnoses
  • Constipation
  • Anxiety
  • Perceived Constipation
  • Deficient Knowledge

9
Diarrhea
  • Fecal Matter Passes Rapidly
  • Decreased Absorption
  • Causes
  • Bacterial/Viral Infection
  • Food Allergies
  • Prevention

10
Diarrhea (contd)
  • Signs And Symptoms
  • Fever
  • Foul Odor
  • Abdominal Cramping
  • Distention
  • Anorexia
  • Intestinal Rumbling

11
Diarrhea (contd)
  • Therapeutic Interventions
  • Identify Cause
  • Replace Fluids/Electrolytes
  • Increase Fiber/Bulk
  • Diphenoxylate (Lomotil), Loperamide (Imodium)
  • Lactinex Restores Normal Flora
  • Antimicrobial Agents

12
Diarrhea (contd)
  • Nursing Diagnoses
  • Acute Pain
  • Diarrhea
  • Risk for Deficient Fluid Volume
  • Risk for Infection
  • Risk for Impaired Skin Integrity

13
Appendicitis
  • Inflammation of the Appendix
  • Fever, Nausea/Vomiting, Anorexia, Pain Right
    Lower Quadrant
  • Increased White Blood Cells
  • NPO, Surgery
  • Postoperative Care

14
  McBurneys Point
15
Peritonitis
  • Inflammation/Infection of Peritoneal Cavity
  • Signs and Symptoms
  • Abdominal Pain
  • Abdominal Rigidity
  • Nausea/Vomiting
  • Fever

16
Peritonitis (contd)
  • Therapeutic Interventions
  • NPO
  • Fluid/Electrolyte Replacement
  • Naso/Orogastric Tube
  • Antibiotics
  • Surgery
  • Pain Control

17
Peritonitis (contd)
  • Complications
  • Intestinal Obstruction
  • Hypovolemia
  • Septicemia

18
Peritonitis (contd)
  • Nursing Diagnoses
  • Acute Pain
  • Deficient Fluid Volume
  • Imbalanced Nutrition Less Than Body
  • Requirements

19
Diverticulosis/Diverticulitis
  • Diverticulum
  • Outpouching of Bowel Mucous Membrane
  • Diverticulosis
  • Multiple Diverticula
  • Diverticulitis
  • Inflammation/Infection of Diverticulum

20
  Diverticulum
21
Diverticulosis/Diverticulitis(contd)
  • Causes
  • Chronic Constipation
  • Decreased Intake of Dietary Fiber

22
Diverticulosis/Diverticulitis (contd)
  • Therapeutic Interventions
  • Prevent Constipation
  • Intravenous Antibiotics
  • Pain Control
  • Surgery

23
Nursing Diagnoses Inflammatory or Infectious
Disorder
  • Acute Pain
  • Risk for Deficient Fluid Volume

24
Crohns Disease
  • Inflammatory Bowel Disease
  • Any Part of the Intestine
  • Remissions and Exacerbations
  • Cause Unknown
  • Hereditary

25
Crohns Disease (contd)
  • Signs and Symptoms
  • Abdominal Pain or Cramping
  • Weight Loss
  • Diarrhea
  • Fluid and Electrolyte Imbalance

26
Crohns Disease (contd)
  • Complications
  • Malnutrition
  • Fissures
  • Abscesses
  • Fistulas

27
  Fistulas
28
Crohns Disease (contd)
  • Diagnosis
  • Laboratory Testing
  • Endoscopy with Biopsy
  • Ultrasound
  • Multiphase CT Enterography
  • Magnetic Resonance Enterography

29
Crohns Disease (contd)
  • Therapeutic Interventions
  • Medications
  • Anti-inflammatories
  • Antidiarrheal
  • Antibiotics
  • Biologics
  • Corticosteriods
  • Immunosuppressants

30
Crohns Disease (contd)
  • Therapeutic Interventions (contd)
  • Avoid Offending Foods
  • Surgery if Necessary
  • Elemental Formula or TPN if Required
  • Support and Education

31
Ulcerative Colitis
  • Inflammatory Bowel Disease
  • Colon and Rectum
  • Remissions and Exacerbations

32
Ulcerative Colitis (contd)
  • Signs and Symptoms
  • Abdominal Pain
  • 5 to 20 Stools Daily
  • Rectal Bleeding
  • Fecal Urgency
  • Anorexia
  • Weight Loss
  • Cramping
  • Vomiting
  • Fever
  • Dehydration

33
Ulcerative Colitis (contd)
  • Therapeutic Interventions
  • Avoid Offending Foods
  • Medications
  • Anti-inflammatories
  • Antidiarrheal
  • Immunosuppressants
  • Corticosteriods

34
Ulcerative Colitis (contd)
  • Therapeutic Interventions (contd)
  • Surgery if Necessary
  • Elemental Formula or TPN if Required

35
Nursing Diagnoses Inflammatory Bowel Disease
  • Acute Pain
  • Diarrhea
  • Deficient Fluid Volume
  • Anxiety
  • Impaired Skin Integrity

36
Nursing Diagnoses Inflammatory Bowel Disease
(contd)
  • Ineffective Nutrition Less Than Body
    Requirements
  • Ineffective Coping

37
Irritable Bowel Syndrome
  • Altered Intestinal Motility/Increased Sensitivity
    to Visceral Sensations
  • Bowel Mucosa Not Changed
  • Psychological Stress/Food Intolerances
  • More Common in Women

38
Irritable Bowel Syndrome (contd)
  • Signs and Symptoms
  • Gas
  • Bloating
  • Constipation
  • Diarrhea
  • Abdominal Pain
  • Depression, Anxiety

39
Irritable Bowel Syndrome (contd)
  • Diagnosis
  • History
  • Physical Examination

40
Irritable Bowel Syndrome (contd)
  • Therapeutic Interventions
  • High Fiber and Bran Diet
  • Avoid Trigger Foods
  • Smaller, Frequent Meals
  • Stress Management

41
Irritable Bowel Syndrome (contd)
  • Therapeutic Interventions (contd)
  • Behavioral Therapy
  • Exercise
  • Medications

42
Irritable Bowel Syndrome (contd)
  • Nursing Diagnoses
  • Constipation
  • Diarrhea
  • Readiness for Enhanced Self-Health Management

43
Abdominal Hernias
  • Pathophysiology
  • Protrusion of Organ or Structure Through
    Weakness or Tear in Wall of Abdomen
  • Etiology
  • Weakness in Abdominal Wall with Increased
    Intra-abdominal Pressure

44
Abdominal Hernias (contd)
  • Types
  • Inguinal
  • Umbilical
  • Ventral (Incisional)

45
Types of Hernias
46
Abdominal Hernias (contd)
  • Signs and Symptoms
  • None
  • Bulging
  • Complications
  • Strangulated Incarcerated Hernia

47
Abdominal Hernias (contd)
  • Therapeutic Interventions
  • None
  • Observation
  • Support Devices
  • Surgery
  • Herniorrhaphy
  • Hernioplasty

48
Abdominal Hernias (contd)
  • Nursing Care
  • Education
  • Postoperative
  • No Coughing
  • Activity
  • Education

49
Absorption Disorders
  • Inability to Absorb One or More Major Nutrients
  • Types
  • Celiac Disease
  • Lactose Intolerance

50
Absorption Disorders (contd)
  • General Signs and Symptoms
  • Weight Loss
  • Weakness
  • General Malaise

51
Absorption Disorders (contd)
  • Therapeutic Interventions
  • Celiac Disease
  • High-calorie, High-protein, Gluten-free Diet
  • Lactose Intolerance
  • Avoid Lactose Foods Lactaid

52
Absorption Disorders (contd)
  • Nursing Care
  • Monitor Fluids, Electrolytes, Nutritional Status
  • Daily Weight
  • Intake and Output
  • Education

53
Bowel Obstruction
  • Flow of Intestinal Contents is Blocked
  • Mechanical Blockage Occurs Within the Intestine
  • Non-mechanical Peristalsis is Impaired
  • Partial or Complete

54
Mechanical Bowel Obstructions
55
Bowel Obstruction (contd)
  • 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

56
Bowel Obstruction (contd)
  • Signs and Symptoms
  • Abdominal Distention
  • Fluid/Electrolyte Imbalance

57
Bowel Obstruction (contd)
  • Diagnosis
  • Abdominal X-Ray
  • CT Scan
  • CBC and Electrolytes

58
Bowel Obstruction (contd)
  • Therapeutic Interventions
  • NPO
  • Frequent Mouth Care
  • Nasogastric Tube
  • Fluid and Electrolyte Replacement

59
Bowel Obstruction (contd)
  • Therapeutic Interventions (contd)
  • Medications
  • Antibiotics
  • Anti-emetics
  • Analgesics
  • Surgery

60
Bowel Obstruction (contd)
  • Nursing Diagnoses
  • Acute Pain
  • Deficient Fluid Volume
  • Deficient Knowledge

61
Anorectal Problems
  • Hemorrhoids
  • Anal Fissures
  • Anorectal Abscess

62
Anorectal Problems (contd)
  • Nursing Care
  • Postoperative
  • Pain Control
  • Sitz Baths
  • Dressing Changes
  • Stool Softeners

63
Lower Gastrointestinal Bleeding Causes
  • Diverticulitis
  • Polyps
  • Anal Fissures
  • Hemorrhoids
  • Inflammatory Bowel Disease
  • Cancer

64
Lower Gastrointestinal Bleeding
  • Occult Blood, Melena, Bright Red Stools
  • Treat Cause

65
Lower Gastrointestinal Bleeding (contd)
  • Nursing Care
  • Monitor Stools, Bleeding
  • Vital Signs
  • Diagnostic Prep

66
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

67
Colorectal Cancer (contd)
  • Major Cause Lack of Dietary Fiber
  • Signs and Symptoms
  • Anemia
  • Obstruction

68
Colorectal Cancer (contd)
  • Diagnosis
  • Colonoscopy with Biopsy
  • Sigmoidoscopy with Biopsy
  • Proctosigmoidoscopy
  • CT Scan

69
Colorectal Cancer (contd)
  • Diagnosis (contd)
  • Abdominal and Rectal Examination
  • Immunological Tests
  • Fecal Occult Blood
  • CEA

70
Colorectal Cancer (contd)
  • Therapeutic Interventions
  • Surgery
  • Resection
  • Abdominoperineal Resection
  • Colostomy

71
Colorectal Cancer (contd)
  • Therapeutic Interventions (contd)
  • Radiation
  • Chemotherapy
  • Monoclonal Antibody Therapy
  • Analgesics
  • TPN as Necessary

72
Colorectal Cancer (contd)
  • Nursing Diagnoses
  • Acute Pain
  • Anxiety
  • Imbalanced Nutrition Less Than Body Requirements

73
Colorectal Cancer (contd)
  • Nursing Care
  • Support and Education
  • Postoperative Care

74
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

75
Ileostomy
  • Terminal Ileum to Abdominal Wall After Total
    Colectomy

76
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

77
Continent Ileostomy
78
Ileostomy Types (contd)
  • Ileoanal Anastomosis
  • Ileorectal Anastomosis

79
 IlealAnal Anastomosis J Pouch
80
  Types of Stomas
81
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

82
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

83
Preoperative Ostomy Care
  • Wound Ostomy Continence Nurse
  • Marks Site
  • Emotional, Physical Support
  • Teaching
  • Bowel Prep
  • Antibiotics

84
Nursing Diagnoses
  • Deficient Knowledge
  • Appliance Change
  • Daily Care and Hygiene
  • Dietary Considerations

85
Nursing Diagnoses (contd)
  • Body Image Disturbance
  • Sexual Dysfunction
  • Ineffective Therapeutic Regimen Management

86
Nursing Diagnoses (contd)
  • Risk for Injury
  • Peristomal Skin Irritation
  • Peristomal Hernia
  • Stomal Prolapse
  • Stomal Necrosis
  • Ileostomy Blockage

87
Postoperative Ostomy Care
  • Data Collection
  • Vital Signs
  • Stoma
  • Pink to Red, Moist Normal
  • Bluish Inadequate Blood Supply
  • Black Necrosis

88
Postoperative Ostomy Care (contd)
  • Data Collection
  • Skin Around Stoma Monitored for Irritation
  • Stoma Shrinks Over Weeks
  • Ostomy Care
  • Appliance Change
  • Teaching
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