Chapt 47 Mgt of Intestinal and Rectal Disorders
Ask the client to remain inactive for 5 minutes.
A nurse applies an ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse utilize to prevent leakage from the appliance? Press the adhesive faceplate from the stomal edge inward Ask the client to remain inactive for 5 minutes. Ensure that no air is trapped in the pouch Ensure that there are no holes in the pouch
nausea
A typical sign/symptom of appendicitis is: pain when pressure is applied to the right lower quadrant. nausea. left lower quadrant pain. high fever.
Abdominal perforation signs and dx
Clinical manifestations include hypotension, increased temperature, tachycardia, and elevated ESR.
incidences of breast cancer exceed
In women, only that of colorectal cancer. In men, only incidences of prostate cancer and lung cancer exceed that of colorectal cancer.
Breast
In women, which of the following types of cancer exceeds colorectal cancer? Breast Skin Lung Liver
Rectal bleeding not cancer
When interviewing a client with internal hemorrhoids, what would the nurse expect the client to report? Soreness Itching Pain Rectal bleeding
maintaining fluid balance.
When planning care for a client with a small-bowel obstruction, the nurse should consider the primary goal to be: Reporting pain relief. maintaining body weight. maintaining fluid balance. reestablishing a normal bowel pattern.
Sudden, sustained abdominal pain
Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction? Sudden, sustained abdominal pain Decreased urine output Decreased blood pressure Purulent drainage from the gluteal fold
Internal hemorrhoids
cause bleeding but are less likely to cause pain, unless they protrude through the anus. External hemorrhoids may cause few symptoms, or they can produce pain, itching, and soreness of the anal area.
The chief characteristic of cancer of the colon is a
change in bowel habits, such as alternating constipation and diarrhea. Excess gas, daily bowel movements, and abdominal cramping when having a bowel movement are not indicators of colon cancer.
Family history of colon cancer or familial polyposis is a risk factor for
colorectal cancer. Age older than 40 years andd a high-fat, high-protein, low-fiber diet are risk factors for colorectal cancer. A history of skin cancer is not a recognized risk factor for colorectal cancer.
Constipation
has many possible causes and assessing the client's usual pattern of elimination is the first step in identifying the cause. The nurse should obtain a description of the bowel elimination pattern, asking about the frequency, overall appearance and consistency of stool, blood in the stool, pain, and effort necessary to pass stool. It is also essential for the nurse to review the client's current medications, diet, and activity levels.
Hemorrhoids (piles)
is a dilated portion of vein in the anal canal.
chief characteristic of cancer of the colon is a change
the in bowel habits, such as alternating constipation and diarrhea .Although abdominal distention and blood in the stool (frank or occult) may be present,. Abdominal pain is a late sign.
Peritonitis s/s:
would typically exhibit a rigid, board-like abdomen, with absent bowel sounds, elevated pulse rate, and rapid, shallow respirations.
The client with peritonitis
would typically exhibit a rigid, board-like abdomen, with absent bowel sounds, elevated pulse rate, and rapid, shallow respirations.
Explain to the client why analgesics are being withheld.
A client has been brought into the ED via ambulance, reporting acute generalized abdominal pain, nausea, fever, and constipation. The healthcare provider suspects appendicitis, but testing has not been performed yet to make a definitive diagnosis. What will the nurse most likely do while initially caring for this client? Administer a laxative to relieve the client's constipation. Frequently palpate the abdomen to assess for changes that might indicate the onset of a perforation. Explain to the client why analgesics are being withheld. Perform the test for rebound tenderness.
White blood cell (WBC) count 22.8/mm3
A client is admitted to the emergency department with reports right lower quadrant pain. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the health care provider immediately? Serum potassium 4.2 mEq/L Hematocrit 42% White blood cell (WBC) count 22.8/mm3 Serum sodium 135 mEq/L
Right Lower Quadrant (RLQ)
A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? Right lower quadrant Right upper quadrant Left lower quadrant Left upper quadrant
Increasing fluid intake to prevent dehydration
A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of? Increasing fluid intake to prevent dehydration Wearing an appliance pouch only at bedtime Consuming a low-protein, high-fiber diet Taking only enteric-coated medications
The consistency of stool and comfort when passing stool
A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important? The consistency of stool and comfort when passing stool That the client has a bowel movement daily That the stool is formed and soft The client is able to fully evacuate with each bowel movement
The consistency of stool and comfort when passing stool
A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important? The consistency of stool and comfort when passing stool That the client has a bowel movement daily That the stool is formed and soft The client is able to fully evacuate with each bowel movement
Every 4 to 6 hours
A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir? At least once every 2 days At least once a day Every 4 to 6 hours Three or four times daily
Peritonitis
A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and boardlike. What complication does the nurse determine may be occurring at this time? Constipation Paralytic ileus Peritonitis Accumulation of gas
Assist client to increase dietary fiber.
A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation? Provide adequate quantity of food. Obtain medical and allergy history. Assist client to increase dietary fiber. Obtain complete food history.
IBS (irritable bowel syndrome)
A high-fiber diet is prescribed to help control diarrhea and constipation. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because they cause abdominal distention.
Ask the client to remain inactive for 5 minutes.
A nurse applies an ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse utilize to prevent leakage from the appliance? Ask the client to remain inactive for 5 minutes. Press the adhesive faceplate from the stomal edge inward Ensure that no air is trapped in the pouch Ensure that there are no holes in the pouch
A change in bowel habits
A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder? Abdominal distention Frank blood in the stool A change in bowel habits Abdominal pain
A change in bowel habits
A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder? Abdominal pain Frank blood in the stool Abdominal distention A change in bowel habits
severe abdominal pain with direct palpation or rebound tenderness
A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find? tenderness and pain in the right upper abdominal quadrant jaundice and vomiting severe abdominal pain with direct palpation or rebound tenderness rectal bleeding and a change in bowel habits
Appendicitis
A patient arrives in the emergency department with complaints of right lower abdominal pain that began 4 hours ago and is getting worse. The nurse assesses rebound tenderness at McBurney's point. What does this assessment data indicate to the nurse? Crohn's disease Ulcerative colitis Appendicitis Diverticulitis
Keep a 1- to 2-week symptom and food diary to identify food triggers.
A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms? Document how much fluid is being taken to determine if the patient is overhydrating. Discontinue the use of any medication presently being taken to determine if medication is a trigger. Begin an exercise regimen and biofeedback to determine if external stress is a trigger. Keep a 1- to 2-week symptom and food diary to identify food triggers.
Lack of free water intake
A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? lack of free water intake lack of solid food lack of exercise increased fiber
lack of free water intake
A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? lack of solid food increased fiber lack of exercise lack of free water intake
Colon cancer
Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign.
Hypokalemia
An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to?
healthcare provider suspects appendicitis
Analgesics may be withheld initially to avoid masking symptoms that may affect the diagnosis. Avoid multiple or frequent palpation of the abdomen; there is danger of causing the appendix to rupture. Perform the test for rebound tenderness at the end of the examination because a positive response causes pain and muscle spasm and makes it difficult to complete the rest of the assessment. Do not administer laxatives or enemas to a client who is experiencing fever, nausea, and abdominal pain, even though the client may complain of feeling constipated. Laxatives and cathartics may cause the appendix to rupture.
Small Bowel Obstruction (SBO)
Because a client can't tolerate oral intake, fluid volume deficit may occur and can be life-threatening. Therefore, maintaining fluid balance is the primary goal. Pain relief and maintaining body weight don't reflect life-threatening conditions, and the client's normal bowel pattern can be reestablished after fluid volume is stabilized.
Mucosal disorders causing generalized malabsorption
Celiac sprue is an example of which category of malabsorption? Postoperative malabsorption Mucosal disorders causing generalized malabsorption Infectious diseases causing generalized malabsorption Luminal problems causing malabsorption
Occurrence is higher in people with a family history of colon cancer.
Colorectal cancer is the third most common type of cancer in the United States. The lifetime risk of developing colorectal cancer is 1 in 20. The incidence increases with age (the incidence is highest in people older than 85).
Low residue
Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? Calorie restriction Iron restriction Low protein Low residue
high-fiber diet.
Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: caffeinated products. spicy foods. high-fiber diet. fluids with meals.
Deficient fluid volume is the primary diagnosis
Feces, fluid, and gas accumulate above a bowel obstruction. Then the absorption of fluids decreases and gastric secretions increase. This process leads to a loss of fluids and electrolytes in circulation.
what are normal and abnormal bowel habits?
In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination. People differ greatly in their bowel habits and normal bowel patterns range from three bowel movements per day to three bowel movements per week. It is important for the stool to be soft to pass without pain. The client may not be able to fully evacuate with a bowel movement; it may take time.
A client who cannot swallow food cannot drink enough water to meet daily needs.
Inadequate fluid intake is a common cause of constipation.
Most common cause of constipation:
Inadequate fluid intake. Who cannot swallow food cannot drink enough water to meet daily needs.
Peritonitis
Lack of bowel motility typically accompanies. The abdomen feels rigid and boardlike as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis.
chronic inflammatory bowel disease
Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet the nutritional needs, reduce inflammation, and control pain and diarrhea.
Osteoporosis
Patients with irritable bowel disease (IBD) are at significantly increased risk for which of the following? Deep vein thrombosis Pneumonia Osteoporosis Hypotension
development of malabsorption syndromes
Postoperative gastric or intestinal resection can result in?
continent ileostomy
The length of time between drainage periods is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. This prevents the accumulating effluent from spilling or causing infection.
irritable bowel syndrome (IBS)
The nurse emphasizes and reinforces good dietary habits (e.g., avoidance of food triggers). A good way to identify problem foods is to keep a 1- to 2-week symptom and food diary.
Usual pattern of elimination
The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation? Usual pattern of elimination Current medications Alcohol consumption Activity levels
Usual pattern of elimination
The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation? Alcohol consumption Current medications Usual pattern of elimination Activity levels
Wound dehiscence has occurred.
The nurse is assigned to care for a patient 2 days after an appendectomy due to a ruptured appendix with resultant peritonitis. The nurse has just assisted the patient with ambulation to the bedside commode when the patient points to the surgical site and informs the nurse that "something gave way." What does the nurse suspect may have occurred? A drain may have become dislodged. Wound dehiscence has occurred. Infection has developed. The surgical wound has begun to bleed.
hypotension
The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process? Bradycardia Hypotension Normal erythrocyte sedimentation rate (ESR) Subnormal temperature
It is the third most common cancer in the United States.
The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program? It is the third most common cancer in the United States. The lifetime risk of developing colorectal cancer is 1 in 10. The incidence of colorectal cancer decreases with age. Colorectal cancer has no hereditary component.
Clamp the tubing and give the patient a rest period.
The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse? Inform the patient that it will only last a minute and continue with the procedure. Clamp the tubing and give the patient a rest period. Stop the irrigation and remove the tube. Replace the fluid with cooler water since it is probably too warm.
Familial polyposis
The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? Low-fat, low-protein, high-fiber diet Familial polyposis History of skin cancer Age younger than 40 years
Anal fissure
The nurse is performing a rectal assessment and notices a longitudinal tear or ulceration in the lining of the anal canal. The nurse documents the finding as which condition? Anorectal abscess Anal fistula Hemorrhoid Anal fissure
Borborygmus
The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition? Borborygmus Tenesmus Azotorrhea Diverticulitis
Change in bowel habits
The nurse is talking with a group of clients who are older than age 50 years about the recognition of colon cancer to access early intervention. What should the nurse inform the clients to report immediately to their primary care provider? Change in bowel habits Abdominal cramping when having a bowel movement Daily bowel movements Excess gas
Dry skin thoroughly after washing
The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation? Apply barrier powder Dust with nystatin powder Apply triamcinolone acetonide spray Dry skin thoroughly after washing
Rovsing sign
The nurse observes the physician palpating the abdomen of a client that is suspected of having acute appendicitis. When the abdomen is pressed in the left lower quadrant the client complains of pain on the right side. What does the nurse understand this assessment technique is referred to? Cremasteric reflex Rebound pain Rovsing sign Referred pain
anorexia reports constipation
The nurse should assist the client to increase the dietary fiber in food because it helps reduce constipation. Providing an adequate quantity of food is necessary in maintaining sufficient nutrition and in sustaining normal body weight. Obtaining medical, allergy, and food history would provide valuable information, however, it would not help reduce constipation.
indicate appendicitis
The nurse should report the elevated WBC count. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured.
Metabolic alkalosis
Vomiting results in which of the following acid-base imbalances? Respiratory alkalosis Metabolic alkalosis Metabolic acidosis Respiratory acidosis
Drink at least 8 to 10 large glasses of fluid every day
What information should the nurse include in the teaching plan for a client being treated for diverticulosis? Avoid unprocessed bran in the diet Avoid daily exercise; indulge only in mild activity Drink at least 8 to 10 large glasses of fluid every day Use laxatives or enemas at least once a week
Deficient fluid volume
What is the primary nursing diagnosis for a client with a bowel obstruction? Deficient fluid volume Deficient knowledge Acute pain Ineffective tissue perfusion
Rovsing sign manipulated by the examiner.
When an examiner deeply palpates the left lower abdominal quadrant and the client feels pain in the right lower quadrant, this is referred to as a positive Rovsing sign and suggests acute appendicitis. Rebound pain is indicated when the pain of palpation is worse when the pressure is off of the site. The cremasteric reflex is a superficial reflex that is present in male clients.
Rectal bleeding
When interviewing a client with internal hemorrhoids, what would the nurse expect the client to report? Rectal bleeding Pain Itching Soreness
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
When preparing a client for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. The appendix may develop gangrene and rupture, especially in a middle-aged client. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
Board-like abdomen
Which of the following would a nurse expect to assess in a client with peritonitis? Deep slow respirations Decreased pulse rate Hyperactive bowel sounds Board-like abdomen
Colorectal cancer is the third most common site of cancer in the United States.
Which statement provides accurate information regarding cancer of the colon and rectum? Colorectal cancer is the third most common site of cancer in the United States. Rectal cancer affects more than twice as many people as colon cancer. The incidence of colon and rectal cancer decreases with age. Colon cancer has no hereditary component.
"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread."
Which statement provides accurate information regarding cancer of the colon and rectum? The incidence of colon and rectal cancer decreases with age. Colon cancer has no hereditary component. Colorectal cancer is the third most common site of cancer in the United States. Rectal cancer affects more than twice as many people as colon cancer.
Examples of luminal problems causing malabsorption include bile acid deficiency:
Zollinger-Ellison syndrome, and pancreatic insufficiency.
small-bowel obstruction can't tolerate oral intake:
a fluid volume deficit may occur and can be life-threatening. Therefore, maintaining fluid balance is the primary goal. Pain relief and maintaining body weight don't reflect life-threatening conditions, and the client's normal bowel pattern can be reestablished after fluid volume is stabilized.
Patients with IBD
also have a significantly increased risk of osteoporotic fractures due to decreased bone mineral.
Fissures
are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation).
Fissures
are usually caused by the trauma of passing a large, firm stool or from persistent tightening of the anal canal secondary to stress or anxiety (leading to constipation). A hemorrhoid is a dilated portion of vein in the anal canal.
Peritonitis s/s:
decreases intestinal motility and causes intestinal distention. A classic sign is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (i.e., appendicitis, diverticulitis, ulcerative colitis, a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.
A client with appendicitis is at Risk for
infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Elderly, not middle-aged, clients are especially susceptible to appendix rupture.
An anal fistula
is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus
An anorectal abscess
is an infection in the pararectal spaces.
Borborygmus
is the intestinal rumbling caused by the movement of gas through the intestines that accompanies diarrhea.
In up to 50% of presenting cases of appendicitis
local tenderness is elicited at McBurney's point when pressure is applied (Black & Martin, 2012) (Fig. 48-3). Rebound tenderness (i.e., production or intensification of pain when pressure is released) may be present.
In addition to celiac sprue, regional enteritis and radiation enteritis are examples of
mucosal disorders.
The older client taking digitalis
must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.
Azotorrhea
refers to excess of nitrogenous matter in the feces or urine.
Tenesmus
refers to ineffectual straining at stool.
Diverticulitis
refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.
Vomiting
results in loss of hydrochloric acid (HCl) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis.
Examples of infectious diseases causing generalized malabsorption include
small-bowel bacterial overgrowth, tropical sprue, and Whipple disease.
irrigating a colostomy,
the nurse should allow tepid fluid to enter the colon slowly. If cramping occurs, the nurse should clamp off the tubing and allow the patient to rest before progressing. Water should flow in over a 5- to 10-minute period.
After applying the ostomy appliance
the nurse should ask the client to remain inactive for 5 minutes to allow body heat to strengthen the adhesive bond. The adhesive faceplate should be pressed from the stomal edge outward to prevent the formation of wrinkles. A small amount of air should also be allowed to be trapped in the pouch; liquid feces will then drain to the bottom of the pouch, placing less tension on it.
After applying the ostomy appliance,
the nurse should ask the client to remain inactive for 5 minutes to allow body heat to strengthen the adhesive bond. The adhesive faceplate should be pressed from the stomal edge outward to prevent the formation of wrinkles. A small amount of air should also be allowed to be trapped in the pouch; liquid feces will then drain to the bottom of the pouch, placing less tension on it.
An anal fistula is a
tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus.
instruct a client with diverticulosis
to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.