🐣 Med/Surg | Unit 8 - GI 2

Herniation

Bowel herniation is the displacement of the bowel through a weakness of the abdominal muscle into other areas of the abdominal cavity. Incisional hernias can occur as a post-surgical complication due to inadequate healing of the incisional site from malnutrition, infection, or obesity. Risk Factors: - Male sex. (indirect inguinal hernia) - Advanced age. (direct hernia) - Increased intra-abdominal pressure due to pregnancy or obesity. (femoral, adult-acquired umbilical hernia) - Genetics (congenital umbilical hernia) Expected Findings: - Protrusion or lump at involved site. Postoperative Client Education: - Avoid increased intra-abdominal pressure for 2 to 4 weeks. - Apply ice as prescribed, and inspect and report redness or swelling at the injection site. - Increase dietary fiber and fluids.

Colorectal Cancer

Cancer of the small or large intestine can be caused by age-related changes (client who are 50 years or older have an increased risk), genetic influence, or chronic bowel disease, such as Crohn's disease or ulcerative colitis.

Celiac Disease

Celiac disease is also know as gluten-sensitive enteropathy, celiac sprue, and gluten intolerance. It is a chronic, inherited, genetic disorder with autoimmune characteristics. Clients who have celiac disease are unable to digest the protein gluten. They lace the digestive enzyme DPP-IV, which is required to break down the gluten into molecules small enough to be used by the body. Nursing Care: - Monitor for complications including bleeding (bruising) due to inadequate vitamin K intake, manifestations of anemias (iron, folate, vitamin B12), and manifestations of osteoporosis. Client Education: - Eat foods that are gluten-free (milk, cheese, rice, corn, eggs, potatoes, fruits, vegetables, fresh meats and fish, dried beans). - Read labels on processed products. Gravy mixes, sauces, cold cuts, coups, and many other products have gluten as an ingredient.

Diverticular Disease

Diverticulitis is inflammation and infection of the bowel mucosa cause by bacteria, food, or fecal matter trapped in one or more diverticula (pouch-like herniations in the intestinal wall). Diverticula can perforate and cause peritonitis, and/or severe bleeding. Nursing Care: - For severe manifestations (severe pain, high fever), the client is hospitalized, NPO, and receives nasogastric suctioning, IV fluids, IV antibiotics, and opioids analgesics for pain. Client Education: - Consume a clear liquid diet until manifestations subside. - Progress to a low-fiber diet once solid food are tolerated without other manifestations. Slowly advance to a high-fiber diet as tolerated when inflammation resolves.

Ulcerative Colitis (UC)

Edema and inflammation primarily in the rectum and rectosigmoid colon. In severe cases, it can be involve the entire length of the colon. Mucosa and submucosa become hyperemic (increase in blood flow), and the colon will become edeatous and reddened. It can lead to abscess formation. Edema and thickened bowel mucosa can cause partial bowel obstruction. Intestinal mucosa cell changes can lead to colon cancer or insufficient production of intrinsic factor, resulting in insufficient production of intrinsic factor, resulting in insufficient absorption of vitamin B12. Nursing Care: - Monitor by colonoscopy due to the increased risk for colon cancer. - Assist client in identifying foods that trigger manifestations. - Monitor for electrolyte imbalance, especially potassium. Client Education: - Seek emergency care for indications of bowel obstruction or perforation (fever, severe abdominal pain). - Avoid caffeine or alcohol. - Small, frequent meals can reduce the occurrence of manifestations.

Hemorrhoids

Hemorrhoids are distended or edematous intestinal veins resulting from increased intra-abdominal pressure (straining, obesity, prolonged sitting or standing, constipation, weightlifting). Pregnancy increases risk of hemorrhoids.

Irritable Bowel Syndrome (IBS)

IBS is a disorder of the gastrointestinal system that causes changes in bowel function (chronic diarrhea, constipation, bloating, and/or abdominal pain). Risk Factors: - Environmental Factors: dairy products, caffeinated beverages, infections agents. - Immunological factors: cytokine genes, tumor necrosis factor (TNF) alpha. - Stress-related factors: anxiety, depression. - Female sex. - Eating large meals containing a large amount of fat. - Alcohol intake. Expected Findings: - Cramping pain in abdomen. - Abdominal pain (left lower quadrant) due to changes in bowel pattern and consistency. - Nausea with meals or passing stool. - Anorexia. - Diarrhea. - Constipation.

Crohn's Disease

Inflammation and ulceration of the gastrointestinal tract, often at the distal ileum. All bowel layers can become involved; lesions are sporadic; fistulas are common. Can involve the entire GI tract from the mouth to the anus. Nursing Care: - Monitor by colonoscopy due to the increased risk for colon cancer. - Assist client in identifying foods that trigger manifestations. - Monitor for electrolyte imbalance, especially potassium. Client Education: - Seek emergency care for indications of bowel obstruction or perforation (fever, severe abdominal pain). - Avoid caffeine or alcohol. - Small, frequent meals can reduce the occurrence of manifestations.

Appendicitis

Inflammation of the appendix. Caused by an obstruction of the lumen or opening of appendix. Fecaliths, or hard pieces of stool, can be the initial cause of the obstruction.

Peritonitis

Inflammation of the peritoneum results from infection of the peritoneum due to puncture (surgery or trauma), rupture of part of the gastrointestinal tract (diverticulitis, peptic ulcer disease, appendicitis, bowel obstruction), or infection from continuous ambulatory peritoneal dialysis.

Gastroenteritis

Inflammation of the stomach and small intestine. Triggered by infection (either bacterial or viral). Vomiting and frequent, watery stools place the client at increased risk for fluid or electrolyte imbalance and impaired nutrition.

Intestinal Obstruction

Mechanical obstruction occurs when the bowel is blocked by something outside or inside the intestines. (adhesions, fecal impaction) Complete mechanical obstructions should be addressed surgically. Nursing Care: - Prepare for surgery and provide preoperative nursing care. - Withhold intake until peristalsis resumes. Non-mechanical obstructions are caused by diminished peristalsis within the bowel. (paralytic ileus) This can occur postoperatively due to the handling of the intestines during surgery. Nursing Care: - Nothing by mouth with bowel rest. - Assess bowel sounds. - Administer IV fluid and electrolyte replacement (particularly potassium). - Manage pain and encourage ambulation. - Place in semi-Fowler's position. Diagnostic Procedures for Both: - X-Ray: Flat plate and upright abdominal x-rays evaluate the presence of free air and gas patterns. - Endoscopy: determines the cause of the obstruction. - CT scan: determines the cause and exact location of the obstruction.

Endoscopy

Proctosigmoiydoscopy: Performed to identify inflamed tissue. Colonoscopy and sigmoidoscopy: A lighted, flexible scope inserted into the rectum to visualize the rectum and large intestine. Newer diagnostic tools used, such as video capsule endoscopy.

Parasitic Infection

Usually obtained oral-fecal (water contamination can be a problem). Giardia, Amebiasis, Cryptosporidium (dx through stool analysis). Client Education: ◦ Handwashing to prevent spread. Wash hands after toileting with antibacterial soap. ◦ Avoid contact with stool, and avoid sexual practices that allow rectal contact. ◦ Keep the toilet area clean ◦ Bath or shower daily Labs: Watch for elevated eosinophils on CBC Diff.