RN 41 Med Surg Unit 3 Ch 43
• Constipation is
a decrease in the frequency of bowel movements from what is "normal" for the individual; hard, difficult-to-pass stools; a decrease in stool volume; and/or retention of feces in the rectum.
diverticulosis • Patient and caregiver teaching
a high-fiber diet, mainly from fruits and vegetables, and decreased intake of fat and red meat are recommended for preventing exacerbations of diverticular disease.
diarrhea • Accurate diagnosis and management require
a thorough history, physical examination, and laboratory testing. Treatment depends on the cause
o Five major classes of medications are used to treat IBD
aminosalicylates, antimicrobials, corticosteroids, immunosuppressants, and biologic and targeted therapy.
IBD is characterized by
an overactive, inappropriate, sustained immune response to substances that are normally tolerated
• Diverticula
are saccular dilations or outpouchings of the mucosa that develop in the colon
diarrhea overall goals
are that the patient with diarrhea will have (1) no transmission of the microorganism causing the infectious diarrhea, (2) cessation of diarrhea and resumption of normal bowel patterns, (3) normal fluid and electrolyte and acid-base balance, (4) normal nutritional status, and (5) no perianal skin breakdown.
• Causes of malabsorption include
biochemical or enzyme deficiencies, bacterial proliferation, disruption of small intestine mucosa, disturbed lymphatic and vascular circulation, and short bowel syndrome
• Treatment goals for IBD include
bowel rest, control of inflammation and infection, improved nutrition, alleviation of stress, symptomatic relief, and improved quality of life
• Crohn's disease
can occur anywhere in the GI tract from the mouth to the anus but occurs most commonly in the terminal ileum and colon. The inflammation involves all layers of the bowel wall with segments of normal bowel occurring between diseased portions—the so-called skip lesions.
Irritable bowel syndrome (IBS) define?
chronic functional disorder characterized by intermittent and recurrent abdominal pain or discomfort and stool pattern irregularities (diarrhea, constipation, or both).
• All cases of acute diarrhea should be
considered infectious until the cause is known. Strict infection control precautions are necessary
Crohn's disease symptoms
diarrhea and colicky abdominal pain are common symptoms. If the small intestine is involved, weight loss and nutritional problems are common because of malabsorption. Patients may have systemic symptoms such as fever.
• SBS is treated with
dietary changes, supplements, and antidiarrheal medications. • In severe cases, patients need parenteral nutrition for survival or a small intestine organ transplant.
• Diarrhea can result
from alterations in gastrointestinal motility, increased secretion, and decreased absorption.
• There are numerous causes of constipation. Clinical presentation varies
from chronic discomfort to an acute event, often depending on cause.
• Malabsorption results
from impaired absorption of fats, carbohydrates, proteins, minerals, and vitamins.
• During an acute exacerbation of IBD, nursing care is focused on
hemodynamic stability, pain control, fluid and electrolyte balance, and nutritional support.
• Types of hernias include
inguinal, femoral, and ventral or incisional. Diagnosis is based on the history and physical examination relative to the type of hernia.
• Short bowel syndrome (SBS) results from
surgical resection of too much small bowel, congenital defect, or disease-related loss of absorption. The length and portions of small bowel affected are associated with the number and severity of symptoms.
important role for you is to teach the patient about constipation
the importance of dietary and activity measures to prevent constipation.
• SBS is characterized by
the inability to obtain adequate nutrients from a standard diet
• Surgery is
the treatment of choice for hernias
• The cause of diverticuli is? symptoms?
unknown. The majority of patients with diverticular disease are asymptomatic. Those with symptoms typically have abdominal pain, bloating, flatulence, and/or changes in bowel habits
• If the hernia becomes strangulated, the patient
will experience severe pain and symptoms of a bowel obstruction, such as vomiting, cramping abdominal pain, and distention
• The overall goals are that the patient with constipation
will increase dietary intake of fiber and fluids; increase physical activity; have the passage of soft, formed stools; and not have any complications, such as bleeding hemorrhoids.
o Ulcerative colitis can be cured
with a total colectomy, since the colon and rectum are not necessary for survival. Surgery is a last resort for Crohn's disease because of high recurrence rates and the risk for developing short bowel syndrome
Clinical manifestations of UC and Crohn's disease include
Bloody diarrhea cramping abdominal pain and nutritional disorders
Pre-op preparation for bowel surgery includes
Bowel cleansing with antibiotics and or cleansing enemas
Diarrhea: Patients receiving antibiotics are susceptible to
Clostridium difficile (C. difficile), which is a serious bacterial infection.
Colorectal polyps places to patient at risk for
Colorectal cancer the tissue candy generate over time and become malignant
inflammatory bowel disease (IBD) related disorders
Crohn's disease and ulcerative colitis are immunologically related disorders
Nasal gastric NG tube is used to
Decompress the stomach by draining stomach contents and thereby prevent vomiting
NG tube should be checked for patency
Every 4 hours
Saline and osmotic solution causes
Fluid retention in the intestinal tract
Diet for diverticular disease
High fiber diet includes dried beans all brand 100% cereal and raspberries
Highest priority teaching for pre-op patient
How to deep breathe and cough because patient can develop atelectasis and pneumonia which can delay recovery
Bowel sounds in early intestinal obstruction
Hyperactive and high pitch AKA twinkling this occurs because peristaltic action increases to push past the area of obstruction the obstruction becomes complete and balance out the creases and finally become absent
Treat constipation with
Increased fluid intake and a high fiber diet
Bisacodyl Dulcolax And effective in
Is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves Effective in 15 to 60 minutes
Magnesium hydroxide mom
Is an osmotic laxative that produces soft semi solid stool within 15 minutes to 3 hours
Docusate
Lowers the surface tension of stool permitting water and fats to penetrate and soften the stool for easier passage that patient to take this test with a full glass of water
Milk of magnesia in patients with renal insufficiency
May cause hypomagnesemia
Irritable bowel syndrome (IBS) cause and treatment
The cause is unknown and there are no specific findings. Treatment is directed at psychologic and dietary factors as well as medications to regulate output and reduce pain/discomfort.
• A hernia
is a protrusion of a viscus through an abnormal opening or a weakened area in the wall of the cavity in which it is normally contained.
Ulcerative colitis? symptoms? meds?
is confined to the mucosal layer of the rectum and colon, but some patients do have mild inflammation in the terminal ileum. The primary symptoms are bloody diarrhea and abdominal pain. Medications are used to achieve and maintain remission.
Diverticulitis
is inflammation of the diverticula, resulting in complications such as perforation, abscess, fistula formation, and bleeding.
Diarrhea is
is the passage of at least 3 loose or liquid stools per day. It can be acute or chronic.
• Most infectious diarrhea runs
its course and does not require hospitalization.
o Surgery is indicated if the patient with IBD fails to
respond to treatment; exacerbations are frequent and debilitating; massive bleeding, perforation, strictures, and/or obstruction occur; tissue changes suggest that dysplasia is occurring; or carcinoma develops.
