Chapter 24 intestinal and rectal disorders

Which of the following health problems may potentially have an etiology that results from the patient's preexisting malabsorption problem? A. Type 1 Diabetes B. Colon Cancer C. Osteoporosis D. Stroke

C. Osteoporosis

A patient has a bowel perforation from a recent surgery and has now been diagnosed with peritonitis. He has hypoactive bowel sounds, a temp of 100.5F, and an elevated WBC. To which of the following should the nurse be alert as the most serious potential complication of peritonitis? A. Nausea B. Diarrhea C. Sepsis D. Abdominal Tenderness

C. Sepsis

Colorectal Cancer Management

Chemotherapy, Radiation Therapy and immunotherapy

What symptoms may be suggestive of intestinal obstruction in a patient with an ileostomy? A. Continuous flow of liquid stools and belching B. Hypervolemia and hyperkalemia C. Muscle spasms and numbness of the extremities D. Nausea and abdominal distention

D. Nausea and abdominal distention

Peritonitis Manifestations

"acute abdomen", rebound tenderness, elevated white count, air fluid levels on abd x-ray means a perforation

Diseases of the anorectal

-Anal fistulas usually from an infection the pt has and fissures -Hemorrhoids: increase fluids and fiber and don't strain, sitz bath (like a baday helps smooth and soothe pain) -Sexually transmitted anorectal diseases -Pilonidal Cysts: @ bottom of sacrum most of the time congenital folding of epithelial tissue and it can become infected and needs to be drained

Acute Inflammatory Conditions

-Appendicitis (age 10-30) -Diverticular Disease -Peritonitis -Inflammatory Bowel Disease: Crohn's and Ulcerative colitis

diarrhea management

-Control symptoms -Prevent complications: dehydration and skin breakdown -Treat underlying cause (antibiotics, c diff) -Assess and monitor character and amount of stool (strict I&O) BUN and creatinine -Monitor electrolytes (K+ worried about cardiac)

Constipation Treatment

-Education ( especially in the elderly: laxative abuse rebound effect is constipation, want them to take Colace which is a stool softener and they can get OTC and wont have rebound) -Increase fiber and fluid -Bowel retraining: try to toilet them every 2 hrs to try and retrain -exercise

Constipation Complications

-Hypertension -Fecal impaction -Hemorrhoids -Fissures: anal laceration in the anus and takes a long time to heal so try to prevent -Megacolon: colon gets larger and larger and gets more difficult to evacuated the contents -Valsalva maneuver: stimulate the parasympathetic by bearing down and causes cardiac issues

examples of each type of malabsorption

-mucosal: celiac -infectious: bacterial -luminal disorders: pancreatic tumor that increases acid production (Zollinger-Ellison Syndrome (ZES) -Post op malabsorption: roux-en-y -Disorders specific to nutrient: lactose intolerant

Colorectal Cancer

150,000 diagnosed each year 2nd most common cancer death among men 40-79 Early diagnosis is key to survival 95% adenocarcinoma, May start as a benign polyp, Increase in western cultures and with family hx need colonoscopy early, Alc and smoking diet high in fat and lower fiber, Exercise needed Screening age 50 colonoscopy

Diverticulosis:

A condition in which small, bulging pouches develop in the digestive tract, have the indentation looks like divots in the colon, you can see this by colonoscopy prevent inflammation increase the fiber prevent constipation 50% of Americans over the age of 80 have diverticulosis

Diverticulitis Complications

Abscess Rupture leading to peritonitis

Ulcerative Colitis:

Affects the superficial mucosa of the colon only resulting in ulcerations, Bleeding from the ulcerations occurs, Begins in the rectum and progresses through entire colon

Constipation

An abnormal infrequency or irregularity of defecation, an interference with: Mucosal transport: facilitates the movement of particles or content Myoelectric activity Process of defecation

Diarrhea

An increased frequency of bowel movements of more than 3 a day, an increased amount of stool or abnormally liquid stool

A patient is complaining of right lower quadrant pain, fever, and decreased appetite. The nurse knows that which of the following is the most likely cause? A. Diverticulitis B. Appendicitis C. Small Bowel Obstruction D. Sigmoid Colon Cancer

B. Appendicitis

A patient complains of abdominal pain that typically occurs after meals along with diarrhea that is unrelieved by defecation. The nurse recognizes that which of the following is the most likely diagnosis? A. Ulcerative Colitis B. Regional Enteritis (Chron's disease) C. Cholecystitis D. Diverticulosis

B. Regional Enteritis (Chron's disease)

Diverticulitis Clinical Manifestations

Bowel irregularity: diarrhea then constipation Cramps, narrow stools Mild to severe pain in lower left quadrant Nausea, vomiting

Fecal Incontinence Priorities for Nursing Care:

Bowel retraining Meticulous skin care

A patient returns to his room following a diagnostic colonoscopy after radiologic evidence of diverticulosis. He reports an increase in abdominal pain, fever, and chills. Which clinical condition is most concerning to the nurse? A. Colon Cancer B. Hemorrhoids C. Bowel Perforation D. Anal fissure

C. Bowel Perforation

A patient complains of abdominal pain and distention, fever, tachycardia and diaphoresis. An abd x-ray shows free air under the diaphragm. The emergency department nurse should suspect which condition? A. Intestinal Obstruction B. Malabsorption C. Intestinal Perforation D. Acute Cholelithiasis

C. Intestinal Perforation

Colorectal Cancer Nursing Management

Prepare the patient for surgery Provide emotional support Maintaining nutrition Wound care: essential especially if the it's an ap resection Monitoring and managing complications: look for bowel obstruction Supporting a positive body image

Crohn's Disease Clinical Manifestations

Prominent right lower quadrant pain unrelieved by defecation, Weight loss (eating less because it hurts and they get diarrhea), malnutrition and secondary anemia, ulcerations in the intestine, Steatorrhea= fatty stools clear indication of malabsorption, Abscesses pus filled area, fistulas connects 2 areas that shouldn't be connected, and fissures

Inflammatory Bowel Disease Nursing Management

Reduce inflammation Suppress inappropriate immune responses Bowel Rest to allow for healing to take place Improving quality of life

Irritable Bowel Syndrome (IBS) Management

Relieve abdominal pain Control diarrhea or constipation Reduce stress Anti depressants

Appendicitis Manifestations

Vague epigastric pain progressing to r. lower quadrant Low grade fever Nausea vomiting Elevated white count with elevation of neutrophils

A patient is being seen in the health clinic for Crohn's disease. The nurse is completing the initial assessment. a. What symptoms would the nurse expect the patient to verbalize b. To what complications should the nurse be alert?

a. Right lower quad abdominal pain not relieved by defecation, have diarrhea, weight loss, malnutrition b. Stricture, obstruction, fluid and electrolyte imbalance, fatty diarrhea, fistula or abscess

Cancer of the colon and rectum is predominantly __________.

adenocarcinoma

Diverticulitis If they need surgery:

assessment no colonoscopy, laparotomy used, Hartman's procedure temporary colostomy to let the bowel to heal You want to prevent diverticulitis from happening

Both Crohn's Disease and Ulcerative Colitis exclusively affect the colon and rectum t/f?

false

The first line of intervention for a patient who is experiencing constipation should be a stimulant laxative. True False

false

Loose, semisolid stools are associated with disorders of the small bowel. T/f?

false, large bowel

Acute appendicitis is common in the elderly population. T/f?

false, uncommon

Diverticulitis

food and bacteria retained in a diverticulum produce infection and inflammation, don't want to colonoscopy for this one, dx by ct scan, left lower abdominal pain

Peritonitis

if any of the contents from the bowel enter the peritoneal, Usually bacterial and life threatening

IBS results from a functional disorder of __________ motility.

intestinal

types of malabsorption (5)

mucosal, infectious, luminal, post op,and disorders specific to a nutrient

__________ is caused by leakage of contents from abdominal organs into the abdominal cavity.

peritonitis

kock pouch

pt doesn't need appliance, uses a catheter into one way valve to drain, has problems with one way valve.

Malabsorption

Inability of the digestive system to absorb one or more of the major vitamins (Vit A, b-12, calcium) minerals and nutrients

Crohn's Disease Complications

Intestinal obstruction, Fluid and electrolyte imbalance, Stricture formation: tightening or narrowing that feels like a band and it needs to be released with a stint , fistulas, malnutrition, adhesions, and Increased risk for colon cancer

Fecal Incontinence

Involuntary passage of stool from the rectum 10% of adults have this Identification of the underlying cause is vital Can be due to a fecal impaction

Ulcerative Colitis manifestations

Lower left abdominal pain, Diarrhea usually blood, Rectal bleeding, Pallor, anemia and fatigue, most likely need blood transfusion, 10-20 liquid stools a day, IV therapy, NPO (needed) , Whole colon removed if they are not responding to treatment within 72 hours

Peritonitis Management and Complications

Management: Surgery (emergency) need to have the peritoneal cavity flushed out, fluid replacement, analgesics, antibiotics, intensive nursing care Complications: Sepsis, wound infection, dehiscence

Intestinal Obstruction

May occur in the small bowel or the large bowel SBO - more rapid onset and treated with nasogastric decompression always since we don't want them to aspirate Large Bowel Obstruction - more gradual onset and may require a colostomy

Constipation risk factors

Medication (opioids narcotics, some HTN and antidepressants and anti cholengereics) , disease, age, low fiber intake, low fluid intake, low physical activity

Irritable Bowel Syndrome (IBS)

Most common GI problem Can be heredity, diet high in fat or irritating foods, alc, smoking, stress, depression, anxiety, more common in women A change in motility Neuroendocrine dysregulation Infection or irritation Vascular or metabolic disturbance, Alteration in bowel patterns

Diverticulitis In acute episodes:

NPO or clear liquids for a bit No NSAIDS, take Tylenol instead IV NGT: incase they are nauseous or vomiting to prevent aspiration Analgesics Antispasmodics

Inflammatory Bowel Disease Interventions

Dietary modifications: Eat regular meals high in calories and low in residue (low fiber) Medication administration( may be put on corticosteroids for decreasing the inflammation) Post surgical care: take colon out, ileostomy for life this is last resort

Colorectal Cancer Manifestations

Fatigue and weight loss (usually indicative of cancer) Minor changes in bowel patterns Occasional bleeding Dull abdominal pain Melena: bloody stools

Colorectal Cancer Diagnostic Procedures

Fecal occult blood test Colonoscopy Blood work for cancer markers

Diverticulitis Management

High fiber, fluids Usually treated on outpatient basis

Malabsorption Risk factors, Manifestations, and Management

Risk factors: Predisposition Manifestations: Diarrhea, Frequent loose, bulky foul smelling stool, Greasy stools with fat, voluminous and liquidy Management: Avoid dietary substances that aggravate, Supplement nutrients that are lost

Diverticular Disease

Sac like herniation of the lining of the bowel. Can occur anywhere in the bowel but most common in the sigmoid colon

general bowel surgeries

Segmental Resection A P Resection If the cancer is in the rectum take out rectum and close up anus and get colostomy and ileostomy, almost always ends up in a wound healing by 2nd intention Temporary colostomy Permanent colostomy Colonic J pouch

Ileostomy Nursing Management

Skin care Education for device management Nutritional promotion: low residue diet, strained fruits and veggies, avoid fiber Prevention of complications: usually skin and stoma issues, body issues, nutritional issues, are they capable of taking care of the stoma Facilitation of coping

Crohn's Disease

Subacute and chronic inflammation of GI tract wall that extends through all layers of the intestine, lumen gets narrower, as it continues bowel loop and stick together and develop adhesions Most commonly occurs in the distal ileum and is dx in adolescence they will have periods of remission and exacerbation, Ulcerations in bowel take on the appearance of cobblestones

Appendicitis Management

Surgery: appendectomy, and Prevention of peritonitis

Ileostomy

Surgical creation of an opening through skin into the ileum or small intestine.( no colon) everything that comes out is liquid since absorption is not happening here Usually performed after a total colectomy Multiple types

Appendicitis

The appendix which is attached to the illocecal valve, becomes inflamed and edematous as a result of becoming kinked or occluded, Common in ages 10-30

Goal for appliance (ileostomy):

sealed well on skin and the hole then pt cuts is right on stoma so nothing goes on skin, need good skin prep soap and water dry and apply skin prep, the longer you can keep the appliance on its better for the pt to preserve skin.

Most bowel obstructions occur in the __________ ___________.

small intestine

Brand new colostomy or ileostomy:

stoma if its purple its bad needs to be pink and rose like, not uncommon to have some blood.

__________ is the primary treatment for most colon and rectal cancers.

surgery

Continence is maintained by tonic contractions of the muscles around the rectum. T/f?

true

Excess fat, high alcohol consumption, and smoking all increase the incidence of colorectal tumors. T/f?

true

The patient with a traditional ileostomy cannot establish regular bowel habits because the contents of the ileum are fluid and are discharged continuously. T/f?

true