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