CP 43 Lower Gastrointestinal Problems Key Points

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What is Diarrhea?

Most commonly defined as an increase in stool frequently or volume and an increase in the looseness of stool.

What can Diarrhea result from?

Alterations in gastrointestinal motility, increased secretion and decreased absorption.

What should all cases of acute diarrhea be considered?

Infectious until the cause is known, strict infection control precautions are necessary.

What are patients receiving antibiotics susceptible too?

CLostridium difficile (C. difficile).

What does accurate diagnosis and management of diarrhea require?

A thorough history, physical examination and laboratory testing.

What does treatment of diarrhea depend on?

The cause.

What is the goal for the patient with diarrhea?

Patient will have no transmission of the MO causing the infectious diarrhea, cessation of diarrhea and resumption of normal bowel patterns, normal fluid and electrolyte and acid-base balance, normal nutritional status, and no perianal skin break down.

What is Fecal Incontinence?

The involuntary passage of stool, occurs when the normal structures that maintain continence are disrupted.

What are risk factors for Fecal Incontinence?

Constipation, diarrhea, obstetrical trauma, and fecal impaction.

What is the prevention and treatment for Fecal Incontinence?

Managed by implementing a bowel training program.

What is Constipation?

Defined as 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.

What is the overall goal of the patient with constipation?

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.

What is important with teaching a patient with constipation?

Dietary measure to prevent constipation.

What is acute abdominal pain?

A symptom of many different types of tissue injury and can arise from damage to abdominal or pelvis organs and blood vessels.

What is pain an indication of?

A problem.

What can acute abdominal pain manifest with as well?

Nausea, vomiting, diarrhea, fatigue, fever and constipation.

What are expected outcomes for the patient with acute abdominal pain?

Resolution of the cause of the acute abdominal pain; relief of abdominal pain; freedom from complications (especially hypovolemic shock and septicemia); and normal fluid, electrolyte and nutritional status.

What do bowel sounds that are diminished or absent indicate?

A complete bowel obstruction, acute peritonitis, or paralytic ileus.

What are causes of Chronic Abdominal Pain?

IBS, diverticulitis, PUD, chronic pancreatitis, hepatitis, cholecystitis, PID, and vascular insufficiency.

What is treatment for chronic abdominal pain?

Comprehensive and directed toward palliation of symptoms using nonopiod analgesics and antiemetics, as well as psychologic or behavioral therapies.

What is IBS?

A chronic functional disorder characterized by intermittent and recurrent abdominal pain and stool pattern irregularities (Diarrhea, constipation, or both).

What is treatment for IBS?

Psychologic and dietary factors as well as medications to regulate output.

When does blunt abdominal trauma commonly occur?

With motor vehicle accidents, and falls and may not be obvious because it does not leave an open wound.

What are common injuries of the abdomen?

Lacerated liver, ruptured spleen, pancreatic tears, renal injury and stomach or intestine rupture.

What is emergency management for the patient with abdominal traume?

Focus on establishing a patent airway, and adequate breathing, fluid replacement, and prevention of hypovolemic shock.

What is Appendicitis?

Inflammation of the appendix with obstruction resulting in distention, venous engorgement, and the accumulation of mucus and bacteria, which can lead to gangrene and perforation.

What do the symptoms of Appendicitis usually begin as?

Perumbilical pain followed by anorexia, nausea and vomiting. Pain is persistent and continuous, eventually shifting to the right lower quadrant and localizing at McBurneys point.

What is treatment for Appendicitis?

Immediate surgical removal.

What is Peritonitis?

Localized or generalized inflammatory process of the peritoneum.

What is surgical intervention for peritonitis?

Drain purulent fluid and repair damage with antibiotics, ng suction, analgesics and IV fluids.

What is Gastroenteritis?

Inflammation of the mucosa of the stomach and small intestine.

What are clinical manifestations of Gastroenteritis?

Nausea, vomiting, diarrhea, abdominal cramping and distention.

What are the treatments for Gastroenteritis?

Antibiotics and antimicrobial drugs. Nursing care for nausea, vomiting and diarrhea.

What are the two types of Inflammatory Bowel Disease?

Crohns disease and ulcerative colitis.

What is IBD characterized by?

Mild to severe acute exacerbations that occur at unpredictable intervals over many years.

Where does Ulcerative Colitis normally start?

In the rectum and moves in a continual fashion toward the cecum. Disease of the colon and rectum but can sometimes be in terminal ileum.

Where can Crohns disease occur?

Anywhere in the GI tract from the mouth to the anus, but occurs most commonly in the terminal ileum and colon. Inflammation involves all layers of the bowel wall with segments of normal bowel occurring between diseased portions called skip lesions.

What are the primary symptoms of ulcerative colitis?

Bloody diarrhea and abdominal pain.

What are the primary symptoms of Crohns disease?

Diarrhea and colicky abdominal pain.

What are they symptoms of Crohns disease if small intestine is involved?

Weight loss and nutritional problems because of malabsorption. May have systemic symptoms such as fever.

What are the goals of treatment for IBD?

Rest the bowel, control the inflammation, combat infection, correct malnutrition, alleviate stress, provide symptomatic relief and improve quality of life.

What are the five classes of medications used to treat IBD?

Aminosalicylates, antimicrobials, corticosteroids, immunosuppressants, and biologic and targeted therapy.

What is surgery indicated for IBD?

Fail in response to treatment, frequent exacerbations that are debilitating, massive bleeding, perforation, strictures and or obstruction occurs; tissue change dysplasia or carcinoma develops.

What is nursing care during a acute exacerbation of IBD?

Hemodynamic stability, pain control, fluid and electrolyte balance, and nutritional support.

What is the nurses role for patients with chronic IBD?

Learn stategies to cope with it recurrent and unpredictable nature.

What are the types of Intestinal Obstruction?

Mechanial or nonmechanical, partial or complete.

What is a mechanical obstruction?

Detectable occlusion of the intestinal lumen, most occur in small intestine.

What is a nonmechanical obstruction?

May result from neuromuscular or vascular disorder. Due to inference in the blood supply to the intestine.

What can retention of fluid in the intestine and peritoneal cavity lead to?

Severe reduction in circulating blood and lead to hypotension and hypovolemic shock.

What are clinical manifestations of intestinal obstruction?

Vary, depending on the location of the obstruction, and include nausea, vomiting, poorly localized abdominal pain, abdominal distention, inability to pass flatus, obstipation, and signs and symptoms of hypovolemia.

When is emergency surgery performed for an intestinal obstruction?

If the bowel is strangulated.

What are nursing diagnosis for Intestinal Obstruction?

Acute pain, deficient fluid volume and imbalanced nutrition.

What are adenomatous polyps?

Characterized by neoplastic changes in the epithelium and are closely linked to colorectal adenocarcinoma.

What is a common hereditary poly disease?

Familial adenomatous polyposis (FAP).

What are the major risk factors of Colorectal cancer?

Age, family or personal history of colorectal cancer, colorectal polyps and IBD. Obesity, smoking, alcohol, and large intake of processed and or red meat.

What are clinical manifestations of Colorectal Cancer?

Nonspecific and differ by the location of the lesion within the colon. Most report hematochezia, melena, abdominal pain and or changes in bowel habits.

What is the gold standard for CRC screening?

Colonoscopy.

At what age should men and women begin screening regularly for CRB?

50.

What does CRC prognosis and treatment correlate with?

Stage of disease.

What are surgical options for CRC?

Abdominal perineal resection.

What are potential complications for abdominal perineal resection?

Delayed wound healing, hemorrhage, persistent and perineal sinus tract, infections and andurinary tract and sexual dysfunctions.

What is chemotherapy used for in regards to CRC and colon resection?

Adjuvant therapy following colon resection and palliative treatment for nonresectable CRB.

What are the goals for the patient with CRC?

Normal bowel elimination patterns, quality of life appropriate to disease progression, relief of pain and feelings of comfort and well-being. Psychologic support is important.

How can bowel surgery effect sexuality?

Can disrupt nerve and vascular supply to the genitals. Radiation therapy, chemo and meds may also alter this.

What is an Ostomy?

Used when the normal elimination route is no longer possible.

What are the two major aspects of nursing care for patient undergoing Ostomy surgery?

Emotional support as the patient copes with a radical change in body image and patient teaching about the many aspects of stoma care and the ostomy.

What are bowel preparations used for Ostomy surgery?

Used to empty the intestines before surgery to decrease the chance of postoperative infection caused by bacteria in the feces.

What is postoperative nursing care for the patient with ostomy surgery?

Assessment of the stoma and provision of an appropriate pouching system that protects the skin and contains drainage and odor.

What should the patient be able to do after an Ostomy Surgery?

Perform a pouch change, provide appropriate skin care, control odor, care for stoma, and identify signs and symptoms of complications.

What are colostomy irrigation's used for?

Stimulate emptying of the colon in order to achieve a regular bowel pattern. If control is achieved, there should be little or no spillage between irrigations.

What should the patient with an ileostomy be observed for?

Signs and symptoms of fluid and electrolyte imbalance, particularly potassium, sodium and fluid deficits.

What are concerns for people with stomas?

Ability to resume sexual activity, altering clothing styles, the effect on daily activities, sleeping while wearing a pouch, passing gas, the presence of odor, cleanliness and deciding when or if not to tell others about the stoma.

What are Diverticular?

Saccular dilations or outpochings of the mucosa that develop in the colon at points where the vasa recta penetrate the circular muscle layer.

What is Diverticulitis?

Inflammation of the diverticular.

What are possible complications of Diverticulitis?

Perforation, abscess, fistula formation, and bleeding.

What are the symptoms of diverticular disease?

Majority asymptomatic. Can have abdominal pain, bloating, flatulance and/or changes in bowel habits.

What is patient and caregiver teaching for Diverticulosis and Diverticulitis?

High fiber diet, mainfly from fruits and vegetables, decreased intake of fat and red meat.

What is a Hernia?

Protusion of a viscus through an abnormal opening or a weakened area in the wall of the cavity in which it is normally contained.

What are different types of hernias?

Inguinal, femoral, and ventral or incisional.

What is the treatment of choice for Hernias?

Srugery.

What happens if the hernia becomes strangulated?

The patient will experience severe pain and symptoms of bowel obstruction such as vomiting, cramping abdominal pain and distention.

What is Malabsorption Syndrome?

Results from impared absorptionof fats, carbs, proteins, minerals and vitamins.

What are causes of Malabsorption?

Biochemical or enzyme deficiencies, bacterial proliferation, disruption of small intestine mucosa, disturbed lymphatic and vascular circulation and surface area loss.

What is Celiac Disease?

An autoimmune disease characterized by damage to the small intestinal mucosa from the ingestion of wheat, barley and rye in genetically susceptible individuals.

What are the three factors that are necessary in the development of Celiac Disease?

Genetic predisposition, gluten indigestion,a nd immune-mediated response.

What are classic signs of celiac disease?

Foul-smelling diarrhea, steatorrhea, flatulence, abdominal distention and symptoms of malnutrition.

What can early diagnosis and treatment of celiac disease prevent?

Complications such as cancer, osteoporosis, and possibly other autoimmune disease.

How is celiac disease treated?

Lifelong avoidance of dietary gluten. Wheat, barley, oats and rye products must be avoided.

What is a Lactase Deficiency?

Lactase enzyme is deficient or absent.

What are symptoms of a Lactase Deficiency?

Bloating, flatulence, cramping abdominal pain, and diarrhea.

What is treatment for a Lactase Deficiency?

Eliminating lactose from the diet by avoiding milk and milk products and/or replacement of lactase.

What is Short Bowel Syndrome?

Results from surgical resection, congential defect or disease related loss of absorption. The length and portion of small bowel effected are associated with the number and severity of symptoms.

What is Short Bowel Syndrome characterized by?

Failure to maintain protein-energy, fluid, electrolyte, and micronutrient balance on a standard diet; may be accompanied by diarrhea.

How is Short Bowel Syndrome Treated?

Dietary changes, supplements and antidiarrheal medications.

What is a Gastrointestinal Tumor?

A rare form of cancer that originates in cells found in the wall of the GI tract.

What is a Hemorrhoid?

Dilated hemorrhoidal veins that may be internal or external.

What are symptoms of a Hemorrhoid?

Bleeding, anal pruitis, prolapse and pain.

When is surgery indicated for Hemorrhoids?

When there is a prolapse or excessive bleeding or pain.

What is nursing management for Hemorrhoids?

Measures to prevent constipation, avoidance of prolonged standing or sitting, proper use of OTC drugs, and the need to seek medical care for severe symptoms of hemorrhoids when necessary.

What is an Anal Fissure?

A skin ulcer or a crack in the lining of the anal wall that is caused by trauma, local infection or inflammation.

What are the major symptoms of an Anal Fissure?

Pain and bleeding.

What is an Anorectal Abscess?

Collection of perianal pus resulting from an infection in the anal glands.

What are the manifestations of an Anorectal Abscess?

Pain and swelling, foul smelling drainage, tenderness and fever.

What is treatment of an Anorectal Abscess?

Drainage of the abscess.

What must a patient with an Anorectal Abscess be taught?

Wound care, sitz baths, and cleansing of the area after bowel movements.

What is an Anal Fistula?

An abnormal tunnel leading from the anus or rectum, often into the vagina or outside skin. Often accompanied by infection and incontinence.

What is a treatment for Anal Fistula?

Closed by surgery or using fibrin glue.

What is a Pilonidal Sinus?

Small tract under the skin between the buttocks in the sacroccygeal area.

What is nursing care for the patient with a Pilnidal Sinus?

Cyst or abscess includes warm, moist heat application when an abscess is present.

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