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Gastrointestinal 3
- Diverticular disease - outpouching of the intestinal mucosa
- Definition/etiology
- most common in sigmoid colon
- constipation, low fiber diet, obesity
- colon wall thickens with increased pressure in bowel
- stool and bacteria retained in diverticulum become inflamed and small perforations occur
- inflammation of surrounding tissue
- Findings
- frequently asymptomatic
- crampy, lower, left abdominal pain
- alternating constipation and diarrhea
- low grade fever, chills, anorexia, nausea
- leukocytosis
- Diagnosis
- barium enema
- complete blood count, urinalysis, stool for occult blood
- colonoscopy
- Management
- diverticulosis (outpouching)
- high fiber diet
- bulk laxatives
- stool softeners
- anticholinergics
- diverticulitis (inflammation)
- NPO
- rest bowel
- antibiotics
- surgery
- bowel resection
- temporary colostomy
- Complications
- abscess formation
- perforation with peritonitis
- fistula
- bowel obstruction
- Nursing interventions
- teach appropriate diet
- avoid straining, coughing, lifting
- avoid increased abdominal pressure
- Constipation
- Definition/etiology
- change in normal bowel habits characterized by
- decreased frequency
- stool is hard, dry, difficult to pass
- stool is retained in rectum
- etiology/risk factors
- insufficient dietary fiber
- insufficient fluid intake
- medications, especially opiates
- lack of activity
- ignoring urge to defecate
- chronic laxative abuse
- lack of privacy/psychological factors
- pregnancy
- neuromuscular impairment
- hypothyroidism
- Findings
- hard, dry stool
- abdominal distention
- decreased frequency of usual patterns
- straining
- nausea/anorexia
- palpable mass
- hemorrhoids
- fecal impactionwith diarrhea
- Complications
- obstruction/perforation
- cardiovascular alterations
- Management
- cathartics
- saline laxatives - milk of magnesia
- stimulant laxatives - bisacodyl (Dulcolax)
- bulk-forming laxatives - psyllium (Metamucil)
- lubricant-emollient - mineral oil
- stool softeners - docusate sodium (Colace)
- enemas
- cleansing - saline, soap solution
- softening - oil retention
- Nursing interventions
- teach nutrition, increased fiber, and increased fluids
- teach: obey urge to defecate
- provide privacy and comfort
- increase activit
- Diarrhea
- Definition/etiology - loose stools due to
- fecal impaction
- ulcerative colitis
- intestinal infections
- increased fiber
- medications
- Finding - loose watery stools
- Complications - dehydration, electrolyte imbalance
- Management
- mild diarrhea - oral fluids to replace lost fluid
- moderate diarrhea - drugs that decrease motility (Lomotil, Imodium)
- severe diarrhea - due to infection, antimicrobials and fluid replacement
- Nursing interventions
- monitor for fluid and electrolyte imbalance
- prevent skin excoriation
- teach client about foods that may affect bowel elimination, e.g., fruits, vegetables
- Bowel obstruction
- Definition/etiology
- mechanical: adhesions, hernias, neoplasms, volvulus, intussusception
- nonmechanical: paralytic ileus, occlusion of vascular supply
- distended abdomen from accumulation of fluid, gas, intestinal contents
- fluid shifts due to increased venous pressure with hypotension and hypovolemic shock
- bacteria proliferate
- Findings
- abdominal pain
- distention (more with large bowel obstruction)
- nausea/vomiting (more with small bowel obstruction)
- hypoxia
- metabolic acidosis
- bowel necrosis from impaired circulation
- Complications
- perforation and peritonitis
- shock
- strangulationof bowel
- Diagnosis
- upper-GI and lower-GI series
- abdominal X rays show air in bowel
- low fluid volume increases white blood cells, hemoglobin & hematocrit, BUN
- Management
- decompress the abdomen
- nasointestinal tube
- surgical bowel resection
- Nursing interventions
- manage pain, but avoid morphine or codeine, which slow bowel motion
- measure abdominal girth
- with nasogastric or nasointestinal tubes, provide oral care
- nasogastric tubes: Salem sump (double lumen), Levin (single lumen)
- nasointestinal tubes
- cantor tube - single lumen, mercury filled weight on tip
- miller-Abbott - double lumen with mercury weighted tip
- advance two inches per hour
- maintain fluid and electrolyte balance
- Colon cancer
- Definition/etiology
- may develop from adenomatous polyps
- risk factors - low residue diet, high-fat diet, refined foods
- Pathophysiology
- adenocarcinoma is the most common type
- most common locations are sigmoid rectum and ascending colon
- often metastasizes to the liver
- classification (staging) systems: TNM or Duke's
- Findings
- rectal bleeding
- change in bowel habits - constipation, diarrhea
- change in shape of stool
- anorexia and weight loss
- abdominal pain, palpable mass
- Diagnostics
- colonoscopy
- sigmoidoscopy
- digital examination
- stool for occult blood
- barium enema
- CT scan
- carcinoembryonic antigen (CEA)
- alkaline phosphataseand AST(aspartate aminotransferase)
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