Adult GI Disorders

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Adult GI Disorders

• Lower GI Disorders

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Appendicitisinflammation of vermiforn appendix
d/t infection

• Assessment
• Progressive, severe, RLQ or periumbilical area
  pain
• Pain localized in RLQ(McBurneys point)
• worse with movement, coughing, sneezing
• anorexia, constipation
• nausea, vomiting
• rebound tenderness
• slight temperature
• moderate leukocytosis

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Nursing Plan of Care

• Assist with diagnostics, ie UA, IVP, Rectal
• NPO, narcotics after cause of pain determined,
  maintain bedrest
• Pre op keep in high fowlers
• NO CATHARTICS or ENEMAS
• Monitor vital signs

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Goals

• Recognize and treat symptoms
• Prevent death from complications
• Re-establish normal bowel function

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Nursing Care Post Op

• Maintain fowlers
• Care of nasogastric tube, suction prn
• Check for return of peristalsis
• May need enema, 3rd-4th day post-op
• Health education (review signs/symptoms)
• Discharge instruction
• monitor incision, watch for infection, return of
  bowel function, return of symptoms

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Hemorrhoids

• Pathophysiology
• congestion of the veins of the hemorrhoidal
  plexus
• leads to varicosities of rectum and anus d.t.
  elevated intra-abd pressure from constipation,
  straining when defecating, pregnancy
• Heredity,obesity,long standing/sitting
  occupations
• also with cirrhosis and portal hypertension

• Assessment Data
• Internal painless, bleeding with defecation
• External apparent outside anal sphincter
• inflammation pain if ruptures w/subsequent
  thrombosis
• itching
• Goal
• alleviate symptoms
• Provide pre/post-op care for hemorrrhoidectomy
• Health education to prevent occurence

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Interventions

• Medical
• analgesic ointmentNupercaine
• ice or warm compresses
• sitz baths
• stool softeners
• local sclerosing may be done, R.N. assists with
  procedure

• Surgical post op
• watch hemorrhage (1st 24 hr and 7-10 days
  post-op)
• promote comfort ice or warm compresses
• watch infection
• bulk laxatives(promote B.M)
• education sitz bath, bulk in diet(to prevent
  constipation) encourage fluid, daily BM, stool
  softeners, laxatives

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Evaluation

• Verbalizes plan for bowel elimination
• Verbalizes signs and symptoms of recurrence
• Verbalizes signs and symptoms of complications,
  i.e.
• bleeding, pain, constipation, etc.
• Recovers without complications from the surgery

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Diverticulosis, Diverticulitis

• Outpouching of mucosa through a weak point in
  muscle layer of bowel wall that
• gets impacted with feces(Diverticulosis) or
• gets inflammed(Diverticulitis)
• Causes are unknown
• Goal relieve pain restore normal bowel function

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Nursing Plan of Care

• Administer medications
• Narcotics (Demerol)
  
  antispasmodics
  , bulk
  laxatives(Metamucil)
  
  antibiotics
• Assess bowel sounds, report changes(increase or
  decrease)
• Observe type, color, frequency of stool
• Intake and output(record)
• Observe for complications
• peritonitis, obstruction, hemorrhage
• Dietary education
• high fiber, bran, lots of fluid(8 glasses per
  day), bulk laxatives

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Evaluation

• Patient establishes regular bowel habits without
  pain
• Patient follows diet principles
• Verbalizes understanding of medications
• Patient verbalizes signs/symptoms of complications

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Ulcerative colitis

• Inflammatory and ulcerative disease of colon
• Superficial ulcers seen in mucosa that
• bleed
• become edematous
• become abscessed causing reduced absorbive
  surface of the bowel
• Cause unknown(auto-immune)
• May be seen more with certain personalities
• Independent exterior but dependent interior
• Structured persons who tend to be perfectionistic

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Ulcerative colitis

• Assessment(Physical)
• frequent diarrhea
• stool with mucus, blood, pus
• colicky abdominal cramps, distention
• low grade fever
• fluid and electrolyte imbalance
• wt loss, anorexia
• weakness cachexia

• Psychosocial/Cultural
• Occurs most often in
• Adolescents Young adults
  Jewish descent
• causes depression, anger, frustration
• stress may cause exacerbation

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Goals

• Restore nutrition/ FE balance
• Combat infection
• Promote comfort
• Decrease bowel motility
• Assist patient to cope with
• Alteration in body image
• Psychological problems

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Nursing Plan of Care

• Antibiotics to prevent or treat secondary
  infections
• ACTH or adrenal steroids(decrease inflammation)
• Bedrest, as needed
• Sitz bath, prn
• Lomotil to decrease GI motility
• Emotional support
• Protect perineum, buttock and anal area
• Wash
• Lubricants to prevent skin breakdown
• Ointments to relieve discomfort

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Nursing Care continued...

• Weight, q.d.
• Assess nutritional status (anemia, vitamin K
  deficiency, dehydration)
• High protein, high calorie diet, TPN
• Record type, amount, character of stools
• Education if surgery indicated

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Ileostomy

• Pre op
• prepare for bowel surgery
• no enemas
• watch fluid and electrolyte status

• Post Op
• care of skin and stoma
• observe for peritonitis
• maintain high protein, high calorie, high
  vitamins
• Teaching rehabilitation principles
• Referrals(to community health nurse)
• discharge planning(social worker for financial,
  etc.)

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Evaluation

• Patient has less diarrhea and is able to control
  or manage
• other signs and symptoms
• Patient maintains their nutritional status
• Patient verbalizes knowledge of the disease
• Patient follows up on their outpatient
  appointments

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Regional enteritis (Crohns Disease)

• Chronic inflammatory disease of small intestine
  affecting the terminal ileum.
• Results in chronic diarrhea
• Causes are unknown

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Crohns

• Physical
• crampy pain after meals
• chronic diarrhea, melena
• low grade fever
• abd tenderness
• lymphadenitis
• UGIgt string sign present, suggests a constriction
  of a segment of intestine

• Psychosocial
• more common in Jews of European ancestry
• familial tendency
• Age, 15 - 35 years
• Goals
• promote comfort
• adequate hydration and nutrition

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Nursing Plan of Care

• Diet low in residue, roughage and fat, high in
  calories, protein, vitamins
• Rest periods
• Antimicrobials to control inflammation
• Assess F E status
• May need colon resection
• Evaluation
• maintains F E status
  , free of symptoms
  understands diet

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Intestinal Obstruction

• Blockage of intestinal tract that inhibits
  passage of fluid, gas, feces
• Caused by
• mechanical obstruction (strangulated hernia,
  adhesion, cancer, volvulus, intussusception)
• neurogenic obstruction (paralytic ileus, uremia,
  electrolyte imbalance(low K), spinal cord lesion)
• Vascular disease (occlusion of superior mesentery
  vessels)

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Intestinal Obstruction

• Physical
• loud frequent bowel sounds above obstruction
• intermittent cramping pain
• vomiting (fecal)
• distention, no stool or gas passage
• severe F E imbalance
• shock

• Goal
• relieve discomfort
• return of normal bowel peristalsis and function

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Nursing Plan of Care

• Administer intravenous fluid, electrolytes
• Administer pain medication (avoid morphine d/t
  effect on respiratory system)
• Maintain intestinal decompression using a Miller
  Abbott tube, (see nursing care in textbook)
• Skin/mouth care
• Watch respiration's, abd. distension may cause
  resp. distress, V.S.
• Check abdomen q2h for changes(distension,
  rigidity, or pain)

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Nursing Care cont..

• Assess for return of peristalsis
• listen for bowel sounds, check abdominal girth,
  passage of stool
• If no resolution, may need surgery
• Maintain diet according to disease that caused
  problem
• Teach good bowel habits
• avoid harsh laxatives
  drink fluid
  
  stool softeners
  , regular exercise

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Evaluation

• Patient remains free of pain
• Patient experiences normal bowel elimination
• Patient normalizes their fluid and electrolyte
  balance
• Patient verbalizes correctly diet changes