Chapter 060

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  • Chapter 060

    1. 1. Interventions for Clients with Noninflammatory Intestinal Disorders Chapter 60
    2. 2. Irritable Bowel Syndrome (IBS) <ul><li>IBS is a chronic gastrointestinal disorder characterized by chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating. </li></ul><ul><li>Manning criteria are present: </li></ul><ul><ul><li>Abdominal pain relieved by defecation </li></ul></ul><ul><ul><li>Abdominal distention </li></ul></ul><ul><ul><li>(Continued) </li></ul></ul>
    3. 3. Irritable Bowel Syndrome (Continued) <ul><ul><li>The sense of incomplete evacuation of stool </li></ul></ul><ul><ul><li>The presence of mucus with stool passage </li></ul></ul><ul><li>A flare-up of symptoms usually brings the client to the health care provider. </li></ul>
    4. 4. Treatment <ul><li>Education—teaching the client to avoid problem stimulants </li></ul><ul><li>Diet therapy—elimination of offending or upsetting foods </li></ul><ul><li>Drug therapy—bulk-forming laxatives, antidiarrheal agents, anticholinergic agents, tricyclic antidepressants, and 5-HT 4 agonists. </li></ul><ul><li>(Continued) </li></ul>
    5. 5. Treatment (Continued) <ul><li>Stress management based on the client’s current and ongoing stressors </li></ul><ul><li>Complementary and alternative therapies used to reduce symptoms and discomfort </li></ul>
    6. 6. Herniation <ul><li>Weakness in the abdominal muscle wall through which a segment of bowel or other abdominal structure protrudes </li></ul><ul><li>Types of hernia include: </li></ul><ul><ul><li>Indirect inguinal </li></ul></ul><ul><ul><li>Direct inguinal </li></ul></ul><ul><ul><li>Femoral </li></ul></ul><ul><ul><li>Umbilical </li></ul></ul><ul><ul><li>Incisional or ventral </li></ul></ul>
    7. 7. Surgical Management <ul><li>Preoperative care—NPO day of surgery </li></ul><ul><li>Operative procedure </li></ul><ul><ul><li>Minimally invasive inguinal hernia repair (MIIHR) </li></ul></ul><ul><ul><li>Conventional herniorrhaphy </li></ul></ul><ul><li>(Continued) </li></ul>
    8. 8. Surgical Management (Continued) <ul><li>Postoperative care in minimally invasive inguinal hernia repair includes: </li></ul><ul><ul><li>Elevate scrotum to prevent and control swelling. </li></ul></ul><ul><ul><li>Address difficulties in voiding that may occur. </li></ul></ul><ul><ul><li>Observe for signs and symptoms of complications. </li></ul></ul>
    9. 9. Colorectal Cancer <ul><li>Colorectal refers to the colon and the rectum, which together make up the large intestine. </li></ul><ul><li>95% of cancers of the colon or rectum are adenocarcinomas. </li></ul><ul><li>Etiology </li></ul><ul><ul><li>Genetic considerations </li></ul></ul><ul><ul><li>Personal factors </li></ul></ul><ul><ul><li>Dietary factors </li></ul></ul><ul><ul><li>Inflammatory bowel disease </li></ul></ul>
    10. 10. Clinical Manifestations <ul><li>Rectal bleeding, hematochezia, passage of red blood via the rectum </li></ul><ul><li>Anemia </li></ul><ul><li>Change in stool texture </li></ul><ul><li>Mass in abdomen </li></ul>
    11. 11. Laboratory Assessment <ul><li>Hemoglobin and hematocrit values usually decreased </li></ul><ul><li>Fecal occult blood test </li></ul><ul><li>Possible elevation of carcinoembryonic antigen </li></ul><ul><li>Radiographic assessment </li></ul><ul><li>Other diagnostic assessments </li></ul>
    12. 12. Anticipatory Grieving Interventions <ul><li>Observe and identify: </li></ul><ul><ul><li>Client and family’s current methods of coping </li></ul></ul><ul><ul><li>Effective sources of support in past crises </li></ul></ul><ul><ul><li>Client and family’s present methods of coping </li></ul></ul><ul><ul><li>Signs of anticipatory grieving, such as crying </li></ul></ul>
    13. 13. Potential for Metastasis Interventions <ul><li>Treatment based on Dukes’ staging classification </li></ul><ul><li>Radiation therapy </li></ul><ul><li>Drug therapy </li></ul><ul><ul><li>Adjuvant chemotherapy after surgery </li></ul></ul><ul><ul><li>Antiangiogenesis medication </li></ul></ul><ul><ul><li>Monoclonal antibodies and colorectal tumor vaccine (in clinical trials) </li></ul></ul>
    14. 14. Surgical Management <ul><li>Colon resection </li></ul><ul><li>Colectomy </li></ul><ul><li>Abdominoperineal resection </li></ul><ul><li>Colostomy </li></ul><ul><li>Transanal approach </li></ul>
    15. 15. Surgical Management <ul><li>Preoperative care includes: </li></ul><ul><ul><li>Consultation with enterostomal therapist </li></ul></ul><ul><ul><li>Discussions with surgeon of risk of sexual and urinary dysfunctions </li></ul></ul><ul><ul><li>Bowel prep </li></ul></ul><ul><ul><li>Nasogastric tube and IV line placed for use after surgery </li></ul></ul><ul><ul><li>Assignment of case manager for long-term consequences </li></ul></ul>
    16. 16. Surgical Management <ul><li>Postoperative care includes: </li></ul><ul><ul><li>Colostomy and wound management </li></ul></ul><ul><ul><li>Nasogastric tube </li></ul></ul><ul><ul><li>Colostomy management </li></ul></ul><ul><ul><li>Wound management </li></ul></ul>
    17. 17. Colostomy Care <ul><li>Normal appearance of the stoma </li></ul><ul><li>Signs and symptoms of complications </li></ul><ul><li>Measurement of the stoma </li></ul><ul><li>Choice, use, care, and application of appropriate appliance to cover stoma </li></ul><ul><li>(Continued) </li></ul>
    18. 18. Colostomy Care (Continued) <ul><li>Measures to protect the skin </li></ul><ul><li>Dietary measures to control gas and odor </li></ul><ul><li>Resumption of normal activities </li></ul>
    19. 19. Intestinal Obstruction <ul><li>Mechanical obstruction </li></ul><ul><li>Nonmechanical obstruction, known as paralytic ileus </li></ul><ul><li>Strangulated obstruction resulting from tumors, hernias, fecal impactions, strictures, intussusception, volvulus, fibrosis, vascular disorder, and adhesions </li></ul>
    20. 20. Clinical Manifestations of Mechanical Obstruction <ul><li>Midabdominal pain or cramping </li></ul><ul><li>Vomiting </li></ul><ul><li>Obstipation </li></ul><ul><li>Diarrhea </li></ul><ul><li>Alteration in bowel pattern and stool </li></ul><ul><li>Abdominal distention </li></ul><ul><li>Borborygmi </li></ul><ul><li>Abdominal tenderness </li></ul>
    21. 21. Clinical Manifestations of Nonmechanical Obstruction <ul><li>Constant diffuse discomfort </li></ul><ul><li>Abdominal distention </li></ul><ul><li>Decreased to absent bowel sounds </li></ul><ul><li>Vomiting </li></ul><ul><li>Obstipation </li></ul>
    22. 22. Assessment <ul><li>Laboratory assessment </li></ul><ul><li>Radiographic assessment </li></ul><ul><li>Endoscopy </li></ul><ul><li>Barium enema </li></ul><ul><li>Computed tomography </li></ul>
    23. 23. Nonsurgical Management <ul><li>Nothing by mouth </li></ul><ul><li>Nasogastric tube placement </li></ul><ul><li>Nasointestinal tubes </li></ul><ul><li>Fluid and electrolyte replacement </li></ul><ul><li>Pain management </li></ul><ul><li>Drug therapy (e.g., Sandostatin), broad-spectrum intravenous antibiotics </li></ul>
    24. 24. Surgical Management <ul><li>Preoperative care </li></ul><ul><ul><li>Teaching </li></ul></ul><ul><ul><li>Nasogastric intubation and suction if time permits </li></ul></ul><ul><li>Operative procedure: exploratory laparotomy to determine procedure </li></ul><ul><li>(Continued) </li></ul>
    25. 25. Surgical Management (Continued) <ul><li>Postoperative care </li></ul><ul><ul><li>Exploratory laparotomy </li></ul></ul><ul><ul><li>Nasogastric tube in place </li></ul></ul><ul><ul><li>Usual postoperative care </li></ul></ul>
    26. 26. Abdominal Trauma <ul><li>Injury to the structures located between the diaphragm and the pelvis, including the large or small bowel, liver, spleen, duodenum, pancreas, kidneys, and urinary bladder </li></ul><ul><li>Blunt abdominal trauma, which often occurs in motor vehicle accidents </li></ul><ul><li>Penetrating abdominal trauma caused by gunshot wounds, stabbing </li></ul>
    27. 27. Assessment <ul><li>Assess airway, breathing, and circulation </li></ul><ul><li>Assess for the following: </li></ul><ul><ul><li>Hypovolemic shock </li></ul></ul><ul><ul><li>Cullen’s sign </li></ul></ul><ul><ul><li>Turner’s sign </li></ul></ul><ul><ul><li>Ballance’s sign </li></ul></ul><ul><ul><li>Kehr’s sign </li></ul></ul>
    28. 28. Emergency Care: Abdominal Trauma <ul><li>Two large-bore intravenous lines are placed </li></ul><ul><li>Central venous catheter </li></ul><ul><li>Balanced saline solution, crystalloids, and possibly blood </li></ul><ul><li>Arterial blood gas assessment </li></ul><ul><li>Fluid and electrolyte management </li></ul><ul><li>Continuous hemodynamic monitoring </li></ul><ul><li>Surgical management </li></ul>
    29. 29. Polyps <ul><li>Small growths in the intestinal tract that are covered with mucosa and are attached to the surface of the intestine </li></ul><ul><li>Various types </li></ul><ul><li>Usually asymptomatic, but can cause gross rectal bleeding, intestinal obstruction, and intussusception </li></ul><ul><li>Nursing care focused on teaching </li></ul>
    30. 30. Hemorrhoids <ul><li>Unnaturally swollen or distended veins in the anorectal region </li></ul><ul><li>Internal hemorrhoids </li></ul><ul><li>External hemorrhoids </li></ul><ul><li>Nonsurgical management </li></ul><ul><li>Surgical management: hemorrhoidectomy </li></ul>
    31. 31. Malabsorption Syndrome <ul><li>Syndrome associated with a variety of disorders and intestinal surgical procedures </li></ul><ul><li>Primary clinical manifestations: Diarrhea and steatorrhea </li></ul><ul><li>Interventions: </li></ul><ul><ul><li>Dietary management </li></ul></ul><ul><ul><li>Surgical or nonsurgical management </li></ul></ul><ul><ul><li>Drug therapy </li></ul></ul>

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