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Chapter 060

Chapter 060






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Chapter 060 Chapter 060 Presentation Transcript

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