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Chapter 060

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    • 1. Interventions for Clients with Noninflammatory Intestinal Disorders Chapter 60
    • 2. 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)
    • 3. 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.
    • 4. 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)
    • 5. Treatment (Continued)
      • Stress management based on the client’s current and ongoing stressors
      • Complementary and alternative therapies used to reduce symptoms and discomfort
    • 6. 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
    • 7. Surgical Management
      • Preoperative care—NPO day of surgery
      • Operative procedure
        • Minimally invasive inguinal hernia repair (MIIHR)
        • Conventional herniorrhaphy
      • (Continued)
    • 8. 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.
    • 9. 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
    • 10. Clinical Manifestations
      • Rectal bleeding, hematochezia, passage of red blood via the rectum
      • Anemia
      • Change in stool texture
      • Mass in abdomen
    • 11. Laboratory Assessment
      • Hemoglobin and hematocrit values usually decreased
      • Fecal occult blood test
      • Possible elevation of carcinoembryonic antigen
      • Radiographic assessment
      • Other diagnostic assessments
    • 12. 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
    • 13. 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)
    • 14. Surgical Management
      • Colon resection
      • Colectomy
      • Abdominoperineal resection
      • Colostomy
      • Transanal approach
    • 15. 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
    • 16. Surgical Management
      • Postoperative care includes:
        • Colostomy and wound management
        • Nasogastric tube
        • Colostomy management
        • Wound management
    • 17. 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)
    • 18. Colostomy Care (Continued)
      • Measures to protect the skin
      • Dietary measures to control gas and odor
      • Resumption of normal activities
    • 19. 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
    • 20. Clinical Manifestations of Mechanical Obstruction
      • Midabdominal pain or cramping
      • Vomiting
      • Obstipation
      • Diarrhea
      • Alteration in bowel pattern and stool
      • Abdominal distention
      • Borborygmi
      • Abdominal tenderness
    • 21. Clinical Manifestations of Nonmechanical Obstruction
      • Constant diffuse discomfort
      • Abdominal distention
      • Decreased to absent bowel sounds
      • Vomiting
      • Obstipation
    • 22. Assessment
      • Laboratory assessment
      • Radiographic assessment
      • Endoscopy
      • Barium enema
      • Computed tomography
    • 23. 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
    • 24. Surgical Management
      • Preoperative care
        • Teaching
        • Nasogastric intubation and suction if time permits
      • Operative procedure: exploratory laparotomy to determine procedure
      • (Continued)
    • 25. Surgical Management (Continued)
      • Postoperative care
        • Exploratory laparotomy
        • Nasogastric tube in place
        • Usual postoperative care
    • 26. 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
    • 27. Assessment
      • Assess airway, breathing, and circulation
      • Assess for the following:
        • Hypovolemic shock
        • Cullen’s sign
        • Turner’s sign
        • Ballance’s sign
        • Kehr’s sign
    • 28. 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
    • 29. 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
    • 30. Hemorrhoids
      • Unnaturally swollen or distended veins in the anorectal region
      • Internal hemorrhoids
      • External hemorrhoids
      • Nonsurgical management
      • Surgical management: hemorrhoidectomy
    • 31. 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

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