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1. Nursing Interventions for Clients
with lower Gastrointestinal
Disorders
1

2. Intestinal and Rectal Disorders
Constipation
Abnormal hardening of stool
Retention of stool on rectum for prolonged period
Clinical Manifestations
Abdominal distention
Pain & pressure
Anorexia fatigue & headache
Incomplete emptying & strain defecation
2

3. Constipation (2)
Medical Management
Treatment of the underlying cause
High Fiber Diet & increase fluid intake
Maintain regular pattern of exercises
Laxatives & bulk forming Agents
Complications:
Hypertension
Hemorrhoid & fissure
Fecal impaction
3

4. Diarrhea
It is an increase frequency of bowel movement
more than three times a day
Causes
Certain medications
Tube feeding formula
Certain metabolic disease
Viral & bacterial infectious disease
Ulcerative colitis, Enteritis & Crohn’s Disease
4

5. Diarrhea (2)
Clinical Manifestations
Abdominal cramps, distention
Increase frequency & fluid content of stool
Anorexia, thirst & dehydration
Fluid electrolytes imbalance
Complications
Cardiac arrhythmia due to fluid & K+ loss
Drowsiness & Hypotension
5

6. Diarrhea (3)
Medical Management
1. Treatment of the underlying cause
2. Controlling symptoms & preventing
complications
3. Antibiotics & anti-inflammatory agents
4. Anti-diarrheal & antispasmoic agents
Opiate related drugs, act on opoid receptors in GI
tract decreased motility.
 Loperamide (Lomotril)
 Defenoxin with atropine (Motofen)
 Diphenoxylate with Atropine (Lomotil)
6

7. Diarrhea (4)
Nursing Managements
1. Assessment of the nature & pattern of the
diarrhea
2. Bed rest & monitoring of fluid status
3. Serum electrolytes (K)
4. Perineal care
7

8. Intestinal Obstruction
 Intestinal obstruction exists when blockage prevents
the normal flow of intestinal contents through the
intestinal tract.
 Obstruction can be Partial or Complete
 Severity of intestinal obstruction depends on
 The region of bowel that is affected
 The degree to which the lumen is occluded
 The degree to which the blood circulation in the
bowel wall is disturbed
8

9. Intestinal Obstruction (2)
Processes of Intestinal Obstruction
Mechanical
 This is due to the obstruction of the lumen of the intestine
 The problem is directly to the lumen
 No problem with the muscles.
Cause
 Strictures
 Adhesion (SBO)
 Hernia
 Tumors
 Volvulus
 Intussusceptions
9

10. Intestinal Obstruction (3)
Functional /Non mechanical/
 The intestinal musculature is unable to propel the
contents along the bowel.
 The problem is due to dysfunction of intestinal
musculature.
Cause
 Muscular dystrophy
 Amyloidosis
 Neurologic disorders
10

11. Types of Intestinal Obstruction
Small Intestine Obstruction
 Acute in onset
 Sever lower abdominal cramp
 Abdominal distention
 Nausea & early profuse
vomiting
 Sever fluid & electrolyte
imbalance
 Metabolic alkalosis
 Accounts for about 85% of an
obstruction
 Mortality rate is about 10%
 If obstruction is due to
strangulation mortality rate is
about 20 - 75%
Large Intestine Obstruction
 Gradual in onset
 Abdominal discomfort
 Abdominal distention is more
pronounced
 Minimal or no vomiting (may
contain fecal)
 No major fluid & electrolyte
imbalance
 Metabolic acidosis
 Accounts for about 15% of all
obstruction
 Mortality rate is about 30%
 If obstruction is due to
strangulation mortality rate is
about 60%.
11

12. Intestinal Obstruction (5)
 The most common site for large bowel obstruction is the
Sigmoid Colon
Cause
 Carcinoma
 Diverticulitis
 Benign Tumors
 Inflammatory Bowel Disorders
 Volvulus of Sigmoid colon
12

13. Intestinal Obstruction (7)
Diagnostic evaluation
 Abdominal X-ray
 Electrolytes studies
13

14. Intestinal Obstruction (8)
Treatment
Medical Management
 Abdominal decompression by using NGT
 IV fluid (replacement of fluid and electrolytes)
 NPO the patient
Surgical Mx
 Indication of surgical Mx
 If obstruction is due to Strangulation, Adhesion ,Hernia
 If pt has increased pulse, increased Temperature,
Decreased B.P, and increased WBC
 Surgery depends on the cause of the obstruction and
severity and size of the obstruction
14

15. Intestinal Obstruction (9)
 Complication
 Hypovolemic shock
 Renal failure
 Septicemia
 Peritonitis
 Metabolic acidosis or alkalosis
 Perforation
 Death
15

16. Intestinal Obstruction (10)
Nursing intervention
 Teach the patient to eat high fiber foods
 To eat raw fruits & vegetables & whole grain products
 Encourage patient to take plenty of fluids
 To exercise regularly
 Close follow up of the NGT
 Monitor input and output
 Preoperative preparation of the patient
 Monitor the patient for passing of feces & flatus
 Observe the color of the stool
16

17. Hernia
 It is a weakness in the abdominal muscle wall through
which a segment of bowel or other abdominal structure
protrudes.
 The most common types of abdominal hernias
 Indirect - sac formed from the peritoneum that contains a
portion of the intestine
 Direct /through a weak point in the ab. wall
 Femoral (protrude through the femoral region
 Umbilical congenital (in infant) /acquired increased intra abd.
pressure
 Incisional (ventral) occur at the site of previous surgical incision
17

18. Hernia (2)
18

19. Hernia (3)
Types of Hernias
Reducible:- Content of the hernia sac can be replaced in to
the abdominal cavity by gentle pressure
Irreducible :-(Incarcerated) can't be reduced or placed back
in to the abdominal cavity
Strangulated:-when the blood supply to the herniated
segment of the bowel is cut off by pressure from the
hernia ring (the band of muscle around the hernia) If a
hernia is strangulated.
 Strangulated hernia is characterized by adhesion and constricted
neck of hernia
19

20. Hernia (4)
Cause
 Weakness of abdominal muscles
 Congenital
 Aging
 Injury
 Surgery
 Increased intra abdominal pressure
 Pregnancy
 Obesity
 Straining
 Coughing
 Lifting of heavy objects
20

21. Hernia (5)
Clinical Manifestations of Strangulates
 Abdominal distention
 Vomiting
 Nausea
 Pain
 Fever
 Tachycardia
 N.B. any hernia that is not reducible requires immediate
and careful surgical evaluation
Diagnostic evaluation
 C/M
 Abdominal X-ray
 WBC count
21

22. Hernia (6)
Treatment
 Medical (non surgical MX)
 Truss - for elderly or debilitated clients who are poor
surgical risks.
Surgical Management
 Repair of the hernia is generally Rx of choice
 Herniorrhaphy - is surgical correction of the defected
structure
 Hernioplasty (less frequently used)
22

23. Appendicitis
 Is an acute inflammation of the vermiform appendix.
 Most common cause of acute inflammation in the RLQ
of the abdominal cavity.
 It is more common between the age of 5 and 30 years
 Perforation is relatively more common in the elderly
because of difficulty in diagnosis.
23

24. Appendicitis (2)
Cause
 Fecal material
 Tumor
 Calculi
 Viral infection
 Barium Ingestion
 Trauma (Scar)
 Worms
 Stricture
24

25. Appendicitis (3)
Clinical Manifestations
 Abdominal pain initially
generalized but later on
localized
 Pain that localizes within a
few hours in the RLQ of the
abdomen is McBurney's
Point
 Anorexia
 Vomiting one or two
episodes
 Malaise
 Constipation or Diarrhea
25

26. Appendicitis (4)
 Low grade fever (37.2- 380C)
 Later palpation may show tenderness in the RLQ of
the abdomen that worsen when the patient is asked
to cough or during gentle percussion
 Sudden cessation of abdominal pain signals
perforation or infarction
Diagnostic evaluations
 C/M
 Slight Leukocytes
 X-Ray
26

27. Appendicitis (5)
RX
 Appendectomy is the treatment of choice
Nursing management
 IV fluids
 Anti-pain while patient is ready for surgery
 Reducing anxiety
 Elimination of infection
 Maintain skin integrity
 Attaining optimum nutrition
27

28. Appendicitis (6)
Preoperative Nursing Management
 Physical & Psychological support
 Secure IV line
 NG tube
 Enema is CI
Postoperative Nursing Management
 Position patient in Semi Fowler's Position
 Administering Antibiotics (if ordered)
28

29. Appendicitis (7)
 Give oral fluids and food on the day of surgical if
tolerated.
 Discharge patient on the day of surgery (if it is un
complicated)
 Provided that the temperature is in a normal limits &
there is no discomfort in the operative area
Complication
 Rupture or Perforation
 Peritonitis
 Appendical abscess
 Pyelonephritis
29

30. Colorectal cancer
 Cancer colon is the abnormal growth of cancer cells
in the lower digestive tract.
Risk factors
 Increasing age
 Family history of colon cancer or polyps
 Previous colon cancer or adenomatous polyps
 High consumption of alcohol
 Cigarette smoking
 Obesity
 History of gastrectomy
 History of inflammatory bowel disease
 High-fat, high-protein (with high intake of beef), low-fiber diet
 Genital cancer (eg, endometrial cancer, ovarian cancer) or
breast cancer (in women)
30

31. Colorectal cancer (2)
Clinical manifestations :determined by the location of the tumor, the
stage of the disease, and the function of the affected intestinal segment:
 a change in bowel habits (most common) .
 The passage of blood in or on the stools (second most common)
 unexplained anemia, anorexia, weight loss, and fatigue.
 Symptoms of Right sided lesions are dull abdominal pain and melena.
 Symptoms of left-sided lesions are abdominal pain and cramping,
narrowing stools, constipation, distention), as well as bright-red blood
in the stool
 rectal lesions symptoms are tenesmus, rectal pain, the feeling of
incomplete evacuation after a bowel movement, alternating
constipation and diarrhea, and bloody stool.
31

32. Colorectal cancer (3)
Assessment and diagnostic findings
 abdominal and rectal examination,
 fecal occult blood testing,
 barium enema,
 proctosigmoidoscopy
 Colonoscopy with biopsy.
 Carcinoembryonic antigen (CEA): With complete excision
of the tumor, the elevated levels of CEA should return to
normal within 48 hours. Elevations of CEA at a later date
suggest recurrence.
32

33. Colorectal cancer (4)
 Stages of colorectal cancer (Duke's classification)
 Class A: Tumor limited to muscular mucosa and
submucosa
 Class B1: Tumor extends into mucosa
 Class B2: Tumor extends through entire bowel wall into
serosa or pericolic fat, no nodal involvement
 Class C1: Positive nodes, tumor is limited to bowel wall
 Class C2: Positive nodes, tumor extends through entire
bowel wall
 Class D: Advanced and metastasis to liver, lung, or
bone
33

34. Colorectal cancer (5)
Medical management
 IV fluids and nasogastric suction
 blood component therapy
Surgical management to remove the tumor(curative or palliative)
 Segmental resection with anastomosis
 Abdominoperineal resection with permanent sigmoid colostomy
 Temporary colostomy
 Permanent colostomy or ileostomy for palliation of unresectable
obstructing lesions
 Construction of a coloanal reservoir called a colonic J pouch
Adjuvant therapy
 Chemotherapy
 Radiotherapy
 Immunotherapy 34

35. Colorectal cancer (6)
A colostomy is the surgical creation of
an opening (ie, stoma) into the colon. It
can be created as a temporary or
permanent fecal diversion. It allows the
drainage or evacuation of colon
contents to the outside of the body. The
consistency of the drainage is related
to the placement of the colostomy,
which is dictated by the location of the
tumor and the extent of invasion into
surrounding tissues 35
Placement of Colostomies

36. Nursing Process: The Care of the Patient with
Cancer of the Colon or Rectum— Assessment
 Health history
 Fatigue and weakness
 Abdominal or rectal pain
 Nutritional status and dietary habits
 Elimination patterns
 Abdominal assessment
 Characteristics of stool
Colorectal cancer (7)

37. Colorectal cancer (8)
 Nursing diagnosis
o Imbalanced nutrition, less than body requirements, related to nausea and
anorexia
o Risk for deficient fluid volume related to vomiting and decrease fluid intake
o Anxiety related to impending surgery and the diagnosis of cancer
o Risk for ineffective therapeutic regimen management related to knowledge
deficit concerning the diagnosis, the surgical procedure, and self-care after
discharge
o Impaired skin integrity related to the surgical incisions, the formation of a
stoma, and frequent fecal contamination of peristomal skin
o Disturbed body image related to colostomy
o Ineffective sexuality patterns related to presence of ostomy and changes in
body image and self-concept
37

38. Collaborative Problems/Potential Complications
 Intraperitoneal infection
 Complete large bowel obstruction
 GI bleeding
 Bowel perforation
 Peritonitis, abscess, and sepsis
Colorectal cancer (9)

39. Nursing Process: The Care of the Patient with Cancer
of the Colon or Rectum— Planning
 attainment of optimal level of nutrition
 maintenance of fluid and electrolyte balance
 reduction of anxiety
 knowledge of diagnosis and treatment
 self-care ability
 optimal tissue healing
 protection of peristomal skin
 expressing feelings and concerns about the colostomy and the
impact on himself or herself
 avoidance of complications.
Colorectal cancer (10)

40. Interventions
 Preparing the patient for surgery
 Emotional support
 Providing postoperative care
 Maintaining optimal nutrition
 Providing wound care
 Monitoring and managing complications
 Removing and applying the colostomy appliance
 Irrigating the colostomy
 Supporting a positive body image
 Discussing sexuality issues
 Promoting home and community-based care
Colorectal cancer (11)

41. Hemorrhoids
 Hemorrhoids are dilated portions of veins in the anal
Canal
Classification
Internal hemorrhoids
 Those occurring above the internal sphincter
External hemorrhoids
 Those appearing outside the external sphincter
Cause
 An increased intravenous pressure and the reason
why the veins are dilated is not clear
41

42. Hemorrhoids (2)
Risk Factor
 Chronic Constipation
 Intestinal disorders
 Prolonged sitting on hot objects
 Presence of varicose vein in the lower leg.
 Hereditary
Aggravating Factors
 Pregnancy
 Straining
42

43. Hemorrhoids (3)
Clinical manifestation
 Anal pain and discomfort
 Itching in the anus
 Inflammation of the anal canal
 Visible blood in stool
 Visible dilated vein
 Thrombosis/Clotting of blood within the hemorrhoid
43

44. Hemorrhoids (4)
Treatment
Palliative
 Cold & warm sits bath alternatively
 High fluid intake to make stool soft
 High roughage foods
 Laxatives in severe constipation
 Avoidance of
 Straining during defecation
 Lifting heavy objects
 Prolonged sitting
44

45. Hemorrhoids (5)
Radical treatment
Surgical treatment
 Elastic Band /Rubber Band/ the dilated blood vessels
will be tighten up.
 Cryotherapy: The dilated blood vessels will be applied
excessive cold.
 Sclerotherapy: injection of a solution (salt) to veins
make them swell and stick together. Overtime the scar
tissue will heal and make the veins normal.
 Haemorrhoidectomy : Surgical removal of the dilated
blood vessels
45

46. Hemorrhoids (6)
Nursing Intervention
 Sits bath to sooth pain and discomfort
 Alternate warm & cold sits bath at every 3-4 hrs
 Provide patient with prescribed anti - biotic
 Teach patient to avoid straining
 Teach patient to avoid prolong sitting on hot objects
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