Adult GI Disorders
Lower GI Disorders
Appendicitis
inflammation of vermiforn appendix d/t infection
• Assessment
– Progressive, severe, RLQ or periumbilical area pain
– Pain localized in RLQ(McBurney’s point)
• worse with movement, coughing, sneezing
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anorexia, constipation
nausea, vomiting
rebound tenderness
slight temperature
moderate leukocytosis
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
Goals
•Recognize and treat symptoms
•Prevent death from complications
•Re-establish normal bowel
function
Nursing Care: Post Op
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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
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
Interventions
• Medical
– analgesic
ointment:Nupercaine
– 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
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
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
Nursing Plan of Care
• Administer medications
– Narcotics (Demerol)
antispasmodics
bulk laxatives(Metamucil)
antibiotics
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• 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
Evaluation
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Patient establishes regular bowel habits without pain
Patient follows diet principles
Verbalizes understanding of medications
Patient verbalizes signs/symptoms of complications
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
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
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Psychosocial/Cultural
Occurs most often in
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Adolescents
Young adults
Jewish descent
causes depression,
anger, frustration
– stress may cause
exacerbation
Goals
•Restore nutrition/ F&E balance
•Combat infection
•Promote comfort
•Decrease bowel motility
•Assist patient to cope with
•Alteration in body image
•Psychological problems
Nursing Plan of Care
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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
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
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.)
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
Regional enteritis
(Crohn’s Disease)
• Chronic inflammatory disease of small
intestine affecting the terminal ileum.
• Results in chronic diarrhea
• Causes are unknown
Crohn’s
• Physical
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crampy pain after meals
chronic diarrhea, melena
low grade fever
abd tenderness
lymphadenitis
UGI> 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
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)
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
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)
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