Care of Patients with
Noninflammatory
Intestinal Disorders
Chapter 59
Mrs. Kreisel MSN, RN
NU130 Adult Health
Summer 2011
Lower GI Bleed
Irritable Bowel Syndrome (IBS)
• IBS is a functional GI disorder
characterized by chronic or recurrent
diarrhea, constipation, and/or abdominal
pain and bloating.
• Manning criteria are present:
• Abdominal pain relieved by defecation
or falling asleep
• Abdominal pain associated with
changes in stool frequency or
consistency
Irritable Bowel Syndrome (Cont’d)
• Abdominal distention
• The sense of incomplete evacuation of
stool
• The presence of mucus with stool
passage
• A flare-up of symptoms usually brings the
patient to the health care provider.
Treatment
• Health teaching—teaching the patient to avoid problem
stimulants
• Diet therapy—eliminating offending or upsetting foods
• Drug therapy—bulk-forming laxatives, antidiarrheal
agents, 5-HT4 antagonists, M3-receptor antagonists,
and tricyclic antidepressants
• Stress management based on the patient’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
Common Abdominal Hernias
Classification of Hernias
• Reducible: When the contents of the hernial sac can be
placed back into the abdominal cavity by pressure.
• Irreducible: Also know as incarcerated hernia, cannot
be reduced or placed back into the abdominal cavity.
Requires emregency surgical evaluation.
• Strangulated: When the blood supply to the herniated
segment of the bowel is cut off by pressure from the
hernial ring (the band of muscle around the hernia).
• WHAT NURSING CONSIDERATIONS ARE
IMPORTANT FOR THIS TYPE OF HERNIA?
Nonsurgical Management
• Truss: For people not able to undergo surgery and is
mainly for males.
• It is a pad made with firm material and is held inplace
over the hernia with a belt to keep the abdominal
contents from protruding into the hernia sac.
• The surgeon must reduce the hernia if it is not
incarcerated. The patient applies it in the morning.
• Lots of Nursing Education is the priority
Surgical Management
• Preoperative care—NPO day of surgery
• Operative procedures:
• Minimally invasive inguinal hernia repair
(MIIHR) (herniorrhaphy)
• Hernioplasty
• Open or conventional herniorrhaphy
Postoperative Care
• After open surgical approach, have patient avoid
coughing.
• After indirect inguinal hernia repair, a scrotal support and
use of ice bags to the scrotum may be used to prevent
swelling. Elevation of the scrotum on a soft pillow helps
prevent and control swelling.
• Difficulty voiding.
Colorectal Cancer (CRC)
• Colorectal refers to the colon and the rectum, which
together make up the large intestine.
• Most CRCs are adenocarcinomas.
• Etiology:
• Age older than 50 years
• Genetic predisposition
• Personal or family history of cancer
• Familial (disease that occurs more in a family then
would be expected by chance) adenomatous
(glandular tissue over growths) polyposis (the
presence of numerous polyps)
Colorectal Cancer (Cont’d)
Health Promotion and Maintenance
• Genetic testing for FAP (familial adenomatous
polyposis)and HNPCC (herediary nonpolyposis
colorectal cancer)
• Diet modification
• Colon cancer screening
• Aspirin therapy
• Dietary calcium supplements
Clinical Manifestations
• Most common signs—rectal bleeding, anemia, and a
change in the stool.
• The clinical manifestations of colon rectal cancer depend
on the location of the tumor.
Laboratory Assessment
•
•
•
•
•
•
Hemoglobin and hematocrit values usually decreased
Fecal occult blood test
Possible elevation of carcinoembryonic antigen
Imaging assessment
Other diagnostic tests
Genetic counseling
Nonsurgical Management
• American Joint Committee on Cancer
• Stage I—tumor invades up to muscle layer
• Stage II—tumor invades up to other organs or perforates
peritoneum
• Stage III—any level of tumor invasion and up to 4
regional lymph nodes
• Stage IV—any level of tumor invasion; many lymph
nodes affected with distant metastasis
Nonsurgical Management (Cont’d)
• Radiation therapy
• Drug therapy
Surgical Management
•
•
•
•
•
Colon resection
Colectomy
Abdominoperineal (AP) resection
Colostomy
Minimally invasive surgery
Surgical Management (Cont’d)
• Preoperative care includes:
• Consultation with enterostomal therapist
• Discussions with surgeon of risk for sexual and
urinary dysfunctions
• Bowel prep
• Nasogastric tube and IV line placed for use after
surgery
• Assignment of case manager for long-term
consequences
Colostomies
Surgical Management
• Operative procedures
• Postoperative care
Nursing Interventions:
PRIMARY: Assess the meaning and effect of
cancer as perceived by the client!
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
• Measures to protect the skin
• Dietary measures to control gas and odor
• Resumption of normal activities
Intestinal Obstruction
• Mechanical obstruction
• Nonmechanical obstruction, also known as paralytic
ileus or adynamic ileus
• Strangulated obstruction resulting from tumors, hernias,
fecal impactions, strictures, intussusception, volvulus,
fibrosis, vascular disorder, and adhesions
Mechanical
Obstruction
Clinical Manifestations of Mechanical
Obstruction
•
•
•
•
•
•
•
Midabdominal pain or cramping
Vomiting
Obstipation (extreme constipation)
Diarrhea
Alteration in bowel pattern and stool
Abdominal distention
Absence of Borborygmi (a gurgling, splashing sound
normally heard over the large intestine; caused by gas
passing through the liquid contents of the intestine)
• Abdominal tenderness
Clinical Manifestations of Nonmechanical
Obstruction
•
•
•
•
•
Constant, diffuse discomfort
Abdominal distention
Decreased to absent bowel sounds
Vomiting
Obstipation
Assessment
• Laboratory assessment
• Imaging assessment
• Other diagnostic tests
Nonsurgical Management
•
•
•
•
•
•
•
Nothing by mouth
Nasogastric tube placement
Nasointestinal tubes
IV fluid replacement and maintenance
Mouth care
Pain management
Drug therapy
Surgical Management
•
•
•
•
Exploratory laparotomy
Preoperative care
Operative procedure
Postoperative care
Abdominal Trauma
• Injury to the structures located between the diaphragm
and the pelvis, which occurs when the abdomen is
subjected to blunt or penetrating forces
• Organs may include 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:
• Hypovolemic shock
• Cullen’s sign: bluish discoloration of the periumbilical
skin due to intraperitoneal hemorrhage.
• Turner’s sign: : bluish discoloration on the flank may
indicate retroperitoneal bleeding into the abdominal wall
• Ballance’s sign: pt on Left side and do percussion. Left
flank dullness and resonance over the right flank
• Kehr’s sign: Left shoulder pain resulting from
diaphragmatic irritation as seen in spleen injury.
• Dullness over hollow organs like the stomach or
intestines may mean blood or fluid in that area.
Abdominal Trauma: Emergency Care
•
•
•
•
•
•
•
•
Two large-bore IV lines are placed
Central venous catheter
Type and crossmatch 4 to 8 units of blood
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
• Familial adenomatous polyposis
• Usually asymptomatic, but can cause gross rectal
bleeding, intestinal obstruction, and intussusception
• Nursing care
Polyps (Cont’d)
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
•NCLEX TIME
Question 1
How many Americans are estimated to suffer from
irritable bowel syndrome?
A.
B.
C.
D.
7% to 12%
10% to 22%
25% to 33%
35% to 40%
Question 2
What symptom does the nurse expect the patient with
intussusception to exhibit?
A. Decrease in pulse
B. Extremely elevated body temperature
C. Singultus (hiccups)
D. Frequent bloody stools
Question 3
What is a priority nursing intervention in the care of a
patient with chronic diarrhea?
A. Keep the skin clean and dry.
B. Use medicated wipes rather than washcloths to clean
the perineal area.
C. Consult a nutritionist for suggested fibers to add to the
diet.
D. Review the patient’s medications that may be
exacerbating the diarrhea.
Question 4
A 21-year-old female college student presents to the clinic
complaining of lower abdominal pain, constipation and
diarrhea, and belching and bloating sensation. The most
likely cause of her symptoms is:
A. Appendicitis
B. Diverticular disease
C. Irritable bowel syndrome
D. Mental health disorder
Question 5
What percentage of people develop polyps or colorectal
tumor by age 70 years?
A. 10%
B. 25%
C. 40%
D. 50%