Lower Gastrointestinal
1. Describe the risk factors, pathophysiology and clinical manifestations of
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Disorders of intestinal motility
 Diarrhea: What is the usual cause of acute diarrhea? What
problem is the most important concern? What is often present
in the etiology of Clostridium difficile?
 Constipation; when would you use a laxative, stool softener,
bulk forming?
 Fecal incontinence/impaction: describe the stool in impaction;
causes of incontinence; describe a bowel training program.
 Irritable Bowel syndrome; define; What is the relationship of
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Structural and Obstructive Disorders
 hernia: inguinal, umbilical, incisional or ventral
 Do all hernias need to be repaired? How do you recognize an
emotional problems to this syndrome?
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incisional hernia?
What is a strangulated hernia? How do you recognize it?
What is the difference between diverticulitis and diverticulosis?
What is the difference in the management? Diet? Medication? Use
of laxatives?
Acute abdominal pain; common symptoms; name five common
causes; why would the patient have fluid volume deficit? What
kind of surgery might be done? What orders would you anticipate
on admission?
Intestinal obstruction. What is the most common cause of small
bowel obstruction? When is surgery required? Bowel sounds are
hyperactive, high-pitched, tinkling, rushing or growling at the
onset of obstruction and may be absent later in obstruction. When a
patient is admitted with possible bowel obstruction what orders
would you anticipate?
Anorectal Disorders
 hemorrhoids
What causes hemorrhoids? How and why are
hemorrhoids treated surgically? What is the conservative
management? What is the criteria for discharge after a
hemorroidectomy? How do you teach the patient to manage the
pain?
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anorectal lesions: anal fissure, anorectal abscess, anorectal
fistula, and pilonidal disease You mostly need to know the
definitions of these.
2. Describe the collaborative management of the above, including diagnostic
tests,
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medications, and surgical management.
stool specimen (occult blood, ova and parasites; culture)
sigmoidoscopy
proctoscopy
colonoscopy
serum electrolytes, osmolality, ABG
biopsy
CBC with diff; ESR
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small bowel series: UGI with small bowel follow through and barium
enema.
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Why is a colostomy done on a patient with diverticulitis? When is it
closed?
3. Identify necessary information for administration of medications in lower GI
disorders.
o Absorbents and protectants
o Opium and opium derivatives:
What is Lomotil? What is the protocol for
administration?
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Anticholinergics
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Why would you not give Donnagel to a patient with
prostatic hypertrophy?
Laxatives and cathartics What advice would you give a person about the
daily use of Milk of Magnesia? Why do you give mineral oil at bedtime?
Why is obstruction a contraindication to osmotic laxatives?
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Antibiotics
4. Use the nursing process to plan for the nursing care of patients with the
above disorders.
o Dietary management: low fat, high residue, high fiber, clear liquids
 What diet is best to prevent diverticulitis?
o Risk for infection
 Why would you give Flagyl and a broad spectrum antibiotic to a
patient with diverticulitis?
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Risk for fluid volume deficit
Diarrhea
 What is the significance
of assessing this patient for Fluid volume
deficit?
5.
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o Risk for impaired skin integrity
o Pain
o Anxiety
o Impaired Tissue Integrity
Describe health promotion and home care strategies for patients with the
above disorders.
What would you teach a person with diverticulitis about straining at stool? Why?
A person with hemorrhoids?
What do you teach a patient about coughing after a hernia operation?
6. Discuss outcome measures used in evaluating goal attainment and revisions
in the nursing care plan.