care of pt. with noninflammatory intestinal disorders Flashcards
types of intestinal obstruction
mechanical
nonmechanical
mechanical obstruction
the bowel is physically blocked by problems outside the intestine (e.g., adhesions), in the bowel wall (e.g., Crohn’s disease), or in the intestinal lumen (e.g., tumors)
non-mechanical obstruction
Does not involve a physical obstruction in or outside the intestine, peristalsis is decreased or absent because of neuromuscular disturbance, resulting in slowing of the movement or backup of intestinal contents
complications of an obstruction
- fluid and electrolyte balance and acid base balance
- Severe hypovolemia results in acute kidney injury or even death
- Bacterial peritonitis with or without perforation
- Closed-loop obstruction (blockage in two different areas) or strangulated obstruction (obstruction with compromised blood flow that can be life threatening)
- Septic Shock
- Sepsis and bleeding can result in an increased intra-abdominal pressure (IAP) or acute compartment syndrome
types of mechanical obstruction
telescoping of bowel
intussusception
etiology and genetic risk for mechanical obstrcution
- Adhesions (scar tissue from surgeries or pathology)
- Tumors
- Appendicitis complications
- Hernia
- FECAL IMPACTION (especially in order adults)
- STRICTURES (due to Crohn’s disease, a chronic inflammatory bowel disease, or previous radiation surgery)
- Intussusception (telescoping of a segment of the intestine within itself)
- Volvulus (twisting of the intestine)
- Fibrosis (due to disorders such as endometriosis)
Etiology and Genetic Risk nonmechanical obstrucution
Handling of intestines during surgery
intestinal obstruction history
- GI disorders, surgeries, treatments
- Recent N/V, color of emesis
- Pain (attention to onset, aggravating factors, alleviating factors, and patterns or rhythms of pain)
- Elimination habits
- SINGULTUS (hiccups) is common with all types of intestinal obstruction
- Family history of colorectal cancer (CRC)
physical assessment of obstruction
Obstipation (NO PASSAGE OF STOOL), PAIN OR CRAMPING. Vomiting, Distention, alteration in bowel pattern, blood in stool, peristaltic waves, high-pitched bowel sounds (borborygmi), ABSENT BOWL SOUNDS, minimal abdominal tenderness and rigidity
lab assessment of intestinal obstruction
- WBC
- Hemoglobin and hematocrit
- Creatinine
- BUN
- Serum sodium, chloride, potassium**
- Serum amylase
lab assessment of intestinal obstruction
diagnsotic assessment for IO
- CT or MTI
- Abdominal ultrasound
- An ENDSCOPY (sigmoidoscopy or colonoscopy)
what does IO have a potential for
Potential for life-threatening complications due to reduced flow or blocked flow of intestinal contents
nonsurgical management for IO
nonsurgical management for IO
- NASOGASTRIC TUBE
- NPO status
- IV Fluid replacement and maintenance (monitor weight for fluid balance)
- Disempaction and enemas for obstruction due to fecal impaction
- For post-op ileus, alvimopan may be used short term
- MOUTH CARE
- PAIN management
- Turn and reposition
- Antibiotics most likely ordered if strangulation is suspected
surgical management for IO
- Exploratory laparotomy (a surgical opening of the abdominal cavity)
- Conventional open surgical approach
- Laparoscopic surgery (MIS)
- Colectomy (surgical removal of the entire colon) in severe cases
evaluation of outcomes for IO
- Have relief from the obstruction and no evidence of life-threatening complications. –> rupture, peritonitis, eschema
- Report that he or she has returned to having USUAL bowel habits.
colorectal
refers to colon and rectum, which together make up large intestine
colonscopy
- CT-guided virtual colonoscopy: noninvasive and includes a CT scan of the rectum and colon
- Sigmoidoscopy: provides visualization of the lower colon using a fiberoptic scope
- COLONOSCOPY (definitive test): provides views of the entire large bowel from the rectum to the ileocecal valve
colostomies ascending colostomy
right-sided tumors
colostomies tranverse
colostomy—used in emergencies and has two stomas
colostomies descending colostomy
left-sided tumors
sigmoid colostomies
rectal tumors
slef management education colostomy
- Before teaching, teach the patient to avoid lifting heavy objects or straining on defecation to prevent tension on anastomosis site
- Patient should avoid driving and extreme physical activity for 4 to 6 weeks while the incision heals
- Laparoscopy: patient can return to normal activity within 1- 2 weeks
IBS
IBS: A functional GI disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating
Most common digestive disorder
One in five people in the U.S.
ibs classdications d c a m
IBS-D (diarrhea)
IBS-C (constipation)
IBS-A (alternating diarrhea/constipation)
IBS-M (mix of diarrhea/constipation)
assessment findings ibs
- Fatigue, malaise
- Cramps
- ABDOMINAL PAIN
- Changes in bowel patterns (***constipation, diarrhea, or an alternating pattern of both)
- Consistency of stools
- Passage of mucus
- FOOD INTOLERANCE
- NAUSEA
- Belching, gas, anorexia and bloating
health teaching for IBS
dietary fiber and bulk; 30 to 40 g fiber each day; eat regular meals, drink 8 to 10 glasses of water each day, and chewing food slowly help promote normal bowel function
drug therapy ibs
bulk-forming or antidiarrheal agents and/or newer drugs to control symptoms such as pain, laxatives
complemenatry and integrative health
- probiotics, peppermint oil
- Stress reduction: relaxation techniques, meditation, and/or yoga, counseling, exercise
herniation
A weakness in the abdominal muscle wall through which a segment of the bowel or other abdominal structure protrudes
Any hernia that is not reducible requires immediate surgical evaluation
strangulated hernia
there is ischemia and obstruction of the bowel loop, which can lead to necrosis of the bowel, sepsis and possible bowel perforation. Signs of strangulation are abdominal distention, N/V, pain, fever, and tachycardia
assessment hernication
- “Lump” or protrusion
- Absent bowel sounds = medical emergency
- The hernia is never forcibly reduced; this maneuver could cause strangulated intestine or rupture
non surgical management herniation
- Truss: a pad made with firm material
- Herniorrhaphy: a minimally invasive inguinal hernia repair (MIIHR) through a laparoscope is the surgery of choice, a conventional open herniorrhaphy performed when laparoscopy is not appropriate
hemmrrhoids
Swollen or distended veins in anorectal region
Internal, external, prolapsed
- Prevention of constipation, straining
- Bleeding, swelling, prolapse
- Manage pain, increase dietary fiber
- Hemorrhoidectomy can be performed if needed
