digestive tract disorders part 4 Flashcards
Weakness in the abdominal wall that allows a portion of the large intestine to push through
Classified as reducible or irreducible
Abdominal Hernia
s/s of Abdominal Hernia
A smooth lump on the abdomen
With incarceration, the patient has severe abdominal pain and distention, vomiting, and cramps
Weak locations include the umbilicus and the lower inguinal areas of the abdomen; may also develop at the site of a surgical incision
medical management of Abdominal Hernia
Surgical repair
Herniorrhaphy
Hernioplasty
Nursing Assessment of Abdominal Hernia
Chief complaint (ask about mesh use in previous surgeries)
Ask about pain and vomiting
Inspect for abnormalities, and listen for bowel sounds in
Preoperative interventions of Abdominal Hernia
Risk for Injury
Impaired Skin Integrity
Postoperative interventions of Abdominal Hernia
Impaired Urinary Elimination
Constipation
Acute Pain
Risk for Injury
Ulcerative colitis and Crohn’s disease
Inflammation and ulceration of intestinal tract lining
Exact cause is unknown
Possible causes: infectious agents, autoimmune reactions, allergies, heredity, and foreign substances
Inflammatory Bowel Disease
Diarrhea with frequent bloody stools, abdominal cramping
s/s of inflammatory^
Ulcerative colitis
If the stomach and duodenum are involved, symptoms include nausea, vomiting, and epigastric pain
Involvement of the small intestine produces pain and abdominal tenderness and cramping
An inflamed colon typically causes abdominal pain, cramping, rectal bleeding, and diarrhea
Systemic signs and symptoms include fever, night sweats, malaise, and joint pain
Crohn’s disease
complications of Inflammatory Bowel Disease
Hemorrhage, obstruction, perforation (rupture), abscesses in the anus or rectum, fistulas, and megacolon
Assessment of inflammatory Bowel Disease
Onset, location, severity, and duration of pain
Note factors that contribute to the onset of pain
Onset and duration of diarrhea; presence of blood
Vital signs, height and weight, measures of hydration
Inspect perianal area for irritation or ulceration
Maintain accurate intake and output records
Measure diarrhea stools if possible and count as output
Small saclike pouches in intestinal wall: diverticula
Weak areas of the intestinal wall allow segments of the mucous membrane to herniate outward
Diverticulosis
risk factors Diverticulosis
Lack of dietary residue
Age, constipation, obesity, emotional tension
s/s Diverticulosis
Often asymptomatic, but many people report constipation, diarrhea, or periodic bouts of each
Rectal bleeding, pain in left lower abdomen, nausea and vomiting, and urinary problems
Bleeding, obstruction, perforation (rupture), peritonitis, and fistula formation
Diverticulitis
medical treatment of diverticulosis
High-residue diet without spicy foods No seeds
Stool softeners or bulk-forming laxatives; antidiarrheals; broad-spectrum antibiotics; anticholinergics
Surgical intervention may be necessary
Assessment of Diverticulosis
Assess patient’s comfort and stool characteristics; note nausea and vomiting
Monitor patient’s temperature
Assess abdomen for distention and tenderness
Interventions of Diverticulosis
Fluids as permitted; monitor intake and output
Antiemetics, analgesics, anticholinergics as ordered
Be alert for signs of perforation
Teach patient about diverticulosis, including the pathophysiology, treatment, and symptoms of inflammation
Cancer of the large intestine
People at greater risk for colorectal cancer are those with histories of inflammatory bowel disease, or family histories of colorectal cancer or multiple intestinal polyps
High-fat, low-fiber diet and inadequate intake of fruits and vegetables also contribute to development
Can develop anywhere in the large intestine
Three fourths of all colorectal cancers are located in the rectum or lower sigmoid colon
Colorectal Cancer
Signs and symptoms Colorectal Cancer
Right side of the abdomen
Left side or in the rectum
Right side of the abdomen
Vague cramping until the disease is advanced
Unexplained anemia, weakness, and fatigue related to blood loss may be the only early symptoms
Left side or in the rectum
Diarrhea or constipation and may notice blood in the stool
Stools may become very narrow, causing them to be described as pencil-like
Feeling of fullness or pressure in the abdomen or rectum
Medical and surgical treatment Colorectal Cancer
Usually treated surgically
Combination chemotherapy postoperatively if tumor extends through the bowel wall or if lymph nodes involved
Early stage rectal cancer sometimes treated with radiation and surgery
Assessment
Colorectal Cancer
Vital signs, intake and output, breath sounds, bowel sounds, and pain
Appearance of wounds and wound drainage
If there is a colostomy, measure and describe the fecal drainage
Small growths in the intestine
Most benign but can become malignant
Inherited syndromes: familial polyposis and Gardner’s syndrome
Usually asymptomatic; found on routine testing
Complications are bleeding and obstruction
Diagnosed by barium enema or endoscopic exam
Colectomy for familial polyposis or Gardner’s syndrome because of the high risk of malignancy
Polyps
Internal or external dilated veins in the rectum
Thrombosed
Blood clots form in external hemorrhoids; become inflamed and very painful
Hemorrhoids
Risk factors of Hemorrhoids
Constipation, pregnancy, prolonged sitting or standing
Signs and symptoms of Hemorrhoids
Rectal pain and itching
Bleeding with defecation
External hemorrhoids easy to see; appear red/bluish
Medical diagnosis and treatment Hemorrhoids
Nonsurgical treatment
Topical creams, lotions, or suppositories soothe and shrink inflamed tissue
Sitz baths often comforting
The physician may order heat or cold applications
Outpatient procedures: ligation, sclerotherapy. Thermocoagulation/electrocoagulation, laser surgery
Hemorrhoidectomy
The surgical excision (removal) of hemorrhoids
Assessment
Hemorrhoids
After hemorrhoidectomy, monitor vital signs, intake and output, and breath sounds. Assess the perianal area for bleeding and drainage
An infection in the tissue around the rectum
Anorectal Abscess
Signs and symptoms of Anorectal Abscess
are rectal pain, swelling, redness, and tenderness
treatment of Anorectal Abscess
Treated with antibiotics followed by incision and drainage
Preoperatively of Anorectal Abscess
Preoperatively, pain is treated with ice packs, sitz baths, and topical agents as ordered
Postoperatively of Anorectal Abscess
Postoperatively, pain treated with opioid analgesics
Patient teaching emphasizes importance of thorough cleansing after each bowel movement
Advise patient to consume adequate fluids and a high-fiber diet to promote soft stools
Laceration between the anal canal and the perianal skin (small, oval shaped tear in skin that lines the opening of the anus
Anal Fissure
cause Anal Fissure
May be related to constipation, diarrhea, Crohn’s disease, tuberculosis, leukemia, trauma, or childbirth
Signs and symptoms Anal Fissure
include pain before and after defecation and bleeding on the stool or tissue
medical management Anal Fissure
If fissure chronic, the patient may experience pruritus, urinary frequency or retention, and dysuria
Usually heal spontaneously, but can become chronic
Conservative treatment: sitz baths, stool softeners, and analgesics
Surgical excision may be necessary
Abnormal opening between anal canal and perianal skin
Develops from anorectal abscesses or related to inflammatory bowel disease or tuberculosis
Patient typically complains of pruritus and discharge
Sitz baths provide some comfort
Anal Fistula
surgical management Anal Fistula
Surgical treatment is excision of fistula and surrounding tissue
Sometimes a temporary colostomy to allow the surgical site to heal
Postoperative care:Anal Fistula
analgesics and sitz baths for pain
Located in the sacrococcygeal area
Results from an infolding of skin, causing a sinus that is easily infected because of its closeness to the anus
Once infected, it is painful and swollen and may form an abscess
Pilonidal Cyst
medical management Pilonidal Cyst
Surgical excision usually recommended
Care is similar to that for the patient having a hemorrhoidectomy
