TLO 2.4 Gastrointestinal/Bowel Adult Flashcards
Barium enema, what is it?
X-ray exam where contrast medium is inserted rectally
Identified structural abnormalities of colon and rectum
Generally no sedation
Enemas not sterile
Barium enema nursing implications
Pre procedure: Signed consent Clear liquids 24 hr prior, NPO 8 hr prior Bowel prep Post procedure: Increase fluid intake Take laxative if ordered Stools white until barium expelled
Gastrointestinal diagnostic tests
Proctoscopy
Visualized rectum using proctoscope
Air inserted to expand rectum
Evaluate abnormal results from the barium enema
Looks at causes of bleeding and monitor polyp growth
Proctoscopy nursing implications
Enema day before or day of the cleanse bowel
Cramping and pressure common during procedure
Normal to feel and hear air escaping during procedure
If cramps continue post= ambulate
Knee chest or left lateral position
Signed consent
Sigmoidoscopy what is it?
Provides visualization of anal canal, rectum and sigmoid colon
Rigid metal scope or flexible scope
Usually no sedation
Sigmoidoscopy nursing implications
Signed consent Bowel prep pre policy/order Clear liquid diet 24-48 hr prior NPO after midnight prior May have cramping after If biopsy done may have some blood traces, avoid high fiber foods for 1-2 days, no heavy lifting for 7 days
Colonoscopy, what is it?
Visualization of entire colon to the ileocecal valve using a flexible endoscope
Identifies tumors, polyps and inflammatory bowel diseases
Can dilate strictures
Colonoscopy nursing implications
Bowel prep per orders
Diet per order, clear liquids, NPO, no red/purple liquids
Sedation usually given, need consent
if polyps removed: avoid high fiber foods 1-2 days, no heavy lifting for 7 days
Hernias, what is it?
A defect in the abdominal wall that allows its contents to protrude out of the abdominal cavity
Types of hernias?
Umbilical:
-located by the umbilicus
Inguinal:
- direct: defects and weakness of the posterior inguinal wall, usually affect older adults
- indirect: congenital
Femoral
Strangulated (blocks and obstructs blood flow to intestine). This is a common complication with umbilical hernias
Hernia surgical treatment
herniorrhaphy:
involves reinforcing the weakened area with a wire, fascia or mesh
Strangulated hernia
Requires exploratory surgery and infarcted bowel resected.
Post operative hernia care assessment
Assess: Bowel sounds Abdominal distention Pain Incision Lung sounds Coughing, deep breathing Ability to void
Factors affecting bowl elimination
Developmental age Diet Activity Psychologic factors Defecation habits Medications Diagnostic procedures Anesthesia and surgery Pathologic conditions Pain
Bowel assessment, history and assessment
Obtain history:
Normal bowel habits
Any changes
History of problems or use of aids
Assess:
Bowel sounds
Follow- inspect, auscultate, percuss, palpate
Bowel assessment sounds and color
Sounds:
Active- high pitched approx. 5-15 gurgles/min
Hypo- low pitched, infrequent, quiet
Hyper- very high pitched more frequent
Absent- no sounds after 3-5 min
Color:
Normal- brown r/t bile pigment
Light brown- r/t diet high in milk, low in meat
Pale- r/t malabsorption of fat
Black/tarry- r/t iron, upper GI bleed, diet high in red meat
Bowel assessment shape and consistency
Shape:
Normal- approx. 1” in diameter about size of rectum
Narrow/pencil like- constriction, obstruction, rapid peristalsis
Small marble- slow peristalsis longer time in intestine
Consistency:
Normal- formed moist and soft
Hard- constipation, dehydration
Liquid- diarrhea, rapid peristalsis, infection
Patient teaching for constipation
Increase fluid intake at least 2500 mL/day
Drink glass of warm water before breakfast
High natural fiber diet unless contraindicated
Encourage ambulation or chair exercises
Doctor may prescribe bulk laxatives long term
Laxatives for occasional use not long term
Provide privacy
Keep patient routines
Hemorrhoid what are they and causes
Rectal lesion common in adults classified as internal or external
Straining to defecate
Pregnancy
Prolonged sitting
Obesity
Hemorrhoid assessment, internal
Internal: Rarely cause pain Usually have bleeding that is bright red Recurrent bleeding may cause anemia Mucous discharge and feeling of incomplete emptying of stool
Hemorrhoid assessment, external
External:
Bleeding is rare
Anal irritation
Feeling of pressure
Difficulty cleaning anal region
Enlargement may cause protrusion through anus
Prolapsed hemorrhoids can be extremely painful
Hemorrhoidectomy nursing care
Pain: meds, ice, sitz bath, side laying
Stool softeners as prescribed, constipation common post op
Encourage fluid intake
Report bleeding, fever >100, purulent drainage
Bowel obstruction, what is it?
Failure of intestinal contents to move through the bowel lumen. More commonly involving the small intestine
Bowel obstruction risk factors
Previous abdominal surgery
Complains of abdominal pain, bloating, constipation
Previous history of bowel obstruction
Inflammatory bowel disease history
Bowel obstruction, mechanical
Mechanical: Scar tissue (adhesions) Hernias (strangulated) Inflammatory bowel disease Tumors
Bowel obstruction, funtional
Functional:
Peristalsis fails to propel intestinal contents
No mechanical causes
Paralytic ileus most common following abdominal surgery
Assessment of small bowel obstruction, high obstructions
Vomiting (bile and mucus)
Abdominal distention minimal
Cramping
Bowel sounds high pitched and tinkling present in attempt to propel past obstruction
Paralytic ileus: bowel sounds diminished or absent
Fluid and electrolyte imbalances occur r/t vomiting
H2O and sodium drawn into bowel causing vascular fluid losses causing hypovolemia
Assessment of small bowel obstruction, low obstruction
Vomiting (fecal matter)
Flatus and feces present are expelled then cease
Abdominal distention pronounced
Cramping
Bowel sounds high pitched and tinkling present in attempt to propel past obstruction
Paralytic ileus: bowel sounds diminished or absent
Fluid and electrolyte imbalances occur r/t vomiting
H2O and sodium drawn into bowel causing vascular fluid losses causing hypovolemia
Medical treatment for obstructions
Most partial small bowel obstruction treated with NG tube
- low suction to decompress abdomen
- collects fluids and gas
- Allows bowel to rest until peristalsis resumes or obstruction is relieved
Surgical treatment for obstructions
Required for complete mechanical obstruction and strangulated obstruction
- lysis of adhesions
- resection of tumor
- foreign body removal
- colostomy may be performed to relieve obstruction
NG tube inserted prior and IV fluids to repair electrolyte imbalances particularly potassium prior to surgery
Why an ostomy?
Traumas (gun shot wounds) Inflammatory bowel disorders (colitis, Crohns) Tumors/cancer resections Bowel perforation Necrotic bowel
Types of ostomy
Precise name of the ostomy depends upon its location of the stoma
- ileostomy
- cecostomy
- ascending colostomy
- transverse colostomy
- descending colostomy
- sigmoid colostomy
Permanence ostomy, temporary and permanent
Temporary:
Traumatic injury or inflammatory condition
Allow the distal portion of the bowel to rest and heal
Permanent:
Done when anus or rectum is nonfunctional (birth defect, cancer of bowel)
Ileostomy information
Opening made in ileum of small intestine
Generally colon and rectum removed, anus closed
Stool is liquid in nature
Loop ileostomy is temporary
Continent ileostomy info
Intra-abdominal reservoir constructed and valve formed to prevent leaking
Catheter is inserted into pouch to drain stool
Not frequently seen
Ileostomy nursing care post-op assess
Bleeding- small amounts
Stoma viability- healthy is pink, red, moist
Function- initial drainage dark green odorless. Later it thickens and is yellow brown
Empty- when nor more 1/3 full
Include contents as output
Ileostomy teaching
Self care
Meticulous skin care around peri-stomal area
Adequate fluid intake, high risk for dehydration
Report increase in stool frequency and amount
Low residual diet, no whole grains, seeds, spicy
Teach s/s food blockage- cramping, swelling of stoma, no output from stoma 4-6 hours
Colostomy stool characteristics
Ascending colostomy: fluid to semi fluid stool
Transverse colostomy- mushy stool
Descending colostomy- semi solid stool
Sigmoid colostomy- more solid stool/common permanent
Colostomy nursing care
Assess location of stoma and type of colostomy
Stoma appearance and surrounding skin
Cleanse around stoma with water, soap if sticky or stool present
Skin barriers
Empty pouch at 1/3 full
Replace bag PRN
Small blood post op normal
Colostomy teaching
Pouch care, skin management
Irrigation attempts to promote regular emptying
Provide practice time prior to discharge
Use return demo and teach back methods
No rectal temps, suppositories, enemas if rectum has been removed
No major diet changes: educate on food that cause odor and gas
