Week 6 Nursing Flashcards
Constipation:
- An abnormal frequency of defaecation (infrequent)
- An abnormal regularity of defaecation (irregular)
- Abnormal hardening of stools (difficult passage)
- Decrease in stool volume
- Retention of stool in the rectum
Causes of Constipation
- Medications
- Rectal or anal disorders
- Obstruction
- Pre-existing conditions
– Metabolic, neurological, neuromuscular - Endocrine disorders
- Lead poisoning
- Connective tissue disorders
- Colon disease
- Acute disease
Risk factors
- Weakness and fatigue
- Immobility and debility
- Poor lifestyle habits
Pathophysiology
Interference with the 3 major functions of the colon:
– Mucosal transport
– Myoelectric activity
– Processes of defaecation
* Urge to defaecate stimulated by rectal distension
* Organic and idiopathic causes
Complications
- Hypertension
- Faecal impaction
- Haemorrhoids
- Fissures
- Megacolon
- Straining – Valsalva’s – arterial rupture
- Seepage of liquid stools
Clinical Manifestations
- Abdominal distension
- Borborygmus
- Pain and pressure
- Decreased appetite
- Headache
- Fatigue
- Indigestion
- Sensation of incomplete emptying
- Straining (at stool)
- Reduced volume, hard and dry stools
Assessment and Diagnostic findings
Most commonly diagnosed by:
* Patient history
* Physical Assessment
But also:
* AXR (abdominal X-Ray)
* PR (per rectum)
* Barium enema
* Sigmoidoscopy
* Stool occult blood testing (FOB)
* Anorectal manometry
* Pelvic floor MRI
Laxative classifications
Types of laxatives
* Bulk forming: Stimulate peristalsis
* Saline agent: Stimulate peristalsis
* Lubricant: Lubricate intestinal mucosa
* Stimulant: Irritates the colon
* Faecal softener: Hydrates the stool
* Osmotic Agent: Induces diarrhoea
Nursing Management
- Assessment:
– Health History: Normal bowel elimination, lifestyle info
– Medical/Surgical History - Medication: Laxative and enema use
- Signs and symptoms of constipation
- Patient education: Bowel habit training
- Health promotion: Risk factors
Diarrhoea:
- Increased frequency: > 3 per day
- Increased amount of stool: > 200g day
- Altered consistency: loose
Causes
- Underlying disease: IBS, IBD, intolerances
- Infection: bacterial or viral
- Medications
- Metabolic/Endocrine disorders:
- Malabsorption
- Intestinal obstruction
Pathophysiology - diarrhoea
Types
* Secretory: Increased secretion into intestinal mucosa
* Osmotic: water pulled into intestines via osmotic pressure
* Malabsorptive: Inhibited absorption of nutrients
* Exudative; Changes in epithelial integrity e.g – due to chemotherapy
Clinical Manifestations - diarrhoea
- Increased frequency and volume of stools
- Abdominal cramps
- Distention
- Borborygmus: rumbling
- Anorexia: LOA
- Thirst
Assessment and Diagnostic Findings - diarrhoea
- Blood tests: Full blood count and chemical profile (FBC/FBE, U&E)
- Urinalysis
- Routine stool examination/culture
- Endoscopy
- Barium enema
Complications - diarrhoea
- Fluid and electrolyte loss: especially potassium
- Cardiac arrhythmias and death
- Dehydration
- Malnutrition: if chronic
- Micronutrient deficiencies
- Hypovolaemia: shock e.g due to Cholera
- Skin complications: dermatitis
Nursing Management - diarrhoea
- Assess: auscultation/palpation
- Monitor: stool charts and FBC
- Infection precautions
- Diagnostic testing: stool samples
- Rehydration
- Nutrition
- Anti-diarrhoeal medication: Loperamide (Imodium), Diphenoxylate Hydrochloride (Lomitil)
- Skin care
Causes - nausea and vomiting
- Motion sickness
- Early pregnancy
- Intense pain
- Emotional stress
- Gall bladder disease
- Food poisoning
- Enteroviruses
- Ulcers: gastric or duodenal: Haematemesis
- Oesophageal varices: Haematemesis
Pathophysiology - nausea and vomiting
- Visceral afferent stimulation: Peritoneal irritation, infection, hepatobiliary disorders
- CNS disorders: Vestibular, increased ICP, infection
- Irritation of the chemoreceptor trigger zone: Radiation therapy, medications
Assessment and Diagnostic Findings - nausea and vomiting
- Health history
- Physical examination
- Neuro assessment: CT/MRI, Blood tests: electrolytes and urea
- Abdo XRay: Seeking a mechanical cause
Nursing Management
- Assess: airway, pain, emesis: haematemesis?
- Monitor: nausea, FBC, LOC, hydration status
- Infection precautions
- Diagnostic testing
- Rehydration
- Nutrition
- Anti-emetics:
– Pro-kinetic (metoclopramide)
– Anti-histamines (promethazine)
– Serotonin antagonists (ondansetron)
