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57 Cards in this Set
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Etiology of Flatulance
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Three Sources:
1.Increased intake of gas, e.g. from swallowed air 2.↑ production of gas as certain undigested foods are broken down by harmless bacteria found in the colon 3.Swallowed air (aerophagia):occurs with improper swallowing -Rapid eating & drinking -Chewing gum -Sucking on hard candy -Drinking carbonated beverages -Loose dentures -Hyperventilation in anxious people -Gas forming foods: nuts, cabbage, broccoli, corn, legumes, onions & fiber |
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CM of Flatulance
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Increased passage of gas
Abdominal bloating Pain & belching |
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Interventions for Flatulance
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Changing diet
Medications Reducing the amount of air swallowed |
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Constipation
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A decrease in the frequency of bowel movements from what is “normal “ for the individual
Also includes: Difficult-to-pass stools Decrease in stool volume Retention of feces in the rectum Reduction in stool may indicate bowel obstruction by a tumor |
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Etiology of Constipation
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-Endocrine (DM) & Neurological diseases (Parkinson’s & multiple sclerosis)
-Endocrine disorders (hypothyroidism) -Diseases of the colon (irritable bowel syndrome & diverticular disease) -Side effect of some medications -Result of physical inactivity, stress, Depression, diet changes, lack of fluids, failure to respond to urge -Rectal or anal disorders -Obstruction (bowel tumors) -Overuse of laxatives -Hospitalization -Immobility -Acute disease process of abdomen (appendicitis) |
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CM of Constipation
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-Fewer than 3 BMs per week
Abdominal distention Decreased appetite Headache Fatigue Indigestion A sensation of incomplete evacuation Straining at stool Elimination of small-volume, hard, dry stools Bloating Nausea Increased flatulence Increased rectal pressure (straining, tenesmus) Hemorrhoids –common with chronic constipation Perforation Rectal mucosal ulcers & fissures Diverticulosis-chronic constipation |
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Diagnostic STudies for Constipation
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History & Physical exam
Abdominal X-rays/barium enema Stool for occult blood Colonoscopy Sigmoidoscopy Anorectal manometry Defecograpy Pelvic floor MRI |
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Complications of Constipation
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HTN
Fecal impaction Hemorrhoids Fissures Megacolon Increased valsalva maneuver |
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Nursing Diagnosis for
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Constipation related to inadequate intake of dietary fiber and fluid and ↓ physical activity
Disuse Syndrome, risk for Knowledge deficit: laxatives or other medications Pain |
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Management of Constipation
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Education
Bowel habit training Increased fiber & fluid intake Judicious use of laxatives (monitor for laxative abuse) Routine exercise Biofeedback Exercise and activity Cholinergic agents Cholinsesterase inhibitors Prokinetic agents (Reglan, Zelnorm) Amitiza |
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Etiology of Flatulance
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Three Sources:
1.Increased intake of gas, e.g. from swallowed air 2.↑ production of gas as certain undigested foods are broken down by harmless bacteria found in the colon 3.Swallowed air (aerophagia):occurs with improper swallowing -Rapid eating & drinking -Chewing gum -Sucking on hard candy -Drinking carbonated beverages -Loose dentures -Hyperventilation in anxious people -Gas forming foods: nuts, cabbage, broccoli, corn, legumes, onions & fiber |
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CM of Flatulance
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Increased passage of gas
Abdominal bloating Pain & belching |
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Interventions for Flatulance
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Changing diet
Medications Reducing the amount of air swallowed |
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Constipation
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A decrease in the frequency of bowel movements from what is “normal “ for the individual
Also includes: Difficult-to-pass stools Decrease in stool volume Retention of feces in the rectum Reduction in stool may indicate bowel obstruction by a tumor |
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Etiology of Constipation
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-Endocrine (DM) & Neurological diseases (Parkinson’s & multiple sclerosis)
-Endocrine disorders (hypothyroidism) -Diseases of the colon (irritable bowel syndrome & diverticular disease) -Side effect of some medications -Result of physical inactivity, stress, Depression, diet changes, lack of fluids, failure to respond to urge -Rectal or anal disorders -Obstruction (bowel tumors) -Overuse of laxatives -Hospitalization -Immobility -Acute disease process of abdomen (appendicitis) |
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CM of Constipation
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-Fewer than 3 BMs per week
Abdominal distention Decreased appetite Headache Fatigue Indigestion A sensation of incomplete evacuation Straining at stool Elimination of small-volume, hard, dry stools Bloating Nausea Increased flatulence Increased rectal pressure (straining, tenesmus) Hemorrhoids –common with chronic constipation Perforation Rectal mucosal ulcers & fissures Diverticulosis-chronic constipation |
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Diagnostic STudies for Constipation
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History & Physical exam
Abdominal X-rays/barium enema Stool for occult blood Colonoscopy Sigmoidoscopy Anorectal manometry Defecograpy Pelvic floor MRI |
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Complications of Constipation
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HTN
Fecal impaction Hemorrhoids Fissures Megacolon Increased valsalva maneuver |
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Nursing Diagnosis for
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Constipation related to inadequate intake of dietary fiber and fluid and ↓ physical activity
Disuse Syndrome, risk for Knowledge deficit: laxatives or other medications Pain |
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Management of Constipation
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Education
Bowel habit training Increased fiber & fluid intake Judicious use of laxatives (monitor for laxative abuse) Routine exercise Biofeedback Exercise and activity Cholinergic agents Cholinsesterase inhibitors |
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Diarrhea
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Increased frequency of bowel movements (passage of more than 3 loose or liquid per day)
Increased amount of stool Altered consistency of stool Usually associated with urgency, perianal discomfort, incontinence, or a combination of these factors. Acute - usually from infection & self limiting Chronic diarrhea (> 2-3 weeks) |
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3 Types of diarrhea
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1.Increased fluid secretion (Secretory diarrhea)
Usually high volume diarrhea Associated with bacterial toxins & neoplasms Clostridium difficile is the most identified agent Prokinetic agents (Reglan, Zelnorm) Amitiza 2. Decreased fluid absorption (Osmotic diarrhea) Rapid transit & malabsorption of water & electrolytes 3. Motility Disturbances (Malabsorptive diarrhea) - Combines mechanical & biochemical actions - Inhibiting effective absorption of nutrients liquid stool. - Irritable bowel syndrome: ↑ visceral sensitivity & transit time - Diabetic enteropathy: ↑ transit secondary to peripheral neuropathy - Gastrectomy : ↑ transit as a result of dumping syndrome |
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CM of Diarrhea
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Manifestations
Increased frequency and fluid content of stools Abdominal cramps Distention Borborygmus Painful spasmodic contractions of the anus Tenesmus Anorexia Thirst |
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Complications of Diarrhea
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Complications
Fluid and electrolyte imbalances (↓K) Dehydration Cardiac dysrhythmia Skin irritation |
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Diarrhea Diagnostic Tests
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History & Physical exam
Stool exam for infectious or parasitic or bacterial toxins Culture & Sensitivity stool Electrolytes CBC Capsule endoscopy & colonoscopy |
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Nursing Diagnosis for Diarrhea
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Diarrhea
Fluid volume deficit, risk for Skin integrity, impaired, risk for Nutrition, altered: less than body requirements Pain Fatigue |
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Nursing Interventions for Diarrhea
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Treat cause (avoid food and meds that cause diarrhea)
Interventions -Assess & monitor -Encourage bedrest & food low in bulk during acute episodes -Bland diet when able to tolerate foods -Avoid caffeine, carbonated beverages, and very hot & cold foods -Prevent dehydration & monitor electrolytes -Prevent skin breakdown -Medication as ordered (Imodium, Lomotil) -Handwashing before & after contact (most important to prevent transfer microbes) -Contact isolation- C-difficile (place pts in a private room, wear gloves & gown for all care) |
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Fecal Incontinence, Etiology
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Involuntary passage of stool from the rectum
Etiology Old age (weakness or loss of anal or rectal muscle tone) Sphincter relaxation Neurologic conditions (Stroke, Spinal cord injury, Parkinson’s) Anal Injury from trauma or surgery Inflammation & infection Childbirth, pelvic floor relaxation Anal intercourse Chronic constipation (fecal impaction) Urinary incontinence Laxative abuse |
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Manifestations of Fecal Incontinence
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involuntary defecation from distended rectum
Minor soiling, occasional urgency & loss of control, or complete incontinence Poor control of flatus, diarrhea or constipation |
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Diagnostic Tests for Fecal Incontinence
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Rectal exam
Abdominal x-ray, CT Anorectal manometry/ultrasonography Anal manometry Defecography Flexible sigmoidoscopy |
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Nursing Diagnosis for Fecal Incontinence
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Bowel incontinence
Skin integrity, impaired, risk for Self-care deficit: toileting Social interaction, impaired, risk for Self-esteem disturbance, risk for |
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Medical Management of Fecal incontinence
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Treat underlying causes
Biofeedback therapy Pelvic floor muscle training Surgery - surgical reconstruction - Artificial sphincter implantation - Sphincter repair - Fecal diversion |
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Nursing interventions of Fecal incontinence
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Assess rectal area
Bowel training program Medication (Metamucil, Imodium) as prescribed High fiber diet Bulk-forming laxatives Patient teaching (avoid coffee, dried fruits, onions, spicy foods, green vegetables, fruits with peels) Skin Care |
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Complications of Fecal incontinence
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Skin breakdown
Odor Decreased or lost self-esteem Disrupted family patterns |
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Intestinal Obstruction
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Occurs when intestinal contents cannot pass through the intestinal tract
May occur in small intestine, or colon, partial or complete Requires prompt treatment if strangulated |
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Etiology of Intestinal Obstruction
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Etiology- 2 Types (Mechanical & Functional)
Mechanical : a detectable occlusion of the intestinal lumen Surgical adhesion –most common cause Hernias, tumors Volvulus (loop of bowel twisted on itself) Intussusception (one part of bowel slides into the next) Paralytic ileus |
Functional (Nonmechanical) obstruction: intestines cannot propel the contents along the bowel
Causes Paralytic ileus – most common Amyloidosis Muscular dystropy Endocrine disorders (DM) Neurologic disorders (Parkinson’s disease) Carcinomas (most common cause of large bowel obstruction) |
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CM of SMALL Intestinal Obstruction
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Crampy pain-wave-like & colicky
Blood and mucus Nausea & Vomiting Fecal vomiting Dehydration Abdominal distention Frequent high pitched bowel sounds above area of obstruction at first then absent as peristalsis decreased Hypovolemic Shock-late sign |
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CM of LARGE bowel obstruction
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Onset slow
Constipation Stool shape altered Bleeding Weakness, Wt loss Anorexia Distented abdomen Crampy lower abdominal pain Fecal vomiting Shock-late sign |
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Diagnostic Tests for intestinal Obstruction
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History & Physical exam
Laboratory – CBC, electrolytes, BUN amylase & stool samples (occult blood) Barium enema (DO NO USE for perforation) Radiology (CT scans & abdominal x-rays (most useful) MRI Colonoscopy |
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Nursing Diagnosis for INtestinal Obstruction
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Fluid volume deficit
Pain Aspiration, risk for Body temperature, altered, risk for Nutrition, altered: less than body requirements Anxiety |
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Management of Intestinal Obstruction
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NGT
IV Surgery Monitoring I & O NPO status Promote comfort – NO PAIN MEDS Monitor electrolytes Monitor for signs of dehydration Preop teaching |
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Hemorrhoids
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Dilated hemorrhoidal veins
Two types: internal & external Symptoms (rectal bleeding, itching, prolapse & pain) Periodical depending on the amount of anorectal pressure |
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Etiology of Hemorrhoids
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Increased intraabdominal pressure & weakening connective tissue supporting hemorrhoidal veins caused by
Pregnancy Constipation with prolonged straining Obesity Heavy lifting Prolonged sitting or standing Cirrhosis with portal hypertension Impaired blood flow through veins |
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CM of Hemorrhoids- External
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External
Reddish bluish skin in anal area Intermittent pain, pain on palpation, itching & burning Rarely bleed If thrombosed or rupture, then very painful Bleeding associated with defecation |
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CM of Hemorrhoids- INTERNAL
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Usually asymptomatic
Painless rectal bleeding Can develop iron deficiency anemia Painful if prolapse or thrombosis occurs |
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Dx tests for Hemorrhoids
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- Digital rectal exam
- Anoscopy - Sigmoidoscopy |
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Tx for Hemorrhoids
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Non Surgical
Infrared coagulation Laser therapy Sclerotherapy Surgical Cryosurgical hemorrhoidectomy –freezing (not widely used) Rubber band ligation Stapled hemorrhoidopexy (new) - Hemorrhoidectomy |
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Nursing interventions for Hemorrhoids
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Prevent constipation and straining
High residue diet (bran, fruits, vegetables) High fluid intake Regular exercise Maybe bulk-forming hydrophillic laxative (Metamucil) Stool softener (Colace) . Avoidance of prolong standing or sitting Comfort Good personal hygiene Apply ice compresses Warm sitz baths Topical analgesic Skin care Pain medications Seek medical care - excessive pain & bleeding, prolapsed hemorrhoids |
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Diverticular Dz
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May occur anywhere in the intestine but are most common in the sigmoid colon
Diverticular disease increases with age & associated with low-fiber diet |
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Diverticulum (Plural Diverticula)
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– saccular herniation of the lining of the bowel through a defect in the muscle layer
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Diverticulosis:
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multiple diverticula without inflammation
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Diverticulitis:
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infection and inflammation of diverticula
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CM of Diverticulosis
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Majority of patients –no symptoms
abdominal distention Nausea Bloating Changes in bowel habits Anorexia Abdominal cramps Narrow stools Constipation |
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CM of Diverticulitis
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LLQ abdominal pain
Nausea & vomiting Fever & chills Leukocytosis |
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Complications of Diverticular Disease
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Perforation with peritonitis
Abscess & fistula formation Obstruction Bleeding |
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Dx studies for Diverticular Disease
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CT scan with oral contrast (preferred)
Testing of stool for occult blood Barium enema Sigmoidoscopy Colonoscopy CBC Urinalysis Blood culture Abdominal x-ray Chest x-ray Erythrocyte Sedimentation Rate (ESR) |
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Management of Diverticular Disease
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Hospitalization for acute episodes
Antibiotic therapy IV fluids NPO NG tube Rest Analgesics (Demerol) Antispadmodics (Bro-Banthine, Daricon) Clear liquid diet progress to high-fiber, low-fat diet Bulk forming Laxative (Psyllium) Stool softener (colace) & suppository (Bisacodyl) |
Surgery for severe complications
- One-stage resection - Multiple-stage procedures CT –guided per cutaneous drainage -Abscess Prevention of constipation Foods to include High in fiber from fruits & vegetables ↓ intake of fat & red meat High level of physical activity Weigh reduction Avoid increased intra abdominal pressure |
