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57 Cards in this Set

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Etiology of Flatulance
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
CM of Flatulance
Increased passage of gas
Abdominal bloating
Pain & belching
Interventions for Flatulance
Changing diet
Medications
Reducing the amount of air swallowed
Constipation
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
Etiology of Constipation
-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)
CM of Constipation
-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
Diagnostic STudies for Constipation
History & Physical exam
Abdominal X-rays/barium enema
Stool for occult blood
Colonoscopy
Sigmoidoscopy
Anorectal manometry
Defecograpy
Pelvic floor MRI
Complications of Constipation
HTN
Fecal impaction
Hemorrhoids
Fissures
Megacolon
Increased valsalva maneuver
Nursing Diagnosis for
Constipation related to inadequate intake of dietary fiber and fluid and ↓ physical activity

Disuse Syndrome, risk for

Knowledge deficit: laxatives or other medications

Pain
Management of Constipation
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
Etiology of Flatulance
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
CM of Flatulance
Increased passage of gas
Abdominal bloating
Pain & belching
Interventions for Flatulance
Changing diet
Medications
Reducing the amount of air swallowed
Constipation
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
Etiology of Constipation
-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)
CM of Constipation
-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
Diagnostic STudies for Constipation
History & Physical exam
Abdominal X-rays/barium enema
Stool for occult blood
Colonoscopy
Sigmoidoscopy
Anorectal manometry
Defecograpy
Pelvic floor MRI
Complications of Constipation
HTN
Fecal impaction
Hemorrhoids
Fissures
Megacolon
Increased valsalva maneuver
Nursing Diagnosis for
Constipation related to inadequate intake of dietary fiber and fluid and ↓ physical activity

Disuse Syndrome, risk for

Knowledge deficit: laxatives or other medications

Pain
Management of Constipation
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
Diarrhea
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)
3 Types of diarrhea
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
CM of Diarrhea
Manifestations
Increased frequency and fluid content of stools
Abdominal cramps
Distention
Borborygmus
Painful spasmodic contractions of the anus
Tenesmus
Anorexia
Thirst
Complications of Diarrhea
Complications
Fluid and electrolyte imbalances (↓K)
Dehydration
Cardiac dysrhythmia
Skin irritation
Diarrhea Diagnostic Tests
History & Physical exam
Stool exam for infectious or parasitic or bacterial toxins
Culture & Sensitivity stool
Electrolytes
CBC
Capsule endoscopy & colonoscopy
Nursing Diagnosis for Diarrhea
Diarrhea
Fluid volume deficit, risk for
Skin integrity, impaired, risk for
Nutrition, altered: less than body requirements
Pain
Fatigue
Nursing Interventions for Diarrhea
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)
Fecal Incontinence, Etiology
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
Manifestations of Fecal Incontinence
involuntary defecation from distended rectum
Minor soiling, occasional urgency & loss of control, or complete incontinence
Poor control of flatus, diarrhea or constipation
Diagnostic Tests for Fecal Incontinence
Rectal exam
Abdominal x-ray, CT
Anorectal manometry/ultrasonography
Anal manometry
Defecography
Flexible sigmoidoscopy
Nursing Diagnosis for Fecal Incontinence
Bowel incontinence
Skin integrity, impaired, risk for
Self-care deficit: toileting
Social interaction, impaired, risk for
Self-esteem disturbance, risk for
Medical Management of Fecal incontinence
Treat underlying causes
Biofeedback therapy
Pelvic floor muscle training
Surgery
- surgical reconstruction
- Artificial sphincter implantation
- Sphincter repair
- Fecal diversion
Nursing interventions of Fecal incontinence
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
Complications of Fecal incontinence
Skin breakdown
Odor
Decreased or lost self-esteem
Disrupted family patterns
Intestinal Obstruction
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
Etiology of Intestinal Obstruction
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)
CM of SMALL Intestinal Obstruction
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
CM of LARGE bowel obstruction
Onset slow
Constipation
Stool shape altered
Bleeding
Weakness, Wt loss
Anorexia
Distented abdomen
Crampy lower abdominal pain
Fecal vomiting
Shock-late sign
Diagnostic Tests for intestinal Obstruction
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
Nursing Diagnosis for INtestinal Obstruction
Fluid volume deficit
Pain
Aspiration, risk for
Body temperature, altered, risk for
Nutrition, altered: less than body requirements
Anxiety
Management of Intestinal Obstruction
NGT
IV
Surgery
Monitoring I & O
NPO status
Promote comfort – NO PAIN MEDS
Monitor electrolytes
Monitor for signs of dehydration
Preop teaching
Hemorrhoids
Dilated hemorrhoidal veins

Two types: internal & external
Symptoms (rectal bleeding, itching, prolapse & pain)
Periodical depending on the amount of anorectal pressure
Etiology of Hemorrhoids
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
CM of Hemorrhoids- External
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
CM of Hemorrhoids- INTERNAL
Usually asymptomatic
Painless rectal bleeding
Can develop iron deficiency anemia
Painful if prolapse or thrombosis occurs
Dx tests for Hemorrhoids
- Digital rectal exam
- Anoscopy
- Sigmoidoscopy
Tx for Hemorrhoids
Non Surgical
Infrared coagulation
Laser therapy
Sclerotherapy

Surgical
Cryosurgical hemorrhoidectomy –freezing (not widely used)
Rubber band ligation
Stapled hemorrhoidopexy (new)
- Hemorrhoidectomy
Nursing interventions for Hemorrhoids
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
Diverticular Dz
May occur anywhere in the intestine but are most common in the sigmoid colon
Diverticular disease increases with age & associated with low-fiber diet
Diverticulum (Plural Diverticula)
– saccular herniation of the lining of the bowel through a defect in the muscle layer
Diverticulosis:
multiple diverticula without inflammation
Diverticulitis:
infection and inflammation of diverticula
CM of Diverticulosis
Majority of patients –no symptoms
abdominal distention
Nausea
Bloating
Changes in bowel habits
Anorexia
Abdominal cramps
Narrow stools
Constipation
CM of Diverticulitis
LLQ abdominal pain
Nausea & vomiting
Fever & chills
Leukocytosis
Complications of Diverticular Disease
Perforation with peritonitis
Abscess & fistula formation
Obstruction
Bleeding
Dx studies for Diverticular Disease
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)
Management of Diverticular Disease
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