Lower GI Tract Issues and Nursing Care

• This chapter excerpt focuses on common issues of the lower gastrointestinal (GI) tract and their related nursing care. It is organized around conditions affecting the lower GI tract such as constipation, diarrhea, appendicitis, peritonitis, diverticulosis/diverticulitis, and lower gastrointestinal bleeding, including symptoms, tests and treatments. It emphasizes the importance of preventative measures.

Lower Gastrointestinal System

• The lower gastrointestinal system components include the small and large intestines, the rectum, and the anus.

Constipation

• Constipation occurs when the fecal mass is retained in the rectum, causing it to become dry and hard.
• Prolonged constipation is referred to as obstipation.

Signs and Symptoms:

• Abdominal pain and distention can occur.
• Other symptoms include indigestion, intestinal rumbling, and rectal pressure.
• Incomplete emptying and hard stool may be noted.
• Headache, fatigue, decreased appetite, and straining during bowel movements are also indicators.

Complications:

• Complications can include impaction and ulcers.
• Straining and megacolon are also possible.

Diagnostic Tests:

• Self-diagnosis is common and can be confirmed with a health history, physical, and a rectal exam.

Prevention:

• Prevention includes a high-fiber diet and drinking 2 to 3 liters of fluid daily.
• Strengthening abdominal muscles and regular exercise are also important.
• Bulk-forming agents and stool softeners can be helpful.
• Patient education is key for prevention.

Diarrhea

• Diarrhea involves the rapid passage of fecal matter, resulting in decreased absorption of water and nutrients.
• It can be caused by bacterial or viral infections and food allergies.

Signs and Symptoms:

• Symptoms include fever and foul odor.
• Abdominal cramping, distention, anorexia, and intestinal rumbling may also occur.

Therapeutic Interventions:

• Interventions involve identifying the cause and replacing fluids and electrolytes.
• Increasing fiber and bulk in the diet is also important.
• Medications like diphenoxylate (Lomotil) and loperamide (Imodium) can be used.
• Probiotics like Lactinex can restore normal flora.
• Antimicrobial agents may be used for infections.

Nursing Concerns:

• Nurses should address diarrhea and the risk for deficient fluid volume.
• Providing sufficient knowledge to the patient is also crucial.

Prevention:

• Washing hands with soap and water is vital for prevention.

Appendicitis

• Appendicitis is the inflammation of the appendix.

Signs and Symptoms:

• Signs and symptoms include fever, nausea/vomiting, and anorexia.
• Pain in the right lower quadrant, specifically at McBurney's point, is a key indicator.

Diagnostic Tests:

• Complete blood count (CBC), ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI) are used for diagnosis.

Therapeutic Interventions:

• Therapeutic interventions include keeping the patient NPO (nothing by mouth) and applying ice.
• Positioning the patient in a semi-Fowler's position is recommended.
• Surgery and post-operative care are typically required.

Complications:

• Abscess formation is a potential complication.

Peritonitis

• Peritonitis is the inflammation/infection of the peritoneum.

Causes:

• Causes include ruptured appendix, peptic ulcer, pancreatitis, and diverticulitis.

Signs and Symptoms:

• Symptoms include abdominal pain, abdominal rigidity, nausea/vomiting, and fever.

Diagnostic Tests:

• Diagnostic tests involve checking white blood cell count and abdominal x-ray or CT scan.
• Exploratory surgery may also be necessary.

Therapeutic Interventions:

• Interventions include keeping the patient NPO.
• Fluid and electrolyte replacement is essential.
• A nasogastric (NG) or orogastric tube may be needed.
• Antibiotics and surgery are often required.
• Pain management is also a key component.

Complications:

• Complications include intestinal obstruction, hypovolemia (due to fluid shift into the peritoneal cavity), and sepsis.

Diverticulosis/Diverticulitis

• Diverticulum refers to an outpouching of the bowel mucous membrane.
• Diverticulosis is the presence of multiple diverticula.
• Diverticulitis is the inflammation/infection of a diverticulum.

Causes:

• Causes include chronic constipation and decreased intake of dietary fiber.

Risk Factors:

• Risk factors include a low-fiber and high animal-fat diet, obesity, sedentary lifestyle, smoking, and certain medications.

Signs and Symptoms:

• Patients may be asymptomatic.
• Symptoms include constipation, possibly diarrhea, cramping, bleeding, and abdominal tenderness.

Diagnostic Tests:

• Flexible sigmoidoscopy or colonoscopy and CT scans are used for diagnosis.

Therapeutic Interventions:

• For mild cases, Tylenol, antibiotics, and a liquid diet may be prescribed.
• Severe cases require pain control, NPO status, IV antibiotics, IV fluids/nutrition, and possibly surgery.

Lower Gastrointestinal Bleeding

• Lower gastrointestinal bleeding can be caused by diverticulitis, polyps, anal fissures, hemorrhoids, inflammatory bowel disease, and cancer.

Signs and Symptoms:

• Signs and symptoms include occult blood, melena, and bright-red stools.
• Nursing care involves monitoring stools/bleeding, vital signs, and signs of shock.
• Diagnostic preparation may also be necessary.

This section reviews common lower gastrointestinal (GI) problems along with nursing care. The content covers constipation, diarrhea, appendicitis, peritonitis, diverticulosis/diverticulitis, and lower GI bleeding. Preventative measures, symptoms, tests and treatments are emphasized.