Management of Patients With Intestinal and Rectal Disorders PDF

Management of Patients With Intestinal and Rectal Disorders Part II Intestinal Obstructions, Disease of the Anorectum ❖ Intestinal Obstructions Blockage of small intestine or colon that prevents the normal flow of intestinal contents through intestin...

Management of Patients With Intestinal and Rectal Disorders Part II Intestinal Obstructions, Disease of the Anorectum ❖ Intestinal Obstructions Blockage of small intestine or colon that prevents the normal flow of intestinal contents through intestinal tract The obstruction can be partial or complete. Severity depends on the region affected, the degree of occluded to which the vascular supply to the bowel wall is disturbed. Most bowel obstructions occur in the small intestine. Adhesions are the most common cause of small bowel obstruction, then hernias and neoplasm.  Mechanical Causes of Obstructions A. Intussusception; B. Volvulus (twisting of bowel); C. Hernia  ❖ Small Bowel Obstruction Accumulation of intestinal contents, fluids and gas develops above the intestinal obstruction. Absorption of fluids is reduced resulting in distention and more gastric secretions. The increased pressure within the intestinal lumen decreases mucosal blood flow causing poor absorption, edema, congestion, necrosis, and possible perforation. Reflux vomiting results in loss of hydrogen ions and potassium from stomach, leading to reduction of chloride & K in blood & result in Metabolic Alkalosis. Metabolic Acidosis from loss of intestinal alkaline fluids, hypovolemic & septic shock may occur.  Clinical Manifestations Crampy pain: Wavelike,& Colicky. Patient may pass blood and mucus but not fecal matter or flatus. Vomiting. If obstruction is complete, the peristaltic waves become extremely vigorous and assume a reverse direction of intestinal content propelled toward the mouth. If obstruction is in the ileum, fecal vomiting occur. Dehydration, drowsiness, general malaise, distended abdomen. Shock may occur.  Medical & Nursing Management ▪ Dx: Abdominal X-RAY & CT, abnormal large quantities of gas or fluid in the intestine, laparoscopy. ▪ Medical & Nursing Management: NGT or small bowel tube for decompression. Monitoring for bowel ischemia. Surgical Treatment: (repairing hernia & dividing adhesion, removed portion of affected bowel) depends on the cause, duration of obstruction, and condition of the bowel. Nurse should assess nasogastric output, assess for fluid & electrolyte imbalances, assess nutritional status, provide perioperative nursing care if surgery is needed. Assessing improvement.  ❖ Large Bowel Obstruction Obstruction of the colon can lead to severe distention and perforation. May not be dramatic if blood supply is not disturbed. If blood supply is cut off, strangulation and necrosis of the bowel may occur- a life-threatening condition. Dehydration occurs more slowly because the colon can absorb its fluid contents. Most obstructions in the large bowel occur in the sigmoid colon. The most common causes are carcinoma, diverticulitis, inflammatory bowel disorders & tumors.  Clinical Manifestations Symptoms develop and progress slowly. If the obstruction in the sigmoid or rectum, constipation may be the only symptoms for months. Blood loss in the stool result in iron deficiency anemia Weakness, weight loss & anorexia Abdominal distention Crampy lower abdominal pain Finally fecal vomiting Symptoms of shock may occur DX: Abdominal X-RAY & CT, or MRI, flexible sigmoidscopy to confirm diagnosis.  Medical & Nursing Management IV fluids, nasogastric aspiration & decompression. A colonoscopy to decompress and untwist the bowel. A cecostomy (surgical opening in the cecum) to urgently relieve distention and pressure if pt is at risk, rectal tube to decompress lower bowel. Metal colonic stent placed endoscopically. The usual treatment is surgical resection to remove the obstruction lesion. Total colectomy with ileoanal anastomosis if complete removal of the colon is needed. Patient may have a temporary or permanent colostomy.  Medical & Nursing Management ▪ Nursing Management: Nurse should monitor symptoms indicating that the obstruction is worsening. Emotional support & comfort Administer IV fluids & electrolytes as prescribed Provide perioperative nursing care Post surgery, routine postoperative nursing care is provided. ❖ Colorectal Cancer-Self reading Tumors of the colon and rectum (colortectal) are common ▪ Risk factors: age, family history, inflammatory bowel disease, smoking, obesity,high fat, protein & low fiber diet. The exact cause of colorectal cancer is still unknown S&S: Change in bowel habits, Rectal bleeding, anemia, weight loss, & fatigue. RX: Adjuvant therapy chemotherapy, radiation. ▪ Surgical management such as ▪ A colostomy: is the surgical opening into the colon by means of a stoma to allow drainage of bowel contents; it is one type of fecal diversion. Areas Where Cancer Can Occur Placement of Colostomies Disease of The Anorectum ❖ Anorectal Conditions Anorectal Abscess Anal Fistula Anal Fissure Hemorrhoids Pilonidal Sinus or Cyst Structure of the Rectum and Anus  Hemorrhoids Are dilated portions of veins in the anal canal. Types: Internal & External Classified by degree of prolapse; first, second, third & fourth degree. Causes: Pregnancy, alcoholism, chronic constipation. S & S: Itching & Painful defecation with bright-red bleeding. External hemorrhoids: Sever pain from inflammation & edema caused by thrombosis.  Hemorrhoids ▪ Rx: Symptoms & discomfort can be relived by good personal hygiene, avoiding excessive straining during defecation. ▪ High-residue diet (fruit, bran, increased fluid intake). ▪ Warm compresses, sitz baths, analgesic ointments & suppositories & bed rest reduce engorgement. ▪ Non Surgical Treatment: Infrared photocoagulation, bipolar diathermy, & laser therapy, sclerotherapy: injection of sclerosing agents. ▪ Surgical RX: rubber-band ligation, cryosurgical hemorrhoidectomy (freezing to cause necrosis before resection).  Pilonoidal Sinus or Cyst Cyst in the intergluteal cleft on the posterior surface of the lower sacrum. Resulting from local trauma, causing penetration of hairs into the epithelium and subcutaneous tissue. Hair frequently is seen protruding from these openings. Pilonidal (nest of hair) S & S: appear in early adult life; when infection produce irritating drainage or abscess Rx: Antibiotics, incision & drainage, packing with gauze to promote healing Pilonidal Sinus Nursing Process: The Care of the Patient With an Anorectal Condition—Assessment Health history Pruritus, pain, or burning Elimination patterns Diet Exercise and activity Occupation Inspection of the area ▪ Complication: ▪ Hemorrhage Nursing Process: The Care of the Patient With an Anorectal Condition—Diagnoses Constipation Anxiety Acute Pain Urinary Retention Risk for ineffective therapeutic regimen management Nursing Process: The Care of the Patient With an Anorectal Condition—Planning Major goals may include: ▪ Adequate elimination patterns ▪ Reduction of Anxiety ▪ Pain relief ▪ Promotion of urinary elimination ▪ Management of the therapeutic regimen ▪ Absence of complications  Interventions Encourage intake of at least 2 L of water a day. Recommend high-fiber foods. Bulk laxatives, Stool softeners, and topical medications. Promote urinary elimination. Hygiene and Sitz baths Monitor for complications Educate on self-care