GI Lecture Fall 2024 Chapters 56-58 PDF

Chapter 56 Coordinating Care for Patients With Oral and Esophageal Disorders Copyright ©2020 F.A. Davis Company  Stomatitis  Pathophysiology Inflammation and ulceration of th...

Chapter 56 Coordinating Care for Patients With Oral and Esophageal Disorders Copyright ©2020 F.A. Davis Company  Stomatitis  Pathophysiology Inflammation and ulceration of the lining of the mouth Primary ‒ Painful oral ulcers, herpes simplex, and traumatic ulcers Secondary ‒ Viral, bacterial, or fungal Copyright ©2020 F.A. Davis Company  Stomatitis  Risk Factors Viral infections Chemotherapy Bacterial Allergic infections Vitamin deficiency Fungal Systemic disease infections Irritants (alcohol, tobacco, mouthwash) Radiation therapy Copyright ©2020 F.A. Davis Company  Oral Candidiasis Copyright ©2020 F.A. Davis Company  Stomatitis  Medical Management – Diagnosis Assessment of oral cavity before, during, and after chemotherapy and radiation therapy  Complications Pain Inflammation Copyright ©2020 F.A. Davis Company  Stomatitis  Nursing Management – Assessment and analysis Diagnosis is based on meticulous assessment Determining the offending irritant is necessary for treatment Copyright ©2020 F.A. Davis Company  Stomatitis  Nursing Management – Nursing diagnoses Acute pain Risk for infection Imbalanced nutrition, less than body requirements Impaired oral mucosa Knowledge deficit Impaired swallowing Copyright ©2020 F.A. Davis Company  Stomatitis  Nursing Interventions – Assessments Vital signs Oral mucosa Nutritional intake Weight Intake and output Copyright ©2020 F.A. Davis Company  Stomatitis  Nursing Interventions – Actions Aspiration precautions Administer medications as prescribed Viscous lidocaine Administer water-soluble lubricants for the lips and mouth Copyright ©2020 F.A. Davis Company  Stomatitis  Nursing Interventions – Teaching Mouth care after each meal Discourage use of alcohol-containing mouthwash Remove dentures Encourage regular dental check ups Encourage saline mouth rinse q4 hours Dietary choices Copyright ©2020 F.A. Davis Company  Stomatitis  Nursing Management – Evaluating care outcomes Prompt recognition of clinical manifestations Stable vital signs Stable fluid status Stable weight Copyright ©2020 F.A. Davis Company  Hiatal Hernia  Pathophysiology Portion of the stomach protrudes upward through esophageal hiatus ‒ Type 1 ‒ Type 2 Copyright ©2020 F.A. Davis Company  Hiatal Hernia  Risk Factors Residing in Western countries Obesity Pregnancy Smoking Copyright ©2020 F.A. Davis Company  Hiatal Hernia  Complications Gastroesophageal reflux Supradiaphragmatic volvulus  Medical Management – Diagnosis Upper abdominal x-ray Endoscopy Barium swallow with fluoroscopy Esophagogastroduodenoscopy Copyright ©2020 F.A. Davis Company  Hiatal Hernia  Medical Management – Medications Antacids Proton pump inhibitors H2-receptor antagonists Complimentary medicine Copyright ©2020 F.A. Davis Company  Hiatal Hernia  Nursing Management – Assessment and analysis Lifestyle changes can help reduce clinical manifestations. Hiatal hernia may be an incidental finding Copyright ©2020 F.A. Davis Company  Hiatal Hernia  Nursing Management – Nursing diagnoses Impaired swallowing Anxiety Pain Knowledge deficit Copyright ©2020 F.A. Davis Company  Hiatal Hernia  Nursing Interventions – Assessments Dysphagia Clinical manifestations of GERD Nausea and vomiting Iron-deficiency anemia  Nursing Interventions – Actions Medication management Position patient supine on right side Elevate HOB after meals Copyright ©2020 F.A. Davis Company  Hiatal Hernia  Nursing Interventions – Teaching Limit foods: spicy, caffeine, chocolate, carbonated, acidic, peppermint, alcohol, certain medications Eat meals 2 hours before lying supine Wear nonrestrictive clothing Maintain normal weight Proper positioning after eating Postoperative education Copyright ©2020 F.A. Davis Company  Hiatal Hernia  Nursing Management – Evaluating care outcomes Free from pain Adequate nutrition Copyright ©2020 F.A. Davis Company  Gastroesophageal Reflux Disease (GERD)  Pathophysiology Retrograde flow of GI contents into esophagus causing inflammation Copyright ©2020 F.A. Davis Company  Gastroesophageal Reflux Disease (GERD)  Risk Factors LES Delayed emptying hypotension of gastric contents Loss of Obesity esophageal Pregnancy motility Ascites Increased Tight belts or girdles compliance of Presence of a the hiatal canal nasogastric tube Increased states of gastric secretion Copyright ©2020 F.A. Davis Company  Gastroesophageal Reflux Disease (GERD)  Complications Barrett’s epithelium Strictures  Medical Management – Diagnosis Twenty-four hour ambulatory esophageal pH monitoring Esophagogastroduodenoscopy Esophageal manometry Copyright ©2020 F.A. Davis Company  Gastroesophageal Reflux Disease (GERD)  Medical Management – Medications Antacids Histamine receptor antagonists Prokinetic medications Proton pump inhibitors  Surgical Management Laparoscopic Nissen fundoplication Copyright ©2020 F.A. Davis Company  Gastroesophageal Reflux Disease (GERD)  Nursing Management – Assessment and analysis Clinical manifestations are due to the irritation from gastric material in the  esophagus Nursing Management – Nursing diagnoses Acute/chronic pain Risk for aspiration Impaired swallowing Imbalanced nutrition, less than body requirements Copyright ©2020 F.A. Davis Company  Gastroesophageal Reflux Disease (GERD)  Nursing Interventions – Assessments Respiratory Signs of Barrett’s symptoms esophagus Regurgitation Dental caries Severe Water brash atypical chest Eructation, pain flatulence, or Hemorrhage bloating CBC Nausea Dyspepsia Globus Dysphagia pH of gastric Copyright ©2020 F.A. Davis Company  Gastroesophageal Reflux Disease (GERD)  Nursing Interventions – Actions Administer medications as ordered Position patient on right side with HOB elevated 6–12 inches Provide small, frequent meals Copyright ©2020 F.A. Davis Company  Gastroesophageal Reflux Disease (GERD)  Nursing Interventions – Teaching Limit irritating foods Avoid smoking and alcohol Eat meals 2 hours before laying supine Wear nonrestrictive clothing Maintain ideal body weight Copyright ©2020 F.A. Davis Company  Gastroesophageal Reflux Disease (GERD)  Nursing Management – Evaluating care outcomes Maintain quality of life Avoid complications Copyright ©2020 F.A. Davis Company  Oral Cancer  Pathophysiology Most are squamous cell carcinoma Copyright ©2020 F.A. Davis Company  Oral Cancer  Clinical Manifestations Oral bleeding Raised area on the lip or in the mouth Oral ulcer with poorly defined margins, mucosal lesion, or nodule White and/or red patches in the oral cavity Increasing pain that radiates to the ear and neck Dysarthria Copyright ©2020 F.A. Davis Company  Oral Cancer  Clinical Manifestations (continued) Dysphagia Difficulty chewing Oral odor Regional lymph node involvement Weight loss Poor-fitting dentures Copyright ©2020 F.A. Davis Company  Oral Cancer  Medical Management – Diagnosis Complete blood count Chemistry profile Liver function test CT scan MRI Chest x-ray Copyright ©2020 F.A. Davis Company  Oral Cancer  Medical Management – Treatment Airway management Removal of source of irritation Radiotherapy Chemotherapy Chemoradiation Surgical removal Retinoids Beta-carotene Copyright ©2020 F.A. Davis Company  Oral Cancer  Complications Infection Facial edema Weight loss Difficulty/inability talking Dysphagia Rare but severe complications of radiotherapy include: Hearing loss Osteoradionecrosis (bone death from radiation) Trismus (difficulty opening the mouth) Copyright ©2020 F.A. Davis Company  Oral Cancer  Nursing Management – Assessment and analysis Clinical manifestations will affect daily functions by impacting the patient’s ability to eat and talk  Nursing Management – Nursing diagnoses Risk for ineffective airway clearance Imbalanced nutrition, less than body requirements Impaired verbal communication Acute or chronic pain Anxiety Copyright ©2020 F.A. Davis Company  Oral Cancer  Nursing Interventions – Assessments Ability to swallow Fluid intake Nutritional intake Weight Albumin and total protein Oral mucosa irritation or infection Lymph nodes Psychosocial adjustment Copyright ©2020 F.A. Davis Company  Oral Cancer  Nursing Interventions – Actions Airway management Aspiration precautions Maintain emergency bedside equipment Provide oral care Administer steroids as prescribed Provide cool mist Nutritional consult Copyright ©2020 F.A. Davis Company  Oral Cancer  Nursing Interventions – Teaching Aspiration Precautions Avoid tobacco and alcohol intake Provide nutritional education Oral hygiene Management of xerostomia Frequent sips of water or saliva substitutes  Nursing Management – Evaluating care outcomes Prevention by decreasing risk factors Copyright ©2020 F.A. Davis Company  Esophageal Cancer  Pathophysiology Rapidly growing cancer Spreads to lymph nodes and into esophageal lumen More than 50% metastasize Copyright ©2020 F.A. Davis Company  Esophageal Cancer  Risk Factors Barrett’s esophagus (columnar cells in the lower esophagus) G E R D (long term, untreated) Lye strictures (esophageal narrowing caused by lye ingestion) Nutritional deficiency (molybdenum, zinc, and vitamin A) Esophageal diverticula Achalasia (decreased esophageal smooth muscle relaxation) Tylosis (esophageal callus formation) Obesity (associated with hiatal hernia and G E R D) Copyright ©2020 F.A. Davis Company  Esophageal Cancer  Clinical Manifestations Progressive Weight loss dysphagia Anorexia Hemoptysis Hoarseness Burning sensation Melena in middle of chest Painful swallowing Vomiting Copyright ©2020 F.A. Davis Company  Esophageal Cancer  Medical Management – Diagnosis Screening Diagnostic tests ‒ Barium swallow ‒ CT scan ‒ PET scan Endoscopy Thoracoscopy Copyright ©2020 F.A. Davis Company  Esophageal Cancer  Surgical Management Esophagectomy Copyright ©2020 F.A. Davis Company  Esophageal Cancer  Complications Dysphagia Strictures Dumping syndrome Stomatitis Nausea and vomiting Diarrhea Copyright ©2020 F.A. Davis Company  Esophageal Cancer  Nursing Management – Assessment and analysis Clinical manifestations related to obstruction of esophageal lumen Copyright ©2020 F.A. Davis Company  Esophageal Cancer  Nursing Management – Nursing diagnoses Impaired swallowing Imbalanced nutrition, less than body requirements Acute/chronic pain Ineffective coping and compromised family coping Copyright ©2020 F.A. Davis Company  Esophageal Cancer  Nursing Interventions – Assessments Nausea and vomiting Painful swallowing Dysphagia Weight loss Hematocrit and hemoglobin Serum calcium levels Liver enzymes Psychosocial adjustment Copyright ©2020 F.A. Davis Company  Esophageal Cancer  Nursing Interventions – Actions Maintain HOB greater than 30 degrees Collaborate with nutritionist Provide six small meals per day Collaborate with speech Copyright ©2020 F.A. Davis Company  Esophageal Cancer  Nursing Interventions – Teaching Lines, tubes incisions Preoperative care Coughing, deep breathing, incentive spirometry, q2 turn, early ambulation Pain management Enteral or parenteral feeding Dental screening Postoperative education Copyright ©2020 F.A. Davis Company  Esophageal Cancer  Nursing Management – Evaluating care outcomes Lifestyle choices Enhancing quality of life Copyright ©2020 F.A. Davis Company  TEN vs TPN  TEN – Total Enteral Nutrition Oral, NG, PEG, J-tube  PPN – Peripheral Parenteral Nutrition Peripheral IV or central line  TPN – Total Parenteral Nutrition Central line only Copyright ©2020 F.A. Davis Company  Entriflex tube Weighted tip Copyright ©2020 F.A. Davis Company  Air vent Salem Sump Insertion – aspirate and check pH (per agency) - x-ray for confirmation Management after GI surgery Copyright ©2020 F.A. Davis Company  NG & PEG feedings  Management of feedings Residual checks Flushes  Medication administration Crush well Flush before and after Copyright ©2020 F.A. Davis Company  Enteral Feeding Complications  Aspiration  Misplaced or dislodged tube  Fluid and electrolyte imbalances  Abdominal distention, N/V  Diarrhea  Clogged tube Copyright ©2020 F.A. Davis Company  TPN  High concentration of dextrose and proteins  Management  Complications Alteration in blood sugar Infection Fluid overload Copyright ©2020 F.A. Davis Company  Chapter 57 Coordinating Care for Patients With Stomach Disorders Copyright ©2020 F.A. Davis Company  Microscopic Anatomy of the Stomach Wall Copyright ©2020 F.A. Davis Company  Gastritis  Epidemiology Caused by chronic stress to stomach lining ‒ Chronic ingestion of irritating foods ‒ Pathogens ‒ Overuse of aspirin or NSAIDs ’ ‒ Stress  Pathophysiology Prolonged irritation of the stomach Copyright ©2020 F.A. Davis Company  Gastritis  Clinical Manifestations Epigastric pain Nausea and vomiting Decreased appetite Changes in color of stool Copyright ©2020 F.A. Davis Company  Gastritis  Medical Management – Diagnosis Biopsy Upper GI x-ray series Urea breath testing Copyright ©2020 F.A. Davis Company  Gastritis  Medical Management – Treatment Supportive care for relieving clinical manifestations Reducing cause of discomfort  Surgical Management Vagotomy Gastretctomy Copyright ©2020 F.A. Davis Company  Gastritis  Nursing Management – Assessment and analysis Epigastric pain Nausea and vomiting Decreased appetite Weight loss Changes in color of stool Copyright ©2020 F.A. Davis Company  Gastritis  Nursing Management – Nursing diagnoses Acute pain Anxiety Deficient knowledge Risk for deficient fluid volume Copyright ©2020 F.A. Davis Company  Gastritis  Nursing Interventions – Assessments Vital signs History of presenting signs and symptoms Laboratory assessment Serum electrolytes Intake and output Copyright ©2020 F.A. Davis Company  Gastritis  Nursing Interventions – Actions Administer IV fluids Administer medications as ordered  Nursing Interventions – Teaching Immediately report hematemesis Take medications as prescribed Avoid irritants associated with gastric episodes  Nursing Management – Evaluating care outcomes Full recovery Recovery of appetite Copyright ©2020 F.A. Davis Company  Gastroenteritis  Inflammation of mucous membranes of stomach and intestinal tract  Viral or bacterial  Fecal-oral  N/V/D, abdominal cramping  Dehydration can occur  Handwashing  Fluid and electrolyte replacement Copyright ©2020 F.A. Davis Company  Peptic Ulcer Disease  Pathophysiology Damage to gastric mucosa Erosions due to corrosive action of gastric juice Copyright ©2020 F.A. Davis Company  Peptic Ulcer Disease  Clinical Manifestations Depends on ulcer location and patient age Pain triggered or worsened by eating With some ulcers, eating may alleviate pain Copyright ©2020 F.A. Davis Company  Peptic Ulcer Disease  Medical Management – Diagnosis Upper GI endoscopy  Medical Management – Medications Antacids H2-receptor antagonigst Proton Pump Inhibitors Mucosal barrier agents Copyright ©2020 F.A. Davis Company  Peptic Ulcer Disease  Surgical Management Indicated with nonhealing and bleeding ulcers Endoscopic procedures Copyright ©2020 F.A. Davis Company  Peptic Ulcer Disease  Complications GI hemorrhage Abdominal or intestinal infarction Perforation and penetration into attached structures Obstruction Peritonitis Copyright ©2020 F.A. Davis Company  Peptic Ulcer Disease  Nursing Management – Assessment and analysis Comprehensive physical exam and rule out of other causes of signs and symptoms Copyright ©2020 F.A. Davis Company  Peptic Ulcer Disease  Nursing Interventions – Assessments Vital signs Diet Gastric pH CBC Use of alcohol Blood culture or other Weight medications Serum electrolytes Pain Copyright ©2020 F.A. Davis Company  Peptic Ulcer Disease  Nursing Interventions – Actions Maintain IV infusions Administer medications as ordered Assist with gastric lavage Prepare patient for endoscopy Limit food intake after evening meal Document and report clinical manifestations Pain Copyright ©2020 F.A. Davis Company  Peptic Ulcer Disease  Nursing Interventions – Teaching Take medications as prescribed Avoid eating within 2 hours of bedtime Advise patients to avoid risk factors  Nursing Management – Evaluating care outcomes Increased comfort Pain control Tolerates diet Copyright ©2020 F.A. Davis Company  Gastric Cancer  Pathophysiology Begins as chronic gastritis Progresses to atrophy, intestinal metaplasia, dysplasia, then adenocarcinoma Copyright ©2020 F.A. Davis Company  Gastric Cancer  Clinical Manifestations Usually asymptomatic until late disease Indigestion Anorexia Weight loss Vague epigastric pain Vomiting Abdominal mass Copyright ©2020 F.A. Davis Company  Gastric Cancer  Medical Management – Diagnosis Barium x-ray Endoscopy Cytology Copyright ©2020 F.A. Davis Company  Gastric Cancer  Medical Management – Medications Antiemetics Opioid analgesics  Surgical Management Gastric resection Copyright ©2020 F.A. Davis Company  Gastric Cancer  Complications after surgery Dumping syndrome Wound infections Leaking of anastomotic sites Strictures Internal bleeding Copyright ©2020 F.A. Davis Company  Gastric Cancer  Nursing Management – Assessment and analysis There are typically no clinical manifestations early in disease. Clinical manifestations of advanced gastric cancer are related to tumor growth Copyright ©2020 F.A. Davis Company  Gastric Cancer  Nursing Management – Nursing diagnoses Pain Anxiety Fear Imbalanced nutrition, less than body requirements Impaired Gastric Motility Copyright ©2020 F.A. Davis Company  Gastric Cancer  Nursing Interventions – Assessments Physical examination Hematocrit and hemoglobin Serum electrolytes Bilirubin and alkaline phosphatase Modified oral glucose tolerance test Copyright ©2020 F.A. Davis Company  Gastric Cancer  Nursing Interventions – Assessments (continued) Comprehensive pain assessment Early signs of dumping syndrome Anxiety End of life care Copyright ©2020 F.A. Davis Company  Gastric Cancer  Nursing Interventions – Actions Small, frequent meals Verbalize feelings and concerns Prepare for surgery Copyright ©2020 F.A. Davis Company  Gastric Cancer  Nursing Interventions – Teaching Medication teaching Pain and precipitating factors High calorie, high protein meals Nutritional supplements Main signs dumping syndrome Relaxation techniques Copyright ©2020 F.A. Davis Company  Gastric Cancer  Nursing Management – Evaluating care outcomes Absence of infection Stable weight Reduced anxiety Optimal nutrition Relief of pain Adjustment to diagnosis Copyright ©2020 F.A. Davis Company  Chapter 58 Coordinating Care for Patients With Intestinal Disorders Copyright ©2020 F.A. Davis Company  Hernias  Pathophysiology Intestines protrude through abdominal opening ‒ Reducible vs incarcerated Caused may include ‒ Straining, lifting heavy objects, sudden twists, pulls or muscle strain, weight gain, chronic cough Copyright ©2020 F.A. Davis Company  Hernia  Risk Factors Obesity Smoking Excessive wound tension Malnutrition Pregnancy Medications Copyright ©2020 F.A. Davis Company  Hernia  Clinical Manifestations Bulge or visible swelling Copyright ©2020 F.A. Davis Company  Hernia  Medical Management – Diagnosis Physical examination Herniography  Surgical Management Hernia repair  Complications Strangulation of intestine Recurrence Copyright ©2020 F.A. Davis Company  Hernia  Nursing Management – Assessment and analysis Clinical manifestations are related to location and type of hernia  Nursing Management – Nursing diagnoses Acute pain Knowledge deficit Copyright ©2020 F.A. Davis Company  Hernia  Nursing Interventions – Assessments Vital signs Pain Intake and output Surgical site Copyright ©2020 F.A. Davis Company  Hernia  Nursing Interventions – Actions Deep breathing Pain medication Ice pack Clear liquid diet and advance as tolerated Copyright ©2020 F.A. Davis Company  Hernia  Nursing Interventions – Teaching Discourage coughing Avoid heavy lifting Pain management Observe incisions Copyright ©2020 F.A. Davis Company  Hernia  Nursing Management – Evaluating care outcomes Return to previous level of functioning Stable vital signs Absence of infection Normal bladder and bowel function Copyright ©2020 F.A. Davis Company  Intestinal Obstruction  Types Mechanical Nonmechanical Copyright ©2020 F.A. Davis Company  Obstruction  Problems Blockage and distention Hypovolemia/electrolyte imbalances Strangulation  Symptoms – alteration in stool/bowel sounds Small bowel – pain, peristaltic waves, upper GI distention, N/V, F&E imbalances, metabolic alkalosis Large bowel – lower abd. cramping, lower GI distention, metabolic acidosis (sometimes) Copyright ©2020 F.A. Davis Company  Management of Obstruction  Diagnosis Labs US CT scan/MRI Endoscopy  Nonsurgical management NPO, NG tube IV fluids Medications for motility Pain management Antibiotics Copyright ©2020 F.A. Davis Company  Surgical Management of Obstruction  Colon resection  Exploratory Laparotomy Pre-op Operative ‒ Laparoscopic/open approach Post-op ‒ NG Copyright ©2020 F.A. Davis Company  Hemorrhoids  Pathophysiology Swollen or dilated veins in anorectal area Internal or external Copyright ©2020 F.A. Davis Company  Hemorrhoids  Clinical Manifestations 40% are asymptomatic Bleeding Itching, irritation, pain Copyright ©2020 F.A. Davis Company  Hemorrhoids  Medical Management – Diagnosis Digital examination Anoscopy Sigmoidoscopy  Medical Management – Treatment Symptom relief Copyright ©2020 F.A. Davis Company  Hemorrhoids  Surgical Management Rubber band ligation Bipolar, infrared and laser coagulation Sclerotherapy Cryosurgery Hemorrhoidectomy Copyright ©2020 F.A. Davis Company  Hemorrhoids  Complications Infection Pain Urinary retention Fecal impaction Damage to sphincter Bleeding Abscess formation Copyright ©2020 F.A. Davis Company  Hemorrhoids  Nursing Management – Assessment and analysis Clinical manifestations may be accompanied by bleeding  Nursing Management – Nursing diagnoses Acute pain Knowledge deficit Risk for altered bowel elimination Risk for bleeding/fluid volume deficit Copyright ©2020 F.A. Davis Company  Hemorrhoids  Nursing Interventions – Assessments Vital signs Visual inspection of rectal area Frequency and character of bowel movements Bowel habits postoperatively Pain Copyright ©2020 F.A. Davis Company  Hemorrhoids  Nursing Interventions – Actions Analgesia prior to first bowel movement after surgery Local anesthetics Corticosteroids Provide cold packs and sitz baths Administer laxatives Apply local moist heat Copyright ©2020 F.A. Davis Company  Hemorrhoids  Nursing Interventions – Teaching Care of surgical site Measures to prevent constipation Avoid straining Avoid stimulant laxatives Nonpharmacologic methods of reducing pain When to contact healthcare provider Copyright ©2020 F.A. Davis Company  Hemorrhoids  Nursing Management – Evaluating care outcomes Return to normal functioning Adequate pain management Avoidance of constipation Copyright ©2020 F.A. Davis Company  Irritable Bowel Syndrome (IBS)  Pathophysiolog y Cause is unknown Abdominal pain and altered bowel habits for which no other cause can be found Copyright ©2020 F.A. Davis Company  Irritable Bowel Syndrome  IBS-D (diarrhea), IBS-C (constipation), IBS-A (alternating), IBS-M (mixed)  Clinical Manifestations Diarrhea Constipation Flatus Abdominal pain Copyright ©2020 F.A. Davis Company  Irritable Bowel Syndrome  Medical Management – Diagnosis Rome IV Diagnostic criteria  Medical Management – Treatment Medications Dietary modification Complementary and alternative therapies Copyright ©2020 F.A. Davis Company  Irritable Bowel Syndrome  Complications Social isolation Spasm, constipation, and diarrhea Fluid volume deficit Hypokalemia Copyright ©2020 F.A. Davis Company  Irritable Bowel Syndrome  Nursing Management – Assessment and analysis Clinical manifestations include abdominal distention and altered bowel  habits Nursing Management – Nursing diagnoses Chronic pain Ineffective coping Ineffective health maintenance Copyright ©2020 F.A. Davis Company  Irritable Bowel Syndrome  Nursing Interventions – Assessments Vital signs Intake and output Serum electrolytes Pain Bowel pattern Weight Psychosocial assessment Copyright ©2020 F.A. Davis Company  Irritable Bowel Syndrome  Nursing Interventions – Actions Administer ordered IV solutions Establish trusting relationship Avoid foods that exacerbate clinical manifestations Establish regular bowel routine Implement complementary and alternative medicines Copyright ©2020 F.A. Davis Company  Irritable Bowel Syndrome  Nursing Interventions – Teaching Avoid trigger foods Keep a food diary Consume regular meals and drink adequate water Encourage regular exercise Smoking cessation Copyright ©2020 F.A. Davis Company  Irritable Bowel Syndrome  Nursing Management – Evaluating care outcomes Stable vital signs and weight Decrease in clinical manifestations Patient’s understanding and adhering to nutrition and activity recommendations Copyright ©2020 F.A. Davis Company  Inflammatory Bowel Disease  Pathophysiology Exact cause is unknown Inappropriate response in intestinal tract causing inflammation Copyright ©2020 F.A. Davis Company  Inflammatory Bowel Disease  Clinical Manifestations Persistent diarrhea Abdominal pain or cramps Fever Weight loss Fluid imbalance Malnutrition Mouth ulcers Anemia Blood from rectum Copyright ©2020 F.A. Davis Company Copyright ©2020 F.A. Davis Company  Inflammatory Bowel Disease  Medical Management – Diagnosis Colonoscopy Sigmoidoscopy Barium enema  Medical Management – Treatment Fluid and electrolyte management Rest Medications Copyright ©2020 F.A. Davis Company  Inflammatory Bowel Disease  Surgical Management Colectomy Ostomy creation  Complications Perineal abscess Fistula Strictures Copyright ©2020 F.A. Davis Company  Inflammatory Bowel Disease  Nursing Management – Assessment and analysis Frequent diarrhea leads to extreme losses of fluid and electrolytes and hypokalemia  Nursing Management – Nursing diagnoses Deficient fluid volume Diarrhea Imbalanced nutrition, less than body requirements Copyright ©2020 F.A. Davis Company  Inflammatory Bowel Disease  Nursing Interventions – Assessments Vital signs Nutritional intake Frequency and characteristics of stool Intake and output Daily weight Fluid and electrolyte status Psychosocial assessment Copyright ©2020 F.A. Davis Company  Inflammatory Bowel Disease  Nursing Interventions – Actions Encourage smaller frequent meals Encourage patient to engage in mealtime with family Encourage periods of rest Establish therapeutic relationship Make appropriate referral to interprofessional team Pain management Provide meticulous skin care Copyright ©2020 F.A. Davis Company  Inflammatory Bowel Disease  Nursing Interventions – Teaching Importance of adequate nutrition Indications, actions, and side effects of prescribed medications Importance of regular follow-ups and annual colonoscopy Copyright ©2020 F.A. Davis Company  Inflammatory Bowel Disease  Nursing Management – Evaluating care outcomes Maintain healthy weight Stable vital signs Fluid and electrolytes balance Copyright ©2020 F.A. Davis Company  Diverticulitis  Pathophysiology Outpouching of intestinal wall that becomes inflamed Copyright ©2020 F.A. Davis Company  Diverticulitis  Clinical Manifestations Abdominal pain Fever Leukocytosis Palpable mass Copyright ©2020 F.A. Davis Company  Diverticulitis  Medical Management – Diagnosis Abdominal x-ray CT scan Endoscopy Copyright ©2020 F.A. Davis Company  Diverticulitis (continued_5)  Medical Management – Treatment Broad-spectrum antibiotics Clear liquid diet IV fluids NPO and bowel rest Copyright ©2020 F.A. Davis Company  Diverticulitis  Surgical Management Indicated for perforation, obstruction, abscess formation, fistula formation Copyright ©2020 F.A. Davis Company  Diverticulitis  Nursing Management – Assessment and analysis Clinical manifestations related to inflammation or infection, as well as G I manifestations Copyright ©2020 F.A. Davis Company  Diverticulitis  Nursing Management – Nursing diagnoses Acute pain Knowledge deficit Copyright ©2020 F.A. Davis Company  Diverticulitis  Nursing Interventions – Assessments Vital signs Serum potassium Intake and output Pain Mental status Copyright ©2020 F.A. Davis Company  Diverticulitis  Nursing Interventions – Actions Administer IV fluids Administer ordered antibiotics Nasogastric tube to lower intermittent suction Provide oral care Copyright ©2020 F.A. Davis Company  Diverticulitis  Nursing Interventions – Teaching Dietary recommendations Avoid straining, bending, lifting Weight reduction Complete antibiotic therapy as prescribed  Nursing Management – Evaluating care outcomes Free from abdominal pain Free from fever Copyright ©2020 F.A. Davis Company  Appendicitis  Pathophysiolog McBurney’s Point y Opening to appendix becomes blocked Mucosa secretes fluid Venous engorgement Restricted blood flow Copyright ©2020 F.A. Davis Company  Appendicitis  Clinical Manifestations Periumbilical abdominal pain Anorexia Nausea Vomiting Copyright ©2020 F.A. Davis Company  Appendicitis  Medical Management – Diagnosis Clinical presentation Ultrasound CT scan  Surgical Management Appendectomy  Complications Rupture Sepsis Copyright ©2020 F.A. Davis Company  Appendicitis  Nursing Management – Assessment and analysis Clinical manifestations related to inflamed appendix which progresses to gangrene or rupture if not treated Copyright ©2020 F.A. Davis Company  Appendicitis  Nursing Interventions – Assessments Vital signs Intake and output Pain Rebound tenderness White blood cell count Copyright ©2020 F.A. Davis Company  Appendicitis  Nursing Interventions – Actions Keep NPO Administer IV fluid as prescribed Prepare patient for OR Provide comfort measures Position patient supine with HOB elevated Advance diet as tolerated after surgery Copyright ©2020 F.A. Davis Company  Appendicitis  Nursing Interventions – Teaching Turn, cough, deep breathe, incentive spirometer Early ambulation Take full course of antibiotics Wound care Copyright ©2020 F.A. Davis Company  Appendicitis  Nursing Interventions – Evaluating care outcomes Resume normal activities in 2–4 weeks Stable vital signs CBC within normal limits Demonstrated understanding of postoperative teaching Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Pathophysiolo gy Most are adenocarcino mas Originate in glandular cells of internal organs Metastasize to adjacent organs Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Risk Factors Family history Inflammatory bowel disease for 10 years or more Physical inactivity Obesity Diet high in red meat Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Clinical Manifestations Pain Change in bowel habits Anemia Fatigue Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Medical Management – Diagnosis Colonoscopy Laboratory studies Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Medical Management – Treatment Chemotherapy Radiation therapy  Surgical Management Colectomy Hemicolectomy Abdominoperineal resection Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Complications Fatigue Infection Anemia Anastomoses Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Preoperative Patient Nursing Management – Assessment and analysis Clinical manifestation is closely associated with location of tumor  Preoperative Patient Nursing Management – Nursing diagnoses Knowledge deficit Fear Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Preoperative Patient Nursing Interventions – Assessments Vital signs Serum electrolytes and CBC Current knowledge of disease Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Preoperative Patient Nursing Interventions – Actions Bowel prep Establish therapeutic relationship Ensure surgical consent form is signed Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Preoperative Patient Nursing Interventions – Teaching Ostomy care Pain Copyright ©2020 F.A. Davis Company  Locations of Stomas Copyright ©2020 F.A. Davis Company  Stool Consistency Based on Ostomy Location Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Postoperative Patient Nursing Management – Assessment and analysis Vital signs LOC Pain Bowel sounds Stoma (in case of ostomy) Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Postoperative Patient Nursing Management – Nursing diagnoses Acute pain Potential for infection Risk for imbalanced fluid volume Knowledge deficit Disturbed body image Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Postoperative Patient Nursing Interventions – Assessments Vital signs Stoma CBC values Ostomy Nausea and drainage vomiting Abdominal/ Intake and perineal output dressing/incisio n Pain Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Postoperative Patient Nursing Interventions – Actions IV fluids Turn, cough, NPO/Advance deep breathe, diet as tolerated incentive NG tube spirometer Pain Early management ambulation Drain Perianal care management Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Postoperative Patient Nursing Interventions – Teaching Postoperative complications Ostomy care Copyright ©2020 F.A. Davis Company  Colorectal Cancer  Nursing Management – Evaluating care outcomes Stable vital signs CBC values No signs of infection Positive bowel sounds Demonstrated understanding of postoperative teaching Pain controlled Copyright ©2020 F.A. Davis Company