Chapter 46: lower GI disorders

What is a hernioplasty?

With an abdominal hernia; weakened area is reinforced with wire, fascia or mesh

What is dehiscence?

Surgical complication in which a wound ruptures along a surgical incision

What is a herniorrhaphy?

With an abdominal hernia; surgical repair of a hernia in which the protruding intestine is repositioned in the abdominal cavity and the defect in the abdominal wall is repaired

What is strangulation?

Acute emergency; blood flow is impaired

What are complications of a hiatal/abdominal hernias?

Enlarging hernias are an issue; organs protrude and bowel becomes trapped in the weakened pouch which can cause blood supply to be compromised

Levofloxacin (levaquin)

Antibiotics; stops growth of bacteria

SE: nausea, diarrhea, headache, dizziness, lightheadedness, or trouble sleeping

Dilantin

Anticonvulsant; treats and prevents seizures

SE: headache, nausea, vomiting, constipation, dizziness, feeling of spinning, drowsiness, trouble sleeping or nervousness. Swelling or bleeding of the gums

Omeprazole (Prilosec)

Proton pump inhibitor; suppresses gastric acid by blocking enzymes associated with the final step of acid production

SE: headache, fatigue, dizziness, depression, abdominal pain, cramps, gas, nausea, diarrhea, flulike symptoms, rash, arthralgia

Dicyclomine hydrochloride (Bentyl)

Anticholinergic; relaxes smooth muscle of the GI tract

SE: constipation, dry mouth, blurred vision, sensitivity to light, difficulty urinating, irregular heartbeat, intolerance to heat

How is distention traced?

Measure abdominal girth

Where do you perform abdominal girth?

Level of belly button

What are nursing measures to reduce constipation?

Enema or laxative in oral or suppository form then followed by a stool softener

Sulfasalazine (Azulifidine)

Anti-inflammatory 5-acetylsalicylic acid; acts in response to inflammation

SE: headache, diarrhea, abdominal pain and cramps, malaise, hair loss, rash, harmless orange discoloration of urine, bone marrow suppression, photosensitivity, decreased sperm motility

Loperamide (lmodium)

Opiate-related Antidiarrheals; act by slowing overall GI motility

SE: sedation, dizziness, dry mouth, paralytic ileus, constipation

Psyllium (Metamucil)

bulk-forming agents; increases intestinal motility by increasing fluids in intestinal contents

SE: nausea, vomiting, diarrhea, intestinal gas, abdominal cramps

Docusate (Colace)

Emollients and lubricants; ease defecation without stimulating movement in GI tract, form slippery coat on intestinal contents, decreasing loss of water and prevents contents from hardening

SE: stomach pain, diarrhea, or cramping

Why would ASA be used?

First line defense in Crohn's, decreases the inflammatory response in the bowels by absorbing directly into the intestines

What occurs with long term laxative use?

Loss of normal colonic motility and intestinal tone, dull gastrocolic reflex

What are the assessment findings for generalized peritonitis?

Severe abdominal pain, distention, tenderness, fever, nausea, vomiting and bowel sounds are typically absent

What are the assessment findings for pilonidal sinus?

Pain and swelling at base of spine and purulent drainage

What is the dietary advice for chronic or prolonged diarrhea?

Clear liquids for one or two meals and gradually advancing to regular diet also eliminate foods that cause diarrhea

What is the most common abdominal hernia?

Inguinal (more prevalent in men)

What are types of abdominal hernias?

Inguinal, umbilical, femoral, and incisional

Where is the inguinal hernia located?

Inguinal ring can extend into the scrotum

Where is the umbilical hernia located?

Umbilical region

Where is the femoral hernia located?

Femoral ring where the femoral artery passes into the femoral canal

Where is the incisional hernia located?

Through scar of a surgical incision when healing is impaired

What would be included in patient teaching about ulcerative colitis?

Special dietary modifications, understand the medications, keep follow-up appointments, rectal hygiene and skin care, know signs to report, have regular medical checkups

What is the pathophysiology of ulcerative colitis?

Early: mucosal ulceration

Late: mucosal minute ulceration

What is the etiology of ulcerative colitis?

Genetic predisposition, infection, allergy, and abnormal immune response

Metoclopramide

Anti-nausea; short-term treatment of heartburn, treats certain conditions of the stomach and intestines

SE: drowsiness, dizziness, tiredness, trouble sleeping, agitation, headache, diarrhea

Famotidine

Antacid and antihistamine; treats ulcers, decreases acid your stomach makes

SE: headache, constipation, or diarrhea

Why would a dr order Lactulose (Chronulac)?

To treat constipation

What are specific side effects a patient on laxatives would need to report?

Abdominal cramps

What places a risk for developing diverticulitis?

Low intake of dietary fiber, congenial predispositions, people over 50 with weakened muscular coats

What is encoporesis?

Passing liquid stool around an obstructive stool mass - misinterpreted as diarrhea

Which one is asymptomatic and symptomatic?

Asymptomatic- diverticulosis

Symptomatic- diverticulitis

What are the s/s of ulcerative colitis?

Onset disease is abrupt, severe diarrhea, expel blood and mucus, cramps and abdominal pain in LLQ

What are the s/s of Crohn's?

Onset is insidious, abdominal pain, distention, tenderness in RLQ, chronic diarrhea

What is the broad spectrum causes of diarrhea?

Increased peristalsis, infection, lactose intolerance, food/allergies intolerance, diverticulitis, ulcerative colitis, intestinal obstruction, adverse drug effects, spicy foods

What are the two characteristic symptoms of ulcerative colitis?

Diarrhea with blood and mucus

What are the drugs given for colorectal cancer?

What are the s/s of colorectal cancer?

Change in bowel habits, occult blood in stool, abdominal pain (late sign) and palpable mass

What is included in the assessment for colorectal cancer?

Assessment of abdomen (feels distended and mass could be palpated), fecal occult blood test, sigmoidoscopy, barium enema, colonoscopy and digital rectal exam

How does the patient present with colorectal cancer?

Change in bowel habits such as alternating constipation and diarrhea, patient feels dull, vague abdominal discomfort

What should you teach a patient taking diphenoxylate with atropine sulfate?

Monitor proper bowel function, advise to not drive or operate dangerous machinery while taking

Why would a patient be prescribed Colace over another laxative?

Least invasive so it's starting point; stool softener

What patient do you not give an ASA drug?

Anyone who has a chance of bleeding especially ulcerative colitis

How does a bowel perforation of peritonitis present?

What is the common cause of pilonidal sinus?

Inadequate personal hygiene, obesity, trauma to area

What is the common cause of peritonitis?

Perforation of peptic ulcer, bowel, or appendix. Abdominal trauma, peritoneal dialysis infection, IBD

What is the most common cause of an anal fissure?

Constipation

What does toxic megacon lead to and how do we treat it?

Can lead to colon dilation and atonic - no peristalsis. Treated by 5-ASA medications

What are nursing instructions for psyllium (Metamucil, Citrucel)?

Do not give if client has intestinal obstruction or fecal impaction, assess abdomen for tenderness/rigidity/bowel sounds, ask about last BM, may cause ECG changes with prolonged use. After administration: amount/color/consistency of stool, daily bowel pattern, bowel sounds, BUN/serum creatinine/magnesium levels

What is a concern with a pendulum swing with diarrhea?

Electrolyte imbalance

How do you recognize and assess bowel perforation?

What is included in diet and patient teaching with diverticulitis?

Add bran, high fiber foods, drink 8-10 glasses of fluid per day

If a patient tests positive for blood in stool but shows no other symptoms, what disease are we concerned about?

Colorectal cancer

What tests are ordered to diagnosis colorectal cancer?

Fecal occult blood test, sigmoidoscopy, barium enema, colonoscopy, and digital rectal examination

What is included in patient teaching for colorectal cancer?

Collect specimens at home by following correct protocol and send to the lab, routine colorectal screenings, and undergo a colonoscopy

What is intussusception?

Disease processes periscope into each other

What is the nursing and patient care for an anal fissure?

Teach patient how to insert a suppository, instruct how to take a sitz bath and discuss strategies to relieve constipation

What are the SE zip Polyethylene glycol?

Nausea, vomiting, abdominal distention and cramps

Severe rectal bleeding and diarrhea accompany what disease?

Crohn's disease, ulcerative colitis, cancer, diverticulosis, hemorrhoids and anal fissures

What type of hernia leads to strangulation?

Irreducible or incarcerated

What part of the intestines is involved in intestinal obstructions?

Lower areas

What does a colonoscopy with biopsies confirm?

Ulcerative colitis, Crohn's disease, diverticula, bowel polyps or bowel cancer

With long term Crohn's, why is methylprednisolone prescribed?

Suppress body's immune system and reduce swelling/inflammation