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Disorders of Intestinal Motility and Absorption

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Disorders of Intestinal Motility and Absorption

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Diarrhea

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* Increase in frequency, volume, and water content of stool * Symptoms not disorders * Result from impaired water absorption or increased water secretion into the bowel

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Diarrhea

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* Increased water absorption ---- Increased peristalsis or decreased bowel surface * Increased water secretion --- Osmosis --- Infection --- Unabsorbed fat --- Medications

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Diarrhea : Manifestations & Complications

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* Depend on the cause, duration, severity, and area, of bowel, affected * Loss of water and electrolytes * Dehydration, hypovolemic shock * Potassium, magnesium, and bicarbonate loss, can lead to metabolic acidosis

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Diarrhea: Collaborative Care

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* Identity and treat underlying cause --- Diagnostic tests * Stool * Blood * Sigmoidoscopy * Dietary management --- Fluid replacement --- Solid food withheld during first 24 hours

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Diarrhea: Collaborative Care

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* Medications --- Antidiarrheal NOT used until cause identified --- Opium derivatives, absorbents * Complementary therapies --- Gentle abdominal massage --- Herbal tea

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Diarrhea: Nursing Care

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*Prioritizing nursing care --- Effects on fluid balance, skin integrity * Health Promotion --- Importance off hand washing * Identifying potential complication --- Hypovolemia

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Diarrhea: Nursing Care

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* Evaluating --- Stool frequency --- Nutritional status --- Weight --- Fluid volume status --- Skin integrity -- Monitor electrolytes * Documenting --- Compliance with fluid, diet

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Nursing Diagnose: Diarrhea

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* Diarrhea --- Stool count --- Abdominal girth --- Medications --- Food intake

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Nursing Diagnose: Diarrhea

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* Risk for deficient fluid volume --- Intake & Output ; daily weights, skin turgor, mucous membrane, urine specific gravity --- Vital signs, orthostatic changes --- Out of bed with assistance --- Fluid and electrolyte replacement

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Nursing Diagnose: Diarrhea

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* Risk for impaired skin integrity --- Skin care --- Frequent position changes --- Protect pressure areas --- Perianal cleansing

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Continuity of Care: Diarrhea

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* Teaching --- Teach causes and preventative measures --- Infection control --- Purification of water for travel --- Fluid replacement --- Chronic diarrhea

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Constipation

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* Infrequent or difficult passage of stools --- Only appropriate when * Patient has two or fewer bowel movements weekly * Defecation excessively difficulty or require straining * Symptoms persist for extended period * Affect older adults more often

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Constipation: Pathophysiology & Manifestation

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* Organic cause --- Tumor or partial bowel obstruction * Lifestyle and psychologic causes * Habitual use of laxatives * Manifestations: Fecal impaction, watery mucus, full sensation in rectum with abdominal cramping

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Constipation: Collaborative

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* Digital exam of rectum * Diagnostic tests --- Serum electrolytes --- Thyroid function tests --- Barium enema --- Flexible colonoscopy ---- Virtual colongraphy

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Constipation: Collaborative

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* Medications --- Laxatives --- Cathartics : Stronger laxative, interfere with normal bowel reflexes

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Constipation: Collaborative care

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* Enemas --- Never used when risk of obstruction, perforation * Types: Saline enemas, tap-water enemas, soap-suds enemas, phosphate enemas, oil- retention enemas * Complementary therapies

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Constipation: Collaborative Care

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* Exercise --- Especially swimming, walking, sit-ups * Abdominal massage * Herbal preparations

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Constipation: Collaborative Care

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* Prioritizing nursing care --- Educating about " normal" bowel habits * Health promotion --- Importance of responding to urge to defecate --- Relationship between regular exercise and bowel regularity

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Constipation: Collaborative Care

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* Diagnosing, Planning, and implementing * Constipation ----- Normal defection pattern ---- Diet, fluid intake, activity ---Abdominal shape, girth, bowel sounds, tenderness ---- Warm water ---Dietary consult --- Provide stool softeners as prescribed

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Constipation: Continuity of Care

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--- Teaching to relieve constipation and prevent recurrence * Diet high in natural fiber * High fluid intake * Exercise * Normal bowel habits *Use of laxatives * Avoid straining

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Irritable bowel Syndrome

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* Motility disorder characterized by alternating constipation and diarrhea * CNS innervation altered * Affected by eating, hormones, stress, drugs * Sensory responses increased * Increase in mucus production

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Irritable bowel Syndrome : Manifestation

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* Change in frequency, consistency of stools, alternating constipation and diarrhea * Stools may contain mucus * Abdominal pain and tenderness, often in Right lower quadrant * Abdominal bloating and flatulence

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Irritable bowel Syndrome: Collaborative Care

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* Diagnostic tests --- Stool specimen --- Sigmodidoscopy ----Colonoscopy ---- Small-bowel series

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Irritable bowel Syndrome: Collaborative Care

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* Treatment --- Relieve symptoms --- Reduce or eliminate precipitating factors * Nursing Care --- Same as that for diarrhea and constipation

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Irritable bowel Syndrome: Continuity of Care

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* Teaching --- Symptoms are real ---Discuss related factors --- Relationship between stress and manifestations --- Stress reduction techniques

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Irritable bowel Syndrome: Continuity of Care

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*Teaching ---- Psychological factors ---- Dietary influences ---- Exercise ---- Dietary patterns ---- Notification of PCP with any changes

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Inflammation Disorders

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Inflammation Disorders

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Appendicitis

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* Obstruction by fecalith * Distention * Pressure leads to impaired blood supply * Leads to inflammation, edema, ulceration, infection * 24-36 hours necrosis * Classified by stages

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Appendicitis: Manifestation & Complications

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* Generalized or upper abdominal pain * Localizes in right lower quadrant * Aggravated by moving, walking, coughing

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Appendicitis: Manifestation & Complications

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* Localized and rebound tenderness * Right hip extension increases pain * Low-grade fever, anorexia, nausea, vomiting * Peroration peritonitis

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Appendicitis: Collaborative Care

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* Prompt diagnoses and management to prevent perforation * Hospitalization intravenous fluids; nothing by mouth until diagnosis confirmed * Diagnostic tests: White blood count, abdominal ultrasound, abdominal CT Scan

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Appendicitis: Surgery

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* Appendectomy: --- Laparotomy: surgery opening of the abdomen ---- Laparoscopy: *Exploration using endoscope * Three very small incision with taped recovery

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Appendicitis: Nursing Care

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* Prioritizing nursing care ---- Prompt assessment vital * Assessing --- Rapid assessment due to risk of perforation ---- Description of pain ---- Ensure informed consent

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Appendicitis: Nursing Diagnosis

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* Risk for ineffective gastrointestinal tissue perfusion ---- Signs of perforation --- Vital signs --- Intravenous fluids ---- Postoperative care

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Appendicitis: Nursing Diagnosis

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* Acute Pain --- Pain assessment --- Prescribed analgesics ---- Effectiveness of pain medications --- Alternative methods of pain relief

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Appendicitis: Continuity of Care

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* Teach wound/ incision care * Wound assessment instructions * Dressing changes * Hand washing * What to report to the physicians * Activity restrictions: Driving; return to work * Home care nurses

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Peritonitis

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* Inflammation of peritoneum ---- Double-layered membrane lining walls and organs of abdominal cavity * Results when sterile space between layers a contaminated

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Peritonitis

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* Risk factors --- Ruptured appendix --- Gunshot wound --- Abdominal surgery

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Peritonitis: Pathophysiology & Complications

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* Bowel contents enter a sterile abdominal cavity * Generalized inflammation of the abdominal cavity * Third spacing * Paralytic ileus : Peristalsis slows or stops

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Peritonitis: Pathophysiology & Complications

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* Complications: --- Life-threatening, localized, systemic --- Abscess formation ---- Septicemia ---- Shock

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Manifestations: Peritonitis

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* Depends on severity and extent of the infection * Systemic --- Fever, Malaise --- Tachycardia, Tachypnea --- Restlessness, confusion --- Oliguria

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Manifestations: Peritonitis

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* Abdominal --- Diffuse or localized, pain, usually severe --- Rebound tenderness --- Boardlike rigidity or guarding of abdomen --- Diminished or absent bowel sound --- Progressive abdominal distention --- Anorexia, nausea, and vomiting

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Collaborative Care: Peritonitis

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* Diagnostic tests --- Blood cultures --- CT scan or ultrasound --- Paracentasis

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Collaborative Care: Peritonitis

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* Management --- Intestinal decompression --- Board-spectrum antibiotics * Surgery --- Laparotomy --- Peritoneal lavage

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Nursing Care: Peritonitis

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* Prioritizing nursing care --- Manage patient responses * Assessing --- Monitor current status --- Progress of recovery ---Identify complications

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Nursing Care: Peritonitis

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* Identifying potential complications --- Increasing pain or changes in Level of conscious * Managing nursing care --- Vital signs, intake & output, positioning, hygiene

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