Transcript File
Care of Patients with Inflammatory Intestinal Disorders Chapter 60 Mrs. Kreisel MSN, RN NU130 Adult Health Summer 2011 Appendicitis • Acute inflammation of the vermiform appendix—the blind pouch attached to the cecum of the colon • Abdominal pain in the epigastric or periumbilical area is the initial symptom of classic appendicitis • McBurney’s point: In accute appendicitis tenderness situated between the unbilicus and the right anteriosuperior iliac crest • Perforation: Puncuture or holes • Rebound tenderness McBurney’s Point Interventions • Nonsurgical management includes: • NPO • IV fluids • Semi-Fowler’s position • Analgesics • No laxatives or enemas • No heat • PROVIDE COMFORT TOUCH AND REASSURANCE! Surgical Management • Laparoscopy or laparotomy to rule out appendicitis • Preoperative care as for general anesthesia surgeries • Operative procedure—appendectomy • Postoperative care Peritonitis • Life-threatening acute inflammation of visceral/parietal peritoneum and endothelial lining of abdominal cavity, or peritoneum • Primary or secondary peritonitis • Rigid, boardlike abdomen, abdominal pain, distended abdomen, high fever, tachycardia, dehydration, low urine output, hiccups, compromised respiratory status, nausea and vomiting • ASSESS FOR BOWEL SOUNDS FREQUENTLY Peritonitis (Cont.) Nonsurgical Management • • • • • • • • IV fluids Broad-spectrum antibiotics Daily weight monitored Fluid volume assessed Nasogastric suctioning NPO status Oxygen Pain management Surgical Management • Exploratory laparotomy • Semi-Fowler's position • Wound care: • Care of the incisions and drains • Peritoneal irrigation • IV fluid replacement Gastroenteritis • Increase in the frequency and water content of stools or vomiting as a result of inflammation of the mucous membranes of the stomach and intestinal tract • Differs from food poisoning • Bacterial form—Campylobacter, Shigella, Escherichia coli • Viral form—Norwalk virus Interventions • • • • • Fluid replacement Nutrition therapy Drug therapy Skin care Health teaching Inflammatory Bowel Disease (IBD) • Several disorders of the GI tract with no known etiology • Ulcerative colitis • Crohn’s disease Ulcerative Colitis • Widespread inflammation of mainly the rectum and rectosigmoid colon; can extend to the entire colon • Associated with periodic remissions and exacerbations • Tenesmus • Loose stools containing blood and mucus, poor absorption of vital nutrients, and thickening of the colon wall can result • Increased risk for colon cancer Assessment • • • • • Physical assessment Clinical manifestations Psychosocial assessment Laboratory assessment Other diagnostic tests Drug Therapy • • • • • Aminosalicylates Glucocorticoids Immunomodulators Antidiarrheal drugs Other drugs Other Therapies • Nutrition therapy • Rest • Complementary and alternative therapies Surgical Management • Colectomy • Total proctocolectomy with a permanent ileostomy • Preoperative care • Operative procedure • Postoperative care: • Loose, dark green liquid, with some blood in stool • Pouch system worn at all times • Skin care Total Colectomy with a Continent (Kock’s) Ileostomy • Internal ileal reservoir • Intra-abdominal pouch created from the terminal ileum by the surgeon • Stool stored in the pouch drained by catheter • Care of pouch • Effluent, or drainage, monitored Kock’s Ileostomy Total Colectomy with Ileoanal Anastomosis (J Pouch) • Removal of the colon and the rectum with the ileum sutured into the anal canal • Spares the rectal sphincter and need for an ostomy • Preoperative care • Operative procedure • Postoperative care Ileoanal Reservoir Crohn’s Disease • Inflammatory disease of the small intestine and the colon, or both. • It can affect the GI tract from mouth to anus but mostly the terminal ileum. • Transmural inflammation causing thickening of the bowel wall with strictures and deep ulcerations with bowel fistulas commonly developing. • Rarely, cancer of the small bowel and colon develop. • Malabsorption of vitamins and nutrients due to diarrhea. It can lead to signs and symptoms of anemia! Fistulas Assessment • • • • Physical assessment Clinical manifestations Psychosocial assessment Diagnostic assessment Nonsurgical Management • • • • • • • • Drug therapy Nutritional therapy Fistula management Complication management Fluid and electrolyte therapy Skin care Prevention of infection Complementary and alternative therapies Skin Barriers Surgical Management • Laparoscopy • Small bowel resection and ileocecal resections • Stricturoplasty • Preoperative care • Operative procedure • Postoperative care Diverticular Disease • Diverticulosis is the presence of many abnormal pouchlike herniations in the wall of the intestine. • Diverticulitis is inflammation of one or more of the diverticula. Diverticula Assessments • • • • History Physical assessment Clinical manifestations Diagnostic assessment Nonsurgical Management • • • • • • • Drug therapy Nutrition therapy Rest IV fluids to correct dehydration IV antibiotics Anticholinergics Analgesics Nonsurgical Management (Cont’d) • Avoid laxatives and enemas • Rest • NPO in the hospital Surgical Management • Preoperative care • Operative procedure • Postoperative care: • Drain care • Care of the ostomy • NPO followed by clear liquids Anorectal Abscess • Localized induration and pus caused by inflammation of the soft tissue near the rectum or anus • Rectal pain first symptom • Surgical incision and drainage • Nursing interventions focused on helping the patient maintain comfort and optimal perineal hygiene • High-fiber diet Anal Fissure • • • • • Tear in the anal lining Acute and chronic forms Assessment Management Patient teaching Anal Fistula • Abnormal tract leading from the anal canal to the perianal skin • Most anal fistulas result from anorectal abscesses • Proctoscopy • Surgery Anal Fistula Parasitic Infection • • • • • • Pathophysiology Entamoeba histolytica Giardia lamblia Cryptosporidium Assessment Interventions Helminthic (worms) Infestation • ROUND WORMS: cause the most infections worldwide • Enterobiasis: pinworm most common in the USA. Oral intake • Trichinosis: very low in the USA roundworm. Get from under cooked meat • Hookworms: roundworm enter body through the skin • Tapeworms: From undercooked meat, eating bugs, contaminated water • WHAT NURSING CONSIDERATIONS ARE IMPORTANT? Food Poisoning • • • • Salmonellosis Staphylococcal infection Escherichia coli infection Botulism •NCLEX TIME Question 1 Ulcerative colitis is most commonly seen in individuals belonging to which ethnic group? A. B. C. D. Hispanic Sephardic Jews Portuguese Romani Ashkenazi Jews Question 2 An older patient diagnosed with bacterial gastroenteritis is complaining of abdominal cramping, diarrhea, nausea and vomiting, and fatigue for the past 24 hours. The nurse should monitor the patient for what priority assessment? A. Dehydration B. Hypokalemia C. Hypernatremia D. Perineal skin breakdown Question 3 What is an expected outcome of a patient taking sulfasalazine (Azulfidine) for treatment of ulcerative colitis? A. B. C. D. Anorexia Anemia Diarrhea Dermatitis Question 4 The patient has recently been placed on corticosteroids as treatment for ulcerative colitis. The nurse should monitor his laboratory results for evidence of: A. Hypernatremia B. Hypercalcemia C. Hyperglycemia D. Hyperkalemia Question 5 How many people are infected with Salmonella organism each year in the United States? A. 10,000 B. 20,000 C. 40,000 D. 50,000