Professional Documents
Culture Documents
Chapter 52
Caring for Clients With Disorders of the Lower GI Tract
Altered Bowel Elimination
Constipation
everyone has different bowel habits, frequency of stool.
What is normal for that client?
If constipated for a long period may develop encopresis, passing liquid stool
around an obstructive stool mass
Box 52-1, dietary modifications for diarrhea or constipation
Drug therapy table 52-1
Diarrhea
passage of frequent liquid or semiliquid stools
S/S: urgency, cramps, hyperactive bowel sounds
Treatment: dietary rest for 1-2 meals , antidiarrheal agents, IV replacement of
fluids & electrolytes, TPN
See nursing process
S/S: severe abd pain with tenderness, distention, n/v. Lack of bowel motility, abd
becomes rigid
Treatment: ngt for decompression, IV fluids, large doses of antibiotics & pain
meds
Requires surgical repair
Intestinal Obstructions
Nonmechanical-adynamic or paralytic ileus such as after surgery, inflammatory
conditions, electrolyte disturbances
S/S: n/v, distention, slow or absent bowel sounds
Mechanical-lumen is blocked by tumors, adhesions, etc- table 52-2
S/S: may have hyperactive bowel sounds above the area of obstruction
Treatment for Obstructions
Medical:
NPO
IV fluids
intestinal decompression via abdominal tube
See nursing guidelines 52-1
Nursing:
I&O
V/S
documentation of emesis, bowel sounds, pain management
Maintenance of the decompression tubes
Diverticular Disorders
Diverticula-sacs or pouches of mucosa of the intestine that protrude through
lining of the intestine
See fig 52-5
If they are asymptomatic they are called diverticulosis
Diverticulitis is an inflammed diverticula
Cause unknown
More common in countries with low fiber diets
S/S: constipation alternating with diarrhea, gas, pain, tenderness, fever, rectal
bleeding
DIVERTICULAR DISORDERS
No treatment if asymptomatic, avoid constipation & foods containing seeds that
could get caught in the pouches. May require removal of that portion of the intestine
Nursing care: follow MD recommended diet, increase bran to add bulk to diet,
avoid use of laxatives or enemas, avoid constipation, do not suppress the urge to defecate,
drink at least 8-10 glasses of fluid daily, exercise
Abdominal Hernias
Protrusion of intestine through the abdominal wall – box 52-3
Incisional-previous scar
Inguinal-along the inguinal canal
Umbilical-protruding umbilicus
Femoral-higher incidence of strangulation
Causes: straining increases intraabd pressure, obesity, congenital weakness in the
abd wall
Treatment: depends on whether symptomatic or not; may wait & see if symptoms
develop & do surgical repair
Abdominal Hernias
Nursing care:
Teaching if supportive care prescribed, s/s of incarcerated or strangulated hernia
to report to MD
Post op care: v/s, home care teaching, avoid constipation & straining at stool,
avoid heavy lifting
Cancer of the Colon And Rectum
2nd leading cause of cancer deaths in the US
Risks increase with age
American Cancer society recommends annual fecal occult blood testing &
colonoscopy every 10 yrs after age 50
Strong genetic component
Cancerous lesion develops from benign due to genetic, environmental & lifestyle
factors
Cancer of the Colon And Rectum
S/S: change in bowel habits, occult or frank blood in stool, dull, vague abdominal
discomfort. Pain is late sign of cancer
Med surg treatment: polyps removed during endoscopic exam, if benign f/u
recommended; if cancerous surgery is done with radiation & chemotherapy
Nursing mgmt: preparation for routin colorectal screening – box 52-5; see post op
care ch 54
HEMORRHOIDS
Dilated veins outside or inside the anal spincter, fig 52-7
Caused by: chronic straining with BM, prolonged sitting, pregnancy, prolonged
labor, portal HTN
External: may be asymptomatic or cause itching, pain, soreness
Internal: bleeding
Medical mgmt: symptomatic with meds or hemorrhoidectomy sometimes done
PILONIDAL SINUS
Infection in the hair follicles in the sacrococcygeal area above the anus, fig 52-9
Seen mostly in people with deep intergluteal cleft & abundant hair in the perianal
& lower back regions
S/S: pain & swelling at base of spine & purulent drainage
Medical/surgical mgmt: I&D done, packed & heals by secondary intention
General Nutritional Considerations
In order to get a enough fiber in diet: 6-11 servings of breads, cereals, & grains to
include high fiber bread & cereal
Encourage clients to eat:
½ cup of dried peas or beans daily
2-4 servings of fruit daily with skin & seeds
3-5 servings of vegetables
For clients with diverticulosis they cannot eat foods with husks & seeds (nuts,
popcorn, cucumbers, etc) which will become trapped in the diverticula