lower gastrointestinal disorders
TRANSCRIPT
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LOWER GASTROINTESTINALLOWER GASTROINTESTINAL
TRACTTRACT
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Imperforated anusImperforated anus
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Hirschsprung D
isease
Hirschsprung D
isease
congenital aganglionic megacolon is acongenital aganglionic megacolon is amechanical obstruction caused bymechanical obstruction caused byinadequate motility of part of theinadequate motility of part of theintestine.intestine.
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Diagnostic EvaluationDiagnostic Evaluation
Rectal examinationRectal examination
xx--ray with barium enemaray with barium enema
rectal biopsyrectal biopsy--((--) or decrease ganglionic) or decrease ganglionicnerve cellsnerve cells
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ManifestationsManifestations
no meconium or ribbon like stoolno meconium or ribbon like stool
bile stained vomitingbile stained vomiting
abdominal distentionabdominal distention
constipationconstipation
anorexiaanorexia
FTTFTT
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TreatmentTreatment
removal of the agangionic, non functional,removal of the agangionic, non functional,dilated segment of the boweldilated segment of the bowel
anastomosisanastomosis improved functioning of internalimproved functioning of internalrectal sphincterrectal sphincter
colostomy or ileostomy to decompresscolostomy or ileostomy to decompressintestine and rest normal bowelintestine and rest normal bowel
definitive treatment:definitive treatment:
abdominoperineal pull throughabdominoperineal pull through
endorectal pull through, rectorectal pullendorectal pull through, rectorectal pullthrough at 9through at 9--12 mos.12 mos.--1515--20lbs20lbs
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olderolder-- isotonic enemas, stool softeners,isotonic enemas, stool softeners,
low residue dietlow residue diet
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IRRITABLE BOWEL SYND
ROME
IRRITABLE BOWEL SYND
ROME
also known as spastic bowel or functionalalso known as spastic bowel or functionalcolitiscolitis
a motility disorder of the gastrointestinala motility disorder of the gastrointestinaltracttract
no identifiable organic causeno identifiable organic cause
characterized by abdominal pain withcharacterized by abdominal pain withconstipation, diarrhea or bothconstipation, diarrhea or both
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MANIFESTATIONS OF IRRITABLE BOWELMANIFESTATIONS OF IRRITABLE BOWELSYNDROMESYNDROME
abdominal painabdominal pain
may be relieve by defecationmay be relieve by defecation
may be intermittent and colicky or dull andmay be intermittent and colicky or dull andcontinuouscontinuous
altered bowel eliminationaltered bowel elimination
constipationconstipation
diarrheadiarrhea
mucous stoolsmucous stools
abdominal bloating and flatulenceabdominal bloating and flatulence abdominal tendernessabdominal tenderness
nausea and vomitingnausea and vomiting
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DIAGNOSTIC TESTDIAGNOSTIC TEST
stoolstool
CBCCBC
sigmoidoscopy or colonoscopysigmoidoscopy or colonoscopy
small bowel series ( upper GI series withsmall bowel series ( upper GI series withsmall bowel follow through) and bariumsmall bowel follow through) and bariumenemaenema
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MEDICATIONSMEDICATIONS
medications may be prescribed to managemedications may be prescribed to managesymptoms ofIBSsymptoms ofIBS
bulk forming laxativesbulk forming laxatives may reduce bowelmay reduce bowel
spasm and normalize the number and form ofspasm and normalize the number and form ofbowel movementsbowel movements
anticholinergic drugsanticholinergic drugs inhibit bowel motility byinhibit bowel motility byinterfering with parasympathetic stimulation ofinterfering with parasympathetic stimulation of
the gastrointestinal tractthe gastrointestinal tract
antidepressantsantidepressants may help relieve abdominalmay help relieve abdominalpainpain
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nursing diagnoses and interventionsnursing diagnoses and interventions
constipation related to altered gastrointestinalconstipation related to altered gastrointestinalmotilitymotility
diarrhea related to altered gastrointestinaldiarrhea related to altered gastrointestinalmotility and excess mucous secretionmotility and excess mucous secretion
anxiety related to situational stressanxiety related to situational stress
ineffective coping related to effects of disorderineffective coping related to effects of disorderon lifestyleon lifestyle
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APPENDICITISAPPENDICITISinflammation of the vermiforminflammation of the vermiform
appendixappendix
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perforation, peritonitis and abcess are possibleperforation, peritonitis and abcess are possible
complicationscomplications perforation is manifested by increased pain andperforation is manifested by increased pain and
high feverhigh fever
ChronicChronic chronic abdominal pain , recurrent acute attackschronic abdominal pain , recurrent acute attacks
at intervals of several months or moreat intervals of several months or more
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Diagnostic testsDiagnostic tests
WBC count with differentialWBC count with differential
urinalysisurinalysis
abdominal xabdominal x--rayray
abdominal ultrasoundabdominal ultrasound pelvic examinationpelvic examination
intravenous pyelogram (IVP)intravenous pyelogram (IVP)
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MedicationsMedications
IVFIVF to restore or maintain volume andto restore or maintain volume andprevent electrolyte imbalanceprevent electrolyte imbalance
antibiotic therapy( 3antibiotic therapy( 3rdrd gen cephalosporin )gen cephalosporin )
-- initiated prior to surgery andinitiated prior to surgery andcontinued for at least 48 hrs operativelycontinued for at least 48 hrs operatively
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SurgerySurgery
acute appendicitisacute appendicitis surgical removal of thesurgical removal of the
appendixappendix
laparascopic approach ( insertion of anlaparascopic approach ( insertion of an
endoscope to view abdominal contents)endoscope to view abdominal contents) laparotomy ( surgical opening of thelaparotomy ( surgical opening of the
abdomen)abdomen)
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nursing diagnoses and interventionsnursing diagnoses and interventions
risk for infectionrisk for infection preventing complications during the operativepreventing complications during the operative
and post operative periodand post operative period
perforation and peritonitis are complicationsperforation and peritonitis are complications
preoperativelypreoperatively post operative wound infection, abscess andpost operative wound infection, abscess and
possible peritonitispossible peritonitis
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monitor vital signs inc. temperaturemonitor vital signs inc. temperature
maintain intravenous infusion until oralmaintain intravenous infusion until oralintake is adequateintake is adequate
Assess wound, abdominal girth andAssess wound, abdominal girth and
postoperative painpostoperative pain
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painpain
assess pain, including its characteristics,assess pain, including its characteristics,location, severity and duration. Report anylocation, severity and duration. Report anychanges in the nature of painchanges in the nature of pain
administer analgesics as orderedadminister analgesics as ordered assess effectiveness of medication 30assess effectiveness of medication 30
mints after administrationmints after administration
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periton
itisper
iton
itis
inflammation of the caused by peritoneuminflammation of the caused by peritoneum
caused by enteric bacteria entering thecaused by enteric bacteria entering the
peritoneal cavity through a perforated ulcer,peritoneal cavity through a perforated ulcer,ruptured appendix, perforated diverticulum,ruptured appendix, perforated diverticulum,necrotic bowel.necrotic bowel.
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Manifestations of PeritonitisManifestations of Peritonitis
abdominal manifestationsabdominal manifestations
diffuse or localized paindiffuse or localized pain
tendernesstenderness
boardlike rigidityboardlike rigidity
diminished or absent bowel sounddiminished or absent bowel sound distentiondistention
anorexia, nausea and vomitinganorexia, nausea and vomiting
systemic manifestationssystemic manifestations feverfever
MalaiseMalaise
RestlessnessRestlessness
ConfusionConfusion
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ComplicationsComplications
abscess formationabscess formation
septicemiasepticemia
septic shockseptic shock Hypovolemic shockHypovolemic shock
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Diagnostic TestsDiagnostic Tests
WBC countWBC count
blood culturesblood cultures
liver and renal function studies and serumliver and renal function studies and serum
electrolyteselectrolytes
abdominal xabdominal x--rayray
paracentesisparacentesis
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MedicationsMedications
broad spectrumbroad spectrum
antibiotic therapy( specific organism)antibiotic therapy( specific organism)
cephalosphorin antibiotic for gram (cephalosphorin antibiotic for gram (--) enteric) entericbacteriabacteria
ampicillinampicillin
metronidazolemetronidazole
clindamycinclindamycin
analgesicsanalgesics
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SurgerySurgery
laparotomylaparotomy-- to close the perforation or removeto close the perforation or removethe damaged and inflammed tissuethe damaged and inflammed tissue
peritoneal lavageperitoneal lavage washing of the peritonealwashing of the peritoneal
cavity with copious amounts of warm isotoniccavity with copious amounts of warm isotonicfluid to dilute residual bacteria and removesfluid to dilute residual bacteria and removesgross contaminants, blood and fibrin clots.gross contaminants, blood and fibrin clots.
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TreatmentsTreatments
IVF and electrolyte replacementsIVF and electrolyte replacements
parenteral nutritionparenteral nutrition
placed on bed rest in fowlers positionplaced on bed rest in fowlers position
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nursing diagnosesnursing diagnoses
PainPain-- abdominal distention and acute inflammationabdominal distention and acute inflammationcontribute to the pain associated with peritonitiscontribute to the pain associated with peritonitis
assess pain including location, severity and typeassess pain including location, severity and typeusing pain scale.using pain scale.
place in fowlers position or semi fowlers withplace in fowlers position or semi fowlers withknees and feet elevatedknees and feet elevated
administer analgesics as ordered or using PCAadminister analgesics as ordered or using PCA
teach and assist with adjunctive painteach and assist with adjunctive pain
management techniques such as meditation,management techniques such as meditation,visualization, massagevisualization, massage
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deficient fluid volumedeficient fluid volume
maintain accurate intake and output recordsmaintain accurate intake and output records monitor vital signs, CVP, cardiac output andmonitor vital signs, CVP, cardiac output and
pulmonary artery pressure every hourpulmonary artery pressure every hour
weigh dailyweigh daily
assess skin turgor , color, temperature andassess skin turgor , color, temperature andmucous membranesmucous membranes
measure or estimate fluid losses throughmeasure or estimate fluid losses throughabdominal drains and on dressingsabdominal drains and on dressings
monitor laboratory values, including hgb, hct,monitor laboratory values, including hgb, hct,urine, electrolytes and ABGsurine, electrolytes and ABGs
administerIVF and electrolytes as orderedadministerIVF and electrolytes as ordered
provide good skin care and oral hygieneprovide good skin care and oral hygiene
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AnxietyAnxiety
assess the client and familys anxiety level andassess the client and familys anxiety level andpresent coping skillpresent coping skill
present a calm, reassuring manner. Encouragepresent a calm, reassuring manner. Encourage
expression of concernsexpression of concerns maintain consistent caregivermaintain consistent caregiver
explain all treatments, procedures, tests andexplain all treatments, procedures, tests andexaminationexamination
reinforce and clarify information neededreinforce and clarify information needed
teach and assist with relaxation techniquesteach and assist with relaxation techniques
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Intestinal Obstruct
ionIntest
inal Obstruct
ion