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Intestinal Elimination Disorders

Intestinal Elimination Disorders. NPN 200 Medical Surgical I. Diarrhea Define : the frequent passage of loose, liquid stool Causes – allergies, cancer, stress, malabsorption, impactions, tube feedings, viral Symptoms – cramping, nausea, urgency

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Intestinal Elimination Disorders

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  1. Intestinal Elimination Disorders NPN 200 Medical Surgical I

  2. Diarrhea Define : the frequent passage of loose, liquid stool Causes – allergies, cancer, stress, malabsorption, impactions, tube feedings, viral Symptoms – cramping, nausea, urgency If continues may lead to dehydration, and decreased nutrition Nurses role – assess stool for color and consistency, determine onset and exposure to virus and dietary habits or changes, any bleeding Assess for weight loss, skin turgor, abd tenderness, perneal irritation Treatment is based on the cause Diarrhea and Constipation

  3. Constipation Defined : hard, dry, infrequent stools Cause – ignoring the urge , frequent laxative use, dietary (not enough fiber or fluid), lack of activity, surgery, drugs, age changes in the intestines Complications – problems with heart, hemorrhoids, fecal impaction Nursing actions – assess for problem, blood, mucus, impaction Interventions – laxatives, enema’s, remove impaction, work with diet and fluid intake, regular habits Diarrhea and Constipation

  4. Obstruction • Partial or complete blockage of the intestinal lumen • Decreased or absent peristaltic movement of contents due to mechanical or neurological disorders • Leads to dilation, loss of tone, pressure on vessels with loss of blood flow, ischemia and death of tissue • Complete obstruction, if untreated, may lead to necrosis, shock, and death • Can occur after abdominal surgery

  5. Obstruction • Causes • Adhesions form prior surgery • Tumors and carcinoma • Foreign bodies – fruit pits, gallstones, worms • Compression of intestinal wall from – stenosis, intussusception (telescoping), volvulus, tumors, atresia

  6. Symptoms for small bowel Subjective Nausea / vomiting Colicky pain Drowsiness Thirst Aching Dry mucus membranes Intestinal spasms Malaise and fatigue Objective Vomiting Constipation Abd distention Borborugmi (gurgling) Obstruction

  7. Symptoms for large bowel Subjective Constipation Colicky abd pain in spasms Hypogastric pain nausea Objective Constipation Leakage of liquid stool Intestinal spasms Fecal vomiting Severe abd pain Obstruction

  8. Obstruction • Diagnostic tests • H&P • Flat plate of abdomen • UGI • Barium enema • E-lytes, CMP, amlyase

  9. Obstruction • Assessment • Past medical history • Abd tenderness and distention • N/V • BM history • Skin turgor and moisture • Vitals • Rectal bleeding or drainage

  10. Obstruction • Medical treatment • NG tube • Labs • IV • Possible surgery

  11. Obstruction • Nursing interventions • Pain control • I/O • Insert and care for NG • Assess bowel sounds • Monitor vitals • Watch for rupture – sudden sharp pain, rigidity, fever • Watch respiratory function – HOB ^, O2 if needed, watch for acidosis or alkalosis • Prepare for surgery

  12. Obstruction • Surgical care • TCDB • NG care • Monitor labs • Pain RX • IV’s and antibiotics • Early ambulation • May have colostomy – needs teaching

  13. Abdominal Hernia • Protrusion of an organ or structure through and abnormal opening • Categories • Reducible • Irreducible • Incarcerated • Types • Umbilical • Inguinal • Femoral • Incisional

  14. Abdominal Hernia • Causes • Congenital weakness in containing wall • Weakness because of infections or aging • Increased intra-abdominal pressure – pregnancy, heavy lifting, obesity or straining • Improper closing in the peritoneal sac in male clients

  15. Abdominal Hernia • Subjective symptoms • Presence of abdominal mass after lifting, straining, etc. • Possible pain • Swelling relieved by lying down • Sharp steady pain in groin • Severe pain and nausea (strangulated) • anorexia

  16. Abdominal Hernia • Objective symptoms • Palpable mass in inguinal, femoral, or umbilical area • Signs of obstruction • Vomiting • Irreducible mass • Diminished bowel sounds • Shock • Increased temp • Bloody stools • Undescended testicle or hydrocele in infants

  17. Abdominal Hernia • Diagnosis • History and physical • Medical treatment • Surgical repair – lap or open • Herniorrhaphy – muscle repair • Hernioplasty – reinforcement with patch • Truss if not able to have surgery

  18. Abdominal Hernia • Post- op care • Routine • Home care • Restrict lifting for 6-8 weeks • Prevent constipation • Hold off on sexual activity

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