1 / 46

Chapter 60

Chapter 60. Care of Patients with Inflammatory Intestinal Disorders. Mrs. Kreisel MSN, RN NU130 Adult Health Summer 2011. Appendicitis. Acute inflammation of the vermiform appendix —t he blind pouch attached to the cecum of the colon

luisa
Télécharger la présentation

Chapter 60

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 60 Care of Patients with Inflammatory Intestinal Disorders Mrs. Kreisel MSN, RN NU130 Adult Health Summer 2011

  2. 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’spoint: In accute appendicitis tenderness situated between the unbilicus and the right anteriosuperior iliac crest • Perforation: Puncuture or holes • Rebound tenderness

  3. McBurney’sPoint

  4. Interventions • Nonsurgical management includes: • NPO • IV fluids • Semi-Fowler’s position • Analgesics • No laxatives or enemas • No heat • PROVIDE COMFORT TOUCH AND REASSURANCE!

  5. Surgical Management • Laparoscopy or laparotomy to rule out appendicitis • Preoperative care as for general anesthesia surgeries • Operative procedure—appendectomy • Postoperative care

  6. 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

  7. Peritonitis(Cont.)

  8. Nonsurgical Management • IV fluids • Broad-spectrum antibiotics • Daily weight monitored • Fluid volume assessed • Nasogastric suctioning • NPO status • Oxygen • Pain management

  9. Surgical Management • Exploratory laparotomy • Semi-Fowler's position • Wound care: • Care of the incisions and drains • Peritoneal irrigation • IV fluid replacement

  10. 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

  11. Interventions • Fluid replacement • Nutrition therapy • Drug therapy • Skin care • Health teaching

  12. Inflammatory Bowel Disease (IBD) • Several disorders of the GI tract with no known etiology • Ulcerative colitis • Crohn’s disease

  13. 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

  14. Assessment • Physical assessment • Clinical manifestations • Psychosocial assessment • Laboratory assessment • Other diagnostic tests

  15. Drug Therapy • Aminosalicylates • Glucocorticoids • Immunomodulators • Antidiarrheal drugs • Other drugs

  16. Other Therapies • Nutrition therapy • Rest • Complementary and alternative therapies

  17. 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

  18. 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

  19. Kock’sIleostomy

  20. 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

  21. Ileoanal Reservoir

  22. 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!

  23. Fistulas

  24. Assessment • Physical assessment • Clinical manifestations • Psychosocial assessment • Diagnostic assessment

  25. Nonsurgical Management • Drug therapy • Nutritional therapy • Fistula management • Complication management • Fluid and electrolyte therapy • Skin care • Prevention of infection • Complementary and alternative therapies

  26. Skin Barriers

  27. Surgical Management • Laparoscopy • Small bowel resection and ileocecal resections • Stricturoplasty • Preoperative care • Operative procedure • Postoperative care

  28. 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.

  29. Diverticula

  30. Assessments • History • Physical assessment • Clinical manifestations • Diagnostic assessment

  31. Nonsurgical Management • Drug therapy • Nutrition therapy • Rest • IV fluids to correct dehydration • IV antibiotics • Anticholinergics • Analgesics

  32. Nonsurgical Management (Cont’d) • Avoid laxatives and enemas • Rest • NPO in the hospital

  33. Surgical Management • Preoperative care • Operative procedure • Postoperative care: • Drain care • Care of the ostomy • NPO followed by clear liquids

  34. 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

  35. Anal Fissure • Tear in the anal lining • Acute and chronic forms • Assessment • Management • Patient teaching

  36. Anal Fistula • Abnormal tract leading from the anal canal to the perianal skin • Most anal fistulas result from anorectal abscesses • Proctoscopy • Surgery

  37. Anal Fistula

  38. Parasitic Infection • Pathophysiology • Entamoeba histolytica • Giardia lamblia • Cryptosporidium • Assessment • Interventions

  39. 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?

  40. Food Poisoning • Salmonellosis • Staphylococcal infection • Escherichia coli infection • Botulism

  41. NCLEX TIME

  42. Question 1 Ulcerative colitis is most commonly seen in individuals belonging to which ethnic group? • Hispanic • Sephardic Jews • Portuguese Romani • Ashkenazi Jews

  43. 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? • Dehydration • Hypokalemia • Hypernatremia • Perineal skin breakdown

  44. Question 3 What is an expected outcome of a patient taking sulfasalazine (Azulfidine) for treatment of ulcerative colitis? • Anorexia • Anemia • Diarrhea • Dermatitis

  45. 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: • Hypernatremia • Hypercalcemia • Hyperglycemia • Hyperkalemia

  46. Question 5 How many people are infected with Salmonella organism each year in the United States? • 10,000 • 20,000 • 40,000 • 50,000

More Related