Post on 11-Jan-2016
UNDERSTANDING LOWER UNDERSTANDING LOWER BOWEL DISEASEBOWEL DISEASE
Knowing Inflammatory Bowel Knowing Inflammatory Bowel DiseaseDisease
Ulcerative ColitisUlcerative Colitis Crohn’s DiseaseCrohn’s Disease SimilaritiesSimilarities
Cause unknownCause unknown Geographic distributionGeographic distribution Genetic componentGenetic component Chronic recurring inflammation of the Chronic recurring inflammation of the
intestinal tractintestinal tract
Inflammatory Bowel Disease ComparisonInflammatory Bowel Disease Comparison
Ulcerative ColitisUlcerative Colitis Usual onset – young to middle ageUsual onset – young to middle age
Affects mucosa and submucosa of the Affects mucosa and submucosa of the colon and rectumcolon and rectum
Common symptomsCommon symptoms weight lossweight loss rectal bleedingrectal bleeding diarrheadiarrhea severe tenesmussevere tenesmus
ComplicationsComplications PerforationPerforation MegacolonMegacolon HemorrhageHemorrhage
Crohn’s DiseaseCrohn’s Disease Usual onset – youngUsual onset – young
Can affect any portion of the GI tract and Can affect any portion of the GI tract and the entire thickness of the bowel wallthe entire thickness of the bowel wall
Common symptomsCommon symptoms diarrheadiarrhea crampingcramping feverfever malabsorptionmalabsorption
ComplicationsComplications FistulasFistulas StricturesStrictures Abscesses Abscesses PerforationPerforation
Inflammatory Bowel DiseaseInflammatory Bowel Disease
Ulcerative Colitis
Crohns
Cobblestoning
Collaborative CareCollaborative Care
DiagnosticsDiagnostics MedicationsMedications NutritionNutrition SurgerySurgery
MedicationsMedications
AntimicrobialsAntimicrobials CorticosteroidsCorticosteroids SedativesSedatives AntidiarrhealsAntidiarrheals Hematinics and VitaminsHematinics and Vitamins
NutritionNutrition
IndividualizedIndividualized GoalsGoals
Adequate nutrition without exacerbating Adequate nutrition without exacerbating
symptomssymptoms Correct and prevent malnutritionCorrect and prevent malnutrition Replace fluid and electrolytes lossesReplace fluid and electrolytes losses Prevent weight lossPrevent weight loss
Nursing DiagnosisNursing Diagnosis Diarrhea Diarrhea related to irritated bowel and intestinal hyperactivityrelated to irritated bowel and intestinal hyperactivity Anxiety Anxiety related to possible social embarrassment, diagnostic tests, and related to possible social embarrassment, diagnostic tests, and
treatmentstreatments Imbalanced Nutrition: Less than Body Requirements Imbalanced Nutrition: Less than Body Requirements
related to decreased intake, decreased absorption, and increased nutrient loss related to decreased intake, decreased absorption, and increased nutrient loss through diarrheathrough diarrhea
Impaired Skin Integrity Impaired Skin Integrity related to diarrhea and altered nutritional related to diarrhea and altered nutritional statusstatus
Ineffective CopingIneffective Coping related to chronic disease, lifestyle changes, stress related to chronic disease, lifestyle changes, stress and pain and pain
Ineffective Therapeutic Regimen Management Ineffective Therapeutic Regimen Management related to related to lack of knowledge of disease course, lifestyle adjustments, nutritional and drug lack of knowledge of disease course, lifestyle adjustments, nutritional and drug
therapytherapy
Colorectal CancerColorectal Cancer
Risk factorsRisk factors Age over 50Age over 50 PolypsPolyps Family HistoryFamily History Inflammatory Bowel DiseaseInflammatory Bowel Disease Exposure to RadiationExposure to Radiation High animal Fat and calorie intakeHigh animal Fat and calorie intake
Colon PolypsColon Polyps
Sessile (villous)Sessile (villous) Pedunculated (tubular)Pedunculated (tubular) FamilialFamilial
Collaborative CareCollaborative Care
ScreeningScreening Diagnostic testsDiagnostic tests SurgerySurgery Radiation Radiation ChemotherapyChemotherapy
Surgical InterventionsSurgical Interventions
Performed when necessitated by complicationsPerformed when necessitated by complications
or failure of conservative treatment measuresor failure of conservative treatment measures Crohns: resection with end to end anastomosisCrohns: resection with end to end anastomosis Ulcerative colitisUlcerative colitis
Total ColectomyTotal Colectomy Ostomy Ostomy
o PermanentPermanento Temporary or loopTemporary or loopo Continent (Kock’s) ileostomyContinent (Kock’s) ileostomy
Ileostomy FactsIleostomy Facts
Stool consistency is liquid to semi-liquidStool consistency is liquid to semi-liquid Fluid requirements may be increasedFluid requirements may be increased No bowel regulationNo bowel regulation Use of pouch and skin barriersUse of pouch and skin barriers No irrigationNo irrigation Indications for surgery: Indications for surgery: ulcerativeulcerative colitis, crohns, diseased colitis, crohns, diseased
or injured colon, birth defetcs, familial polypois, trauma, canceror injured colon, birth defetcs, familial polypois, trauma, cancer
Nursing Diagnosis for Patients with Nursing Diagnosis for Patients with a Colostomy/Ileostomya Colostomy/Ileostomy
Risk for Impaired Skin Integrity – Risk for Impaired Skin Integrity – related to irritation from fecal related to irritation from fecal drainage, irritation from appliance, and lack of knowledgedrainage, irritation from appliance, and lack of knowledge
Disturbed Body ImageDisturbed Body Image – related to presence of ostomy and odor – related to presence of ostomy and odor
Imbalanced Nutrition: Less than Body RequirementsImbalanced Nutrition: Less than Body Requirements - - related to lack of knowledge of appropriate foods and decreased appetiterelated to lack of knowledge of appropriate foods and decreased appetite
Ineffective Sexuality PatternsIneffective Sexuality Patterns - related to perceived loss of sexual - related to perceived loss of sexual appeal and possibility of seepage of fecal material during sexual activityappeal and possibility of seepage of fecal material during sexual activity
Risk for Deficient Fluid VolumeRisk for Deficient Fluid Volume - related to excess fluid loss - related to excess fluid loss from ileostomy or diarrhea with colostomy and decreased intakefrom ileostomy or diarrhea with colostomy and decreased intake
Stoma CharacteristicsStoma Characteristics
CharacteristicCharacteristic ColorColor
Rose to redRose to red PalePale Blanching, dark red to Blanching, dark red to purplepurple
EdemaEdema Mild to moderateMild to moderate
Moderate to severeModerate to severe
BleedingBleeding Small amountSmall amount Moderate to largeModerate to large
CauseCause
Viable stomaViable stoma AnemiaAnemia Inadequate blood supplyInadequate blood supply
Normal initial postopNormal initial postop Trauma to stoma, medical causeTrauma to stoma, medical cause ObstructionObstruction Allergic reactionAllergic reaction GastroenteritisGastroenteritis
Small amount normalSmall amount normal Coag deficiency, varices, GI bleedCoag deficiency, varices, GI bleed
Colostomy ComparisonsColostomy Comparisons Ascending Ascending
Stool consistency semiliquidStool consistency semiliquid Fluid requirement increasedFluid requirement increased No bowel regulationNo bowel regulation Pouch ans skin barriersPouch ans skin barriers Irrigation noIrrigation no Indications: perforating diverticulitis, tumorsIndications: perforating diverticulitis, tumors
Transverse: semiliquid to semiformed, irrigation noTransverse: semiliquid to semiformed, irrigation no Sigmoid: formed stool , no change in fluids, bowel regulation Sigmoid: formed stool , no change in fluids, bowel regulation
possible, may need irrigation, cancer of the rectum or possible, may need irrigation, cancer of the rectum or perforating diverticulumperforating diverticulum
Other Bowel DisordersOther Bowel Disorders
Celiac DiseaseCeliac Disease HerniasHernias Intestinal ObstructionIntestinal Obstruction Diverticular DiseaseDiverticular Disease Irritable BowelIrritable Bowel Lactase DeficiencyLactase Deficiency