Alteration in elimination bowel disease
Download
1 / 140

Alteration in elimination: Bowel disease - PowerPoint PPT Presentation


  • 442 Views
  • Updated On :

Alteration in elimination: Bowel disease. Alteration in elimination bowel. Inflammatory bowel disease Small bowel obstruction Cancer of the colon and ostomies. Small intestine. Made up of three parts: ileum, jejunum, and duodenum. Main function is absorption. Small intestine.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Alteration in elimination: Bowel disease' - flora


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.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Alteration in elimination bowel l.jpg
Alteration in elimination bowel

  • Inflammatory bowel disease

  • Small bowel obstruction

  • Cancer of the colon and ostomies.


Small intestine l.jpg
Small intestine

  • Made up of three parts: ileum, jejunum, and duodenum.

  • Main function is absorption



Diarrhea l.jpg

It is a symptom not a primary disorder.

It is the increase in: fluid, volume, and fluid content of the stool.

Causes:

Bacteria toxins

Parasitic infections

Malabsorption syndromes

Medication

Systemic disease

Allergies

Psychogenic

Diarrhea


Constipation l.jpg
Constipation

  • Two or less BM’s weekly or when defecation is excessively difficult or requires straining.

  • Most common cause: Ignoring the urge to defecate. Treat this cause with education ( a daily BM is not necessary for good health) exercise and diet modification.


Nursing assessment l.jpg
Nursing assessment

  • Questions ask?

    • Have you been out of the country?

    • What medications have you used?

    • When did the diarrhea start?

    • Are there any associated symptoms?


Nursing assessment15 l.jpg
Nursing assessment

  • Observe the patient’s stool for steatorrhea, blood, pus, or mucus.

  • Monitor frequency and characteristics of bowel movement.

  • Measure abdominal girth and auscultate bowel sounds every shift.


Nursing diagnosis l.jpg
Nursing diagnosis

  • Fluid volume deficit

  • Risk for impaired skin integrity

  • Altered nutrition: less than body requirements related to loss of nutrients


Fluid and electrolyte imbalance r t diarrhea l.jpg
Fluid and electrolyte imbalance r/t diarrhea

  • The increased water content of the stool places the patient at risk for fluid deficit.

    • Record Accurate I&O

    • Weight patient QD

    • Assess the patient’s mucous membrane, skin turgor, and urine specific gravity.

    • Monitor and record vital signs including orthostatic blood pressures.


Fluid and electrolyte imbalance r t diarrhea18 l.jpg
Fluid and electrolyte imbalance r/t diarrhea

  • Postural (orthostatic) blood pressure changes.

  • When the BP drops more than 10mmHg when changing positions (lying to sitting, sitting to standing). Orthostatic changes indicate fluid deficit. Pulse typically increases at the same time.


Risk for impaired skin integrity l.jpg
Risk for impaired skin integrity

  • Provide good skin care

  • Assist the client with cleaning the perianal area as needed. Use warm water and soft cloths.

  • Provide protective ointment to the perianal area


Caution on pharmacological treatments l.jpg
Caution on pharmacological treatments

  • Laxatives should never be administer to a patient with bowel obstruction or impaction.

  • People with abdominal pain of undetermined cause.

  • Laxatives can cause mechanical damage and perforate the bowel.


Caution on pharmacological treatments21 l.jpg
Caution on pharmacological treatments

  • Enemas are use for chronic constipation or fecal impaction.

  • As a general rule use only for acute phase on a short time bases.

  • Excessive use of enema can lead to fluid electrolyte imbalance.

  • Never use enemas if you suspect perforation.


Chronic inflammatory bowel disease l.jpg
Chronic inflammatory bowel disease

  • Two inflammatory diseases(Crohn’s disease and Ulcerative colitis )similar on the following :

    • Etiology is unknown (autoimmune component involve)

    • genetic components/run families/ethnic groups

    • Affect young adults between the ages 15-35 years.

    • Diarrhea is the predominant symptom


Ulcerative colitis l.jpg
Ulcerative colitis

  • Affects the mucous and the submucosa of the colon and rectum.

  • Primarily affects the young (15-30)

  • More common in whites

  • Cause unknown found in families with hx. of the same, hx crohn’s, Hx certain arthritis.


Pathophysiology of ulcerative colitis l.jpg
Pathophysiology of ulcerative colitis

  • Inflamed crypts of Lieberkuhn in the distal large intestine and rectum

  • Pinpoint microscopic hemorrhages develop

  • Then crypt abscesses develop.

  • The abscesses penetrated the superficial submucosa an spread laterally leading to mucosal necrosis and sloughing.


Pathophysiology of ulcerative colitis26 l.jpg
Pathophysiology of Ulcerative Colitis

  • The inflammatory process leads to further tissue damage from exudate and the release of inflammatory mediators such as prostanglandins and cytokines.

  • The mucosa becomes red because of vascular congestion, friable and edematous.

  • It bleeds easy and hemorrhage is common.


Pathophysiology of ulcerative colitis27 l.jpg
Pathophysiology of Ulcerative Colitis

  • Edema obscure the submucosal vessels and creates a granular appearance.

  • Pseudopolyps tongue line projections are common.

  • Polypoid changes represent areas of edematous tissue between areas of ulceration ..

  • Chronic inflammation leads to shortening of the colon from fibrosis and loss of haustra.


Pathophysiology of ulcerative colitis28 l.jpg
Pathophysiology of Ulcerative Colitis

  • The inflammatory process begins at the rectosigmoid are of the anal canal and progresses proximal.

  • May progress to involve the entire colon.

  • Blood, mucus and pus pool in he lumen of the colon (characteristic diarrhea)

  • The extent of the colon involving correlates with severity of the disease.




Ulcerative colitis signs and symptoms l.jpg
Ulcerative Colitis signs and symptoms

  • Insidious onset

  • Attacks last 1-3 months

  • Occur at intervals of months to years

  • Diarrhea is the predominant symptoms of all types of ulcerative colitis.

  • Typically 30-40 stools per day, with blood and mucus.


Ulcerative colitis signs and symptoms32 l.jpg
Ulcerative Colitis signs and symptoms

  • When severe disease is present may have other manifestation such as arthritis (related to the inflammatory process going on), uveitis, thromboemboli, lesions of the liver, gallbladder, and pancreas as well as pericarditis.

  • Patients with Ulcerative Colitis have an increased risk of developing colon cancer.


Complications of ulcerative colitis l.jpg
Complications of Ulcerative Colitis

  • Bowel perforation most deadly

  • Hemorrhage

  • Toxic megacolon

  • Increased risk of developing colon cancer.

  • The risk is higher when there is intensive involvement of the colon with disease for >10 years.


Diagnostic of ulcerative colitis l.jpg
Diagnostic of Ulcerative Colitis

  • Stool for occult blood

  • Hemoglobin and hematocrit

  • Colonoscopy**not on active phase

  • Barium enema**”

  • A yearly colonoscopy is strongly recommended for anyone who has ulcerative colitis with 8-10years after the DX.


Treatment of ulcerative colitis l.jpg
Treatment of Ulcerative Colitis

  • Pharmacological

  • Dietary management

  • Surgical management


Pharmacological treatment l.jpg
Pharmacological treatment

  • Sulfasalazine (Azulfidine) anti-inflamatory

    • inhibits prostaglandin production in the bowel.

  • Mesalamine (Rowasa) & Olsalazine (Dipentum) -Same action as above.

  • Corticosteroids-anti-inflammatory effects

    • Use as a treatment during acute attacks.


Pharmacological treatment37 l.jpg

Immunossupression

Imuran (Azathioprine)

Cyclosprine (Sandimmune)

Antidiarrheal (not used during an acute attack)

Loperamide

Diphenoxylate

Pharmacological treatment


Dietary management in ulcerative colitis l.jpg
Dietary management in ulcerative colitis

  • No milk products

  • No caffeine

  • No gas producing or raw fruits & vegetables

  • Bulk forming products such as psyllium or methylcellulose to decreased diarrhea and reduce symptoms.

  • TPN during acute exacerbation


Surgery as a treatment for ulcerative colitis l.jpg
Surgery as a treatment for ulcerative colitis.

  • Procedure of choice is a total colectomy with ileonal anastomosis.

  • The entire colon and rectum are remove

  • A pouch is formed from the terminal ileum


Surgery as a treatment for ulcerative colitis40 l.jpg
Surgery as a treatment for ulcerative colitis.

  • The pouch is brought into the pelvis and anastomosed to the anal canal.

  • A temporary or loop ileostomy is performed and maintained for 2 to 3 months.

  • When the anastomosis sites heal the ileostomy is closed and the patient has bowel movements through the anus.



Surgery as a treatment for ulcerative colitis43 l.jpg
Surgery as a treatment for ulcerative colitis.

  • The Kock’s ileostomy(continent)

    • an intra-abdominal reservoir is constructed from the terminal ileum.

    • Stool collects in the pouch until the patient drains it with a catheter

    • A nipple valve prevent leakage of stool.



Surgery as a treatment for ulcerative colitis45 l.jpg
Surgery as a treatment for ulcerative colitis.

  • Total proctocolectomy with permanent ileostomy.

    • Colon, rectum, and anus are remove, and the end of the terminal ileum is exteriorized as a stoma on the right abdominal wall.



Surgery as a treatment for ulcerative colitis47 l.jpg
Surgery as a treatment for ulcerative colitis.

  • Temporary or loop ileostomy is often used to eliminate feces and allow healing for 2-3 months after an ileoanal anastomosis.

    • A loop of the ileum is brought to the body surface and allows stool drainage into the external pouch.

    • When the stoma is not needed a second surgery is done to close the stoma and repair the bowel.

  • See Lemone text pp.826-829 for nursing care of patients with an ileostomy, for changing an ostomy pouch, and for ileostomy lavage.


Nursing care in ulcerative colitis l.jpg

Relieving abdominal cramping

Providing emotional support

Teaching about the illness and special needs.

Nursing diagnosis:

Fluid and electrolytes imbalance R/T diarrhea

Body image disturbance R/T disease process

Nursing care in ulcerative colitis


Fluid and electrolyte imbalance l.jpg

Monitor the appearance and frequency of bowel movement.

Assess and document presence of blood in the stool by testing for occult blood and BRB

Assess document Vital signs q4hrs.

Record pt. wt. qd.

Assess the pt. for signs of fluid deficit.

Maintain fluid intake by mouth or by parenteral means as indicated

Fluid and electrolyte imbalance


Disturbance in body image l.jpg

Encourage the patient to discuss physical changes and their consequences.

Accept patient feeling and perception of self.

Encourage discussion about concerns regarding the effects of the disease on close relationship.

Encourage pt. to make choice and decision regarding care.

Involve pt. in the teaching plans and provide instructions as needed.

Arrange for interaction with group of people with similar problems.

Teach coping strategies.

Disturbance in Body image


Teaching tips for patients with ulcerative colitis l.jpg

Emphasize the need to maintain an intake of 2 to 3 quarter of fluids per day to compensate for fluid losses.

Provide diet teaching refer to dietician if needed

If a surgical intervention is planned, teach about the surgery and follow up care . Contact an ET nurse.

Discuss medications , actions, side effects special consideration.

Teaching tips for patients with ulcerative colitis


Teaching tips for patients with ulcerative colitis53 l.jpg

Teach about ileostomy care verbal and written instructions. of fluids per day to compensate for fluid losses.

Discuss the use of OTC medications such as enteric coated or time release tablets and the fact that these medications might not be absorbed adequately before elimination through the ileostomy.

Refer to support groups and make community referral.

Teaching tips for patients with ulcerative colitis


Crohn s disease l.jpg
Crohn’s disease of fluids per day to compensate for fluid losses.

  • Primarily affects young people (10-30 years)

  • Can occur anywhere in the GI tract.

  • Most frequently affects the terminal ileum and right colon.


Crohn s disease55 l.jpg
Crohn’s disease of fluids per day to compensate for fluid losses.

  • Most frequently affects the terminal ileum and the right colon

  • Full thickness (transmural) disease

  • Can lead to ulceration, strictures, fistula development.

  • Skip lesions with areas of the bowel that appear normal.


Crohn s disease56 l.jpg
Crohn’s disease of fluids per day to compensate for fluid losses.

  • Cause is unknown

  • Like ulcerative colitis can have arthritis, uveitis, thromboembolism, and vascular disorders. Also the pt can have cystitis, renal calculus, and ureteral obstruction.


Pathophysiology of crohn s disease l.jpg
Pathophysiology of Crohn’s disease of fluids per day to compensate for fluid losses.

  • Begins with an aphthoid lesion similar to canker sore in the mucosa and submocosa of the bowel.

  • Deeper ulcerations, lesions, lumen takes on a cobblestone appearance.

  • Fibrotic changes in the bowel cause to thicken and lose of flexibility.


Aphtoid lesions of the mucosa l.jpg
Aphtoid lesions of the mucosa of fluids per day to compensate for fluid losses.


View of the intestine with crohn s l.jpg
View of the intestine with Crohn’s of fluids per day to compensate for fluid losses.


Late stages of crohn s l.jpg
Late stages of crohn’s of fluids per day to compensate for fluid losses.


Manifestations of crohn s disease l.jpg
Manifestations of Crohn’s disease of fluids per day to compensate for fluid losses.

  • Continuous or episodic diarrhea

  • Stools are liquid or semiformed and typically do not contain blood.

  • Abdominal pain and tenderness are common

  • A palpable RLQ mass is often present

  • Fever, malaise, weight loss, fatigue, and anemia are common.


Complications of crohn s disease l.jpg
Complications of Crohn’s Disease of fluids per day to compensate for fluid losses.

  • Intestinal obstruction

  • Abscess

  • Fistula

  • No associated risk of toxic megacolon as with ulcerative colitis.


Management of crohn s disease l.jpg
Management of Crohn’s Disease of fluids per day to compensate for fluid losses.

  • Managing symptoms

  • Controlling the disease process

  • Rest

  • Stress reduction

  • bowel rest


Management of crohn s disease65 l.jpg
Management of Crohn’s Disease of fluids per day to compensate for fluid losses.

  • Pharmacological support

    • Sulfasalazine is limited to the large bowel

    • Mesaline and olsalazine are more effective treating ileal inflammation.

  • Immunosuppressive agents

    • Corticosteroid

    • Mercaptopurine (6 MP, Purinerol)

    • Imuran (Azathioprine)

    • Cyclosporin (Sandimmune)


Management of crohn s disease66 l.jpg
Management of Crohn’s Disease of fluids per day to compensate for fluid losses.

  • Nutritional support

    • Well balance diet

    • Elimination of milk or milk products.

    • Ensure- elemental enteral feeding is helpful

    • Fiber added to diet if the Dx. Is located in the colon.

    • If a pt. shows symptoms of obstruction a low roughage is recommended


Management of crohn s disease68 l.jpg
Management of Crohn’s Disease of fluids per day to compensate for fluid losses.

  • Surgery

    • Bowel obstruction is the leading cause for surgery

    • With Crohn’s disease there is increased risk for fistula formation.

    • With Crohn’s disease, the surgery does not cure as it does with ulcerative colitis.

    • Crohn’s disease recur 50 to 75% of the time


Nursing care for crohn s disease l.jpg

The disease is a chronic life long illness and teaching becomes one of the nursing care priorities.

One of the most significant problems patients suffer is alteration in nutrition.

This disease significantly alter the ability of the bowel to absorb nutrients.

In addition, protein rich fluid and blood may be lost due to diarrhea.

The nutritional deficiencies can impair growth and development, healing, cause muscle wasting, bone diseases, and electrolyte imbalance.

Nursing care for Crohn’s disease


Nursing care for crohn s disease70 l.jpg

Weight daily becomes one of the nursing care priorities.

Maintain accurate I &O

Monitor laboratory studies closely.

Provide a diet high in calories, protein, low fat , and restriction of milk products .

Arrange for dietary consult.

Provide parental nutrition if absorption of nutrients is highly impair.

Administer prescribe nutritional supplements.

Involve family member specially the person who prepare meal on dietary teaching.

Nursing care for Crohn’s disease


Neoplastic disorders polyps and colorectal cancer l.jpg
Neoplastic Disorders:Polyps and Colorectal Cancer becomes one of the nursing care priorities.

  • The large intestine and the rectum are the most common sites of cancer in the digestive tract.


Polyps l.jpg
Polyps becomes one of the nursing care priorities.

  • Polyps are masses of tissues that arise from the bowel wall and protrude into the lumen. Most polyps are benign but some have the potential to become malignant.

  • Familial polyposis is an uncommon disorder characterized by hundreds of adenomatous polyps throughout the large intestine. The risk of malignancy is almost 100% by the age 40.


Sessile and pendunculated intestinal polyps l.jpg
Sessile and pendunculated intestinal polyps becomes one of the nursing care priorities.


Polyposis l.jpg
Polyposis becomes one of the nursing care priorities.


Symptoms of polyps l.jpg
Symptoms of polyps becomes one of the nursing care priorities.

  • Most are asymptomatic

  • Intermittent painless rectal bleeding

  • Dark or bright blood


Diagnostic for polyps l.jpg

Barium enema becomes one of the nursing care priorities.

Sigmoscopy

Digital examination

Colonoscopy

Once identify polyps need to be remove because of the risk of malignancy.

They can be remove during colonoscopy using electrocautery snare or hot biopsy forceps passed through the scope

Diagnostic for polyps


Nursing implications for barium enema l.jpg
Nursing implications for Barium Enema becomes one of the nursing care priorities.

  • Liquid diet a day before procedure

  • Pt. NPO 8 hours before the procedure

  • Inform consent

  • Administer laxatives if order.

  • Laxative given after procedure

  • Stools may be white for 1 to 2 days


Nursing implications for colonoscopy l.jpg
Nursing implications for colonoscopy becomes one of the nursing care priorities.

  • Usually a liquid diet is prescribe 2 days before procedure.

  • Pt. Needs to be NPO 8 hours before procedure.

  • Administer or instruct the pt in bowel preparation procedures.

  • Conscious sedation is usually used


Cathartics for bowel preparation l.jpg
Cathartics for bowel preparation becomes one of the nursing care priorities.

  • Magnesium Citrate

    • Empty stomach follow by a full glass of water.

    • Chill the solution, Give the medication early in the evening so it does not interfere with sleep.

  • Polyethylene Glycol

    • No food should be consumed 2 to3 hrs prior nor within 2 hours of ingesting the solution.Chill,give in early evening.


Nursing implications for colonoscopy81 l.jpg
Nursing implications for colonoscopy becomes one of the nursing care priorities.

  • Inform consent must be sign

  • Instruct client about procedure

    • Biopsy

    • Polyps removed

  • After the procedure

    • Report any abdominal pain, chills,fever, rectal bleeding or mucupurulent discharge.

    • If a polyp is remove avoid heavy lifting for 7 days and avoid high-fiber food for 1 to2 days.


Diagnostic for polyps83 l.jpg
Diagnostic for polyps becomes one of the nursing care priorities.

  • Polyps tend to recur.

    • Need to follow-up with another colonoscopy in 3 years and then every 5 years if no further polyps are detected.

    • See the table on p. 844 of Lemone: The risk factors for colorectal cancer. Polyps are on the list.


Colorectal cancer l.jpg
Colorectal Cancer becomes one of the nursing care priorities.

  • It is a malignant tumor arising from the epithelial Tissue of the colon or rectum.

  • It is the second leading caused of cancer death in Western countries.

  • In the United states the incident is 5%


Risk of colorectal cancer l.jpg
Risk of colorectal cancer becomes one of the nursing care priorities.

  • Age >50 years

  • Polyps of the colon and or rectum

  • Cancer elsewhere in the body

  • Family Hx of colorectal cancer

  • Ulcerative Colitis Crohn’s disease


Risk factors for colorectal cancer l.jpg
Risk factors for colorectal cancer becomes one of the nursing care priorities.

  • Exposure to radiation

  • Immunodeficiency disease

  • High fat intake

  • Low calcium and fiber intake.


Pathophysiology of colorectal cancer l.jpg
Pathophysiology of colorectal cancer becomes one of the nursing care priorities.

  • Nearly all come from adenocarcinomas that develop from adenomas polyps.

  • Insidious

  • Undetected, few symptoms

  • Spread into the entire bowel, submocousa and the bowel layers, then to the liver, stomach etc...


Pathophysiology of colorectal cancer89 l.jpg
Pathophysiology of colorectal cancer becomes one of the nursing care priorities.

  • Slow growth pattern

  • 5-15 years of growth before symptoms appear.

  • It spread by direct extension to involve the entire bowel circumference, the submucosa and outer bowel layers.


Manifestations of bowel cancer l.jpg
Manifestations of bowel cancer becomes one of the nursing care priorities.

  • Bleeding

  • Changes in bowel habits

  • Pain, anorexia, weight loss (late sign)

  • Palpable abdominal or rectal mass might be present.

  • Anemia caused from occult bleeding.


Prognosis l.jpg
Prognosis becomes one of the nursing care priorities.

  • Prognosis depends on the stage of the disease at the time of the diagnosis and on the initiation of treatments.


Primary complications of bowel cancer l.jpg
Primary complications of bowel cancer becomes one of the nursing care priorities.

  • Bowel obstruction (narrow lumen) cause by tumor or lesions.

  • Bowel perforation ( of the wall by the tumor)allowing contamination of the peritoneal cavity with bowel content.

  • Direct extension of the tumor to adjacent organs


Laboratories and diagnostic for colorectal cancer l.jpg

Colorectal cancer is a silent disease and treatment in the early stages has high cure rate.

The American cancer society recommends screening for early detection of the disease.

Annual digital rectal examination for all people over age 40.

Annual guaiac testing for occult fecal blood for people over 50.

Flexible sigmoidoscopy every 3 to 5 years for any body over the age of 50.

Laboratories and diagnostic for colorectal cancer


Laboratories and diagnostic for colorectal cancer94 l.jpg

CBC early stages has high cure rate.

Barium enema

Blood chemistry

Chest x-ray

Computed topography (CT)

Endoscopy(colonos-copy, sigmoidoscopy )

Tissue biopsy

Laboratories and diagnostic for colorectal cancer


Treatment of bowel cancer is surgery l.jpg
Treatment of bowel cancer is surgery early stages has high cure rate.

  • Treatment of bowel cancer is surgery

  • Chemotherapy (adjunct) and radiation (adjunct)


Treatment of bowel cancer is surgery96 l.jpg

Laser photocoagulation uses a very small intense light to generate heat in tissue towards it is directed.

The heat destroy small tumors and it is palliative for large tumors causing obstruction.

Incision and fulguration are performed during endoscopy eliminating the need for surgery.

Incision can be used to remove a disk of rectum containing tumor with pts. Small well differentiate polyps.

Fulguration is used to decreased the size of large tumors.

Treatment of bowel cancer is surgery


Treatment of bowel cancer is surgery97 l.jpg

Most of the patients with colorectal cancer undergo surgical resection of the colon with anastomosis of the remaining bowel.

The distribution of the regional lymph nodes determine the extend of the resection as these may contain metastatic lesions

Most tumors of the ascending, transverse , descending and sigmoid can be resected.

Treatment of bowel cancer is surgery


Surgery treatment for colorectal cancer l.jpg
Surgery/treatment for colorectal cancer resection of the colon with anastomosis of the remaining bowel.

  • Tumors of the rectum usually are treated as follow:

    • Abdominal perineal resection

    • The sigmoid colon, rectum, and anus are removed through both abdominal and perineal incisions.

    • A permanent sigmoid colostomy is performed.

    • See the critical pathway in(p. 849 in Lemone)


Surgery treatment for colorectal cancer99 l.jpg
Surgery/treatment for colorectal cancer resection of the colon with anastomosis of the remaining bowel.

  • Surgical resections may be accompanied by a colostomy for diversion of fecal contents.

  • A colostomy is an ostomy made in the colon.

  • It can be perform if the bowel is obstructed by the tumor, as a temporary measure to promote healing of anastomoses or permanent means of fecal evacuation when the rectum and sigmoid colon have been removed.



Types of colostomies l.jpg
Types of colostomies which they are found

  • Sigmoid (most common permanent): the sigmoid colon, rectum and anus are remove through abdominal and perineal incisions.

  • The anal canal is closed and a stoma formed from the proximal sigmoid colon.

  • The stoma is located in the left lower quadrant of the abdomen.


Types of colostomies104 l.jpg
Types of colostomies which they are found

  • Double -barrel : Two separate stomas are created. The distal colon is not remove but bypassed.

  • The proximal stoma which is functional, diverts fecal flow to the abdominal wall.

  • The distal portion (mucus fistula) expel mucus from the distal colon.

  • This temporary colostomy may be temporary or permanent, being created for cases of trauma, tumor or inflammation.


Types of colostomies114 l.jpg
Types of colostomies which they are found

  • An emergency procedure used to relieve an intestinal obstruction or perforation is a

    • Transverse loop colostomy: a loop of the transverse colon is brought out of the abdominal wall and suspended over a plastic rod or bridge which prevents it from back into abdomen. Usually temporary.

  • See your text book for nursing care of patient with a colostomy pre-and post-op.


Hartmann procedure l.jpg

The distal portion of the colon is left in place and is oversewn for closure.

This is a temporary colostomy usually done when bowel rest or healing is require such as tumor resection or inflammation of the bowel.

Surgical reconnection or anastomosis of the severe portions of the colon is not done immedially because of the heavy bacterial colonization of the colon would not allow the anastomosis to heal properly.

About 3 to 6 months following a temporary colostomy , the colostomy is close and the anastomosis is performed

Hartmann procedure


Radiation therapy l.jpg

While radiation therapy is not effective as a primary treatment for colon cancer it is recommended as adjunct therapy specially for rectal tumors.

Small rectal cancer may be treated with intracavitary, external,or implantation radiation.

Radiation reduce the recurrences of rectal and pelvic tumors

Radiation therapy


Chemotherapy l.jpg

Chemotherapeutic agents such as oral levamisole and intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

When radiation and chemotherapy are used in combination after surgery it improves control and survival for patients with stage II and stage III in rectal tumors.

Chemotherapy


Nursing care for colorectal cancer l.jpg

Nursing care is directed at: intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

Providing emotional support

Teaching about specific diagnostic procedures , pre-op and post-op.

Instruct in colostomy care

Nursing diagnosis

Pain

Alteration in nutrition

Anticipatory grieving

Risk for sexual dysfunction

Nursing care for colorectal cancer


Intestinal obstruction l.jpg
Intestinal Obstruction intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • When the intestinal contens fail to be propelled through the lumen of the bowel.

    • Usually involves the small bowel

      • Mechanical obstruction: Scar tissue, hernia tumor

      • Functional obstruction: Peristalsis problem (paralytic ileus)


Causes of intestinal obstruction l.jpg
Causes of intestinal obstruction intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Adhesions

  • Incarcerated Hernia

  • Volvulus

  • Foreign bodies

  • Stricture

  • Inflammatory bowel disease(ulcerative colitis).


Paralytic ileus l.jpg
Paralytic ileus intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Paralytic ileus an impair in the propulsion or forward movement of bowel content. It can be cause by:

    • GI surgery

    • Irritation of the bowel due to inflammation, hemorrhage, peritonitis, or perforation of an organ.

    • Hypokalemia

    • Effects of narcotics or antidiarrhea medications.


What happens in a small obstruction l.jpg
What happens in a small obstruction intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Obstruction occurs

    • Gas fluid collect in the area of the bowel proximal.

    • Lumen of bowel distends

    • Swallowed air and gases contributed to further distention.


What happens in a small obstruction123 l.jpg
What happens in a small obstruction intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Endotoxins and prostanglandins are released

  • Large quantities of fluid and electrolytes are drawn into the area.

  • Further distension occur


What happens in a small obstruction124 l.jpg
What happens in a small obstruction intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Cycle of intestinal distention, water and sodium and potassium, further reduction in motility occurs.

  • The danger is all of this lead to pressure distention and necrosis of the bowel.

  • Large volume of fluid trapped in the bowel lead to hypovolemic and shock.


Signs and symptoms of intestinal obstruction small bowel l.jpg
Signs and symptoms of intestinal obstruction (small bowel) intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Cramping or colicky abdominal pain intermittent or increasing in intensity.

  • Vomiting with both high and low obstructions. (becomes feculent with low or distal obstructions)

  • Visible peristalsis waves


Signs and symptoms of intestinal obstruction small bowel126 l.jpg
Signs and symptoms of intestinal obstruction (small bowel) intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Cramping or colicky abdominal pain intermittent or increasing in intensity.

  • Vomiting with both high and low obstructions. (becomes feculent with low or distal obstructions)

  • Visible peristalsis waves


Signs and symptoms of intestinal obstruction small bowel127 l.jpg
Signs and symptoms of intestinal obstruction (small bowel) intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Signs of fluid and electrolytes imbalance

  • Dehydration

  • Fever

  • Later the bowel becomes silent (absent bowel sounds)


Laboratory and diagnostic test l.jpg
Laboratory and Diagnostic Test intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Abdominal x-ray

  • Bowel contrast x-ray studies(gastrografin)

  • WBC count is often elevated

  • Hemoglobin and hematocrit elevated

  • Serum osmolality is increased

  • Decreased K+ and CL-


Management of small bowel obstruction l.jpg
Management of small bowel obstruction intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Gastrointestinal decompression

    • 90% of partial bowel obstructions are success fully treated with gastrointestinal decompression.

  • Surgery

    • NGT put in to prevent vomiting and abdominal distention and prevent aspiration of abdominal content. Fluid and electrolytes deficit need to be corrected before surgery.


Goals of surgical intervention l.jpg
Goals of surgical intervention intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Relieve colonic distention

  • Prevent perforation

  • Remove obstruction


Cantor tube use for abdominal decompression l.jpg
Cantor tube use for abdominal decompression intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.


Frequent complications with bowel obstructions l.jpg
Frequent complications with bowel obstructions intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Fluid electrolytes imbalance

  • Acid base imbalance

  • Hypovolemic shock

  • Perforation/peritonitis


Nursing diagnosis135 l.jpg
Nursing diagnosis intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Alteration in tissue perfusion/Gastrointestinal

  • Fluid volume deficit

  • Ineffective breathing pattern


Alteration in tissue perfusion gastrointestinal l.jpg
Alteration in tissue perfusion/gastrointestinal intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • The same obstruction of the bowel lumen may reduce or block the blood supply to the bowel wall.

    • Monitor V. S

    • Monitor I & O

    • Assess level pain frequently

    • Keep NPO until peristalsis return.


Fluid volume deficit l.jpg
Fluid volume deficit intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Large collection of fluid in the bowel proximal to the obstruction, the accompanied vomiting, and Nasogastric suction the patient with bowel obstruction usually has problems in this area.

    • Monitor V.S

    • Accurate intake and output/ replace with IVF

    • Measure abdominal girth every 4 hrs.


Symptoms of intestinal obstruction large bowel l.jpg
Symptoms of intestinal obstruction (large bowel) intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

  • Less common than small bowel obstruction

  • Constipation and abdominal pain are the more common signs and symptoms.

  • Vomiting is a late signs if it happens at all

  • Abdomen is distended with high pitch bowel sounds.


Large bowel obstruction l.jpg

A barium enema is used to confirm a large bowel obstruction and determined its location.

Most common large bowel obstructions occur in the sigmoid segment.

Most common cause is cancer of the bowel.

Gangrene and perforation is the most common potential complications.

Large bowel obstruction


ad