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.
It is the increase in: fluid, volume, and fluid content of the stool.
Antidiarrheal (not used during an acute attack)
Providing emotional support
Teaching about the illness and special needs.
Fluid and electrolytes imbalance R/T diarrhea
Body image disturbance R/T disease processNursing care in ulcerative colitis
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 indicatedFluid and electrolyte imbalance
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
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
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
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
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
Barium enema becomes one of the nursing care priorities.
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 scopeDiagnostic for polyps
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
CBC early stages has high cure rate.
Computed topography (CT)
Endoscopy(colonos-copy, sigmoidoscopy )
Tissue biopsyLaboratories and diagnostic for colorectal cancer
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
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
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 performedHartmann procedure
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 tumorsRadiation therapy
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 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
Alteration in nutrition
Risk for sexual dysfunctionNursing care for colorectal cancer
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