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Nursing Care & Interventions for Clients with Inflammatory Intestinal Disorders. Keith Rischer RN, MA, CEN. Today’s Objectives…. Describe commonalities in diseases of the gastro-intestinal tract. Compare indicators for malignancy throughout the gastro-intestinal system.

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nursing care interventions for clients with inflammatory intestinal disorders

Nursing Care & Interventions for Clients with Inflammatory Intestinal Disorders

Keith Rischer RN, MA, CEN

today s objectives
Today’s Objectives…
  • Describe commonalities in diseases of the gastro-intestinal tract.
  • Compare indicators for malignancy throughout the gastro-intestinal system.
  • Discuss relevance of diagnostic test results to the nursing plan of care.
  • Discuss the pathophysiology and assessment findings of ulcerative colitis and Crohn’s disease.
  • Consider nursing interventions for a client with a new ostomy.
  • Develop a teaching plan for a client integrating the use of medication and diet.
chronic inflammatory bowel disease
Chronic Inflammatory Bowel Disease

Ulcerative colitis is one of a group of bowel diseases of unknown etiology characterized by remissions and exacerbations (flare-ups).

Mucosal lining of the colon or rectum is affected.

Loose stools containing blood and mucus, poor absorption of vital nutrients, and thickening of the colon wall can result.

assessment
Assessment

Physical assessment

Clinical manifestations

Psychosocial assessment

Laboratory assessment

Radiographic assessment

diarrhea
Diarrhea
  • Interventions:
    • Record the color, volume, frequency, and consistency of stools.
    • Identify factors that cause or contribute to diarrhea.
    • Eliminate gas-producing and spicy foods.
diarrhea continued
Diarrhea(Continued)
  • Eliminate by trial foods containing lactose.
  • Eat a low-fiber, high-protein, high-calorie diet.
  • Use antidiarrheal medications.
  • Monitor skin.
  • Record weight regularly.
  • Rest the bowel.
drug therapy
Drug Therapy

Salicylate compounds

Corticosteroids

Immunosuppressive drugs

Antidiarrheal drugs

Other drugs

total colectomy with a continent kock s ileostomy
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

total colectomy with ileoanal anastomosis j pouch
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

acute pain chronic pain
Acute Pain; Chronic Pain
  • Interventions include:
    • Pain management in ulcerative colitis
      • Comprehensive pain assessment
      • Evaluation of effectiveness of pain control measures used
      • Reduction or elimination of precipitating factors for pain.
      • Teach use of non-pharmacologic pain reducing measures.
potential for gastrointestinal bleeding
Potential for Gastrointestinal Bleeding
  • Interventions include:
    • Monitoring for signs and symptoms of gastrointestinal bleeding
    • Monitoring all stools for blood, using both gross and occult examination
    • Monitoring hematocrit, hemoglobin, and electrolyte values
    • Monitoring vital signs
    • Preparing for possible blood administration
crohn s disease
Crohn’s Disease

Idiopathic inflammatory disease of the small intestine and the colon, or both

All layers of the bowel involved, mostly terminal ileum

Bowel fistulas

Rare cancer of the small bowel and colon develop.

Malabsorption of vitamins and nutrients

assessment1
Assessment
  • Physical assessment
  • Clinical manifestations
  • Psychosocial assessment
  • Diagnostic assessment
nonsurgical management
Nonsurgical Management

Drug therapy

Nutritional management

Complication management

Fluid and electrolyte therapy

Skin care

Prevention of infection

Complementary and alternative therapy

surgical management
Surgical Management

Laparoscopy

Small bowel resection and ileocecal resections

Stricturoplasty

Preoperative care

Operative procedure

Postoperative care

diverticular disease
Diverticular Disease

Diverticulosis is the presence of many abnormal pouchlike herniations in the wall of the intestine.

Diverticulitis is the term used to describe an inflammation of one or more of the diverticula.

assessments
Assessments
  • History
  • Physical assessment
  • Clinical manifestations
  • Diagnostic assessment
nonsurgical management1
Nonsurgical Management
  • Drug therapy
  • Diet therapy
  • Rest
  • Intravenous fluids to correct dehydration
  • Intravenous antibiotics
  • Anticholinergics
  • Analgesics

(

nonsurgical management2
Nonsurgical Management

Avoid laxatives

Rest

Nothing by mouth in the hospital

surgical management1
Surgical Management
  • Preoperative care
  • Operative procedure
  • Postoperative care
    • Drain care
    • Care of the ostomy
    • Nothing by mouth followed by clear liquids
anorectal abscess
Anorectal Abscess

Localized induration and fluctuance due to the inflammation of the soft tissue near the rectum or anus

Rectal pain first symptom

Surgical incision and drainage

Nursing interventions focused on helping the client maintain comfort and optimal perineal hygiene

High-fiber diet