Care of Clients with Problems In Oxygenation, Fluids and Electrolytes, Metabolism and Endocrine (NCM103) Patients With Gastrointestinal

Alterations IV

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Continuation Appendicitis
Inflammation of the vermiform appendix, can affect many age groups, most common in males 10 – 30 years old Causes: o Obstruction of the intestinal lumen infection o Stricture o Fecal mass o Foreign body or tumor

Topics Discussed Here Are: 1. Continuation a. Appendicitis (Plus Peritonitis) b. Diverticular Disease 2. Anorectal Disorders a. Hemorrhoids b. Anal Fissure

Clinical Manifestations 1. General or localized abdominal pain in the epigastric or periumbilical areas and upper right abdomen within 2 – 12 hours, the pain localized in the RLQ and intensity increases 2. Anorexia, moderate malaise, mild fever, nausea, vomiting 3. Usually constipation occurs, occasionally diarrhea 4. Rebound tenderness, involuntary guarding, general abdominal rigidity (RUPTURED APPENDICITIS) Diagnostic Test 1. CBC will show ↑ WBC (Leukocytes) 2. Urinalysis to rule out urinary disorder 3. Abdominal X-ray may visualize shadow consistent with fecalith 4. Abdominal CTZ/CT Scan Pathophysiology
Nursing Interventions 1. PreOp! Care Monitor bowel sounds, hydration status Position of Comfort: RIGHT SIDE LYING IN A LOW FOWLER’S Avoid laxatives, enemas and heating application 2. PostOp! Care Monitor VS and signs of surgical complications Maintain NPO until bowel function returns If rupture occurred, expect drain and IV antibiotic Position PostOp!: RIGHT SIDE LYING HIGH FOWLER’S (To ↓ tension on incision and legs flexed to promote drainage) Administer prescribed pain medications

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SEMI-FOWLER’S N/V Prevent complications of immobility ↑ Pulse. VS. ↑ BP ↓ Bowel sounds Dehydration Diagnostics CBC. An incisional drain may be placed if an abscess or rupture occurs b.Anorexia .Exploratory Laparoscope PERITONITIS “HOT BELLY” (Mnemonics thingy din) Risk Factors Ectopic pregnancy Abdominal Surgery Perforation o Diverticulum o Appendix Nursing Care: o Ulcer Maintain F&E balance and ↓ GI distention o Trauma o NG Suction o IV Solution (NS.Clinical signs and symptoms . Simple appendectomy or laparoscopic appendectomy in absence of rupture or peritonitis b.Rare in children < 2 years .Appendicitis (Mnemonics Thingy) . Paracentesis. History Treatment Identify cause Antibiotics IV Fluids ↓ Abdominal distention Management a.Begins AS DULL. STEADY pain in PERIUMBILICAL AREA. LR) Clinical Manifestations o Potassium Supplement with acare Pain over area o Peristalsis Bowel sounds? Presence of a CAUSE o I&O Rebound tenderness o Signs and Symptoms of Abdominal rigidity (Board like) HYPOVOLEMIA Fever ↓ Infectious process Anorexia o Antibiotics. Surgery (Appendectomy is indicated) a.Sudden pain relief may indicate RUPTURE of appendix which may lead to PERITONITIS . possible antibiotic prophylaxis. progresses over 4 – 6 hours and localizes to RLQ .Rebound pain or tenderness DIAGNOSIS . X-ray.Abdominal sonogram .↑ WBC . analgesia jcmendiola_Achievers2013 . Pre-operative: Maintain bed rest.Nausea . IV hydration. NPO status.Low Grade FEVER .

Alteration in comfort: Pain related to inflamed appendix 2. X-ray. Palpate over McBurney’s Point  Rebound Tenderness? 4. Perforation (95%) 2. Risk for infection related to perforation of the intestinal lumen Nursing Interventions and Patient Education 1. Instruct client to report symptoms of anorexia. PQRST 2. Assess for Psoas’ Sign 5. pain. such as Semi-fowler’s and knees up 3. INFECTION. Assess for (+) Obturator sign 6. Increasing age 5. Restrict activity that may aggravate pain such as cough and ambulation 4. ↓ Fiber Diet 2. incisional redness or drainage post-operative Diverticular Disease Diverticulum – Blind out pouching or herniation of intestinal mucosa through the muscular layer coat of the large intestine Common to men and women above 45 years old (15 – 20%) Obese person (Increase intra-abdominal pressure) Two Forms • Diverticulosis: Diverticulas are present but may cause only MILD or NO SYMPTOMS. Assist patient to comfortable position. Auscultate bowel sounds (Absent / hypoactive) 3. N/V. rectum. HEMORRHAGE Etiology 1. Obtain History for local and extent of pain 2. Apply ice bag to abdomen to decrease discomfort 5.Complication: 1. Unnatural sitting posture Diagnostic Evaluation 1. Assess for Murphy’s Sign Nursing Diagnosis 1. may progress to DIVERTICULITIS • Diverticulitis: Diverticulas are INFLAMED and may cause potentially FATAL OBSTRUCTION. Give analgesics ONLY as ordered after diagnosis is determined 6. Peritonitis Nursing Assessment 1. fever. Colonoscopy – Visualization of the colon 2. Abscess 3. MRI jcmendiola_Achievers2013 . Monitor pain level. Avoid indiscriminate palpation of the abdomen to avoid increasing patient’s discomfort 7. Diminished colonic motility and ↑ Intraluminal pressure 3. Instruct client to avoid HEAVY lifting 4 – 6 weeks after surgery 8. Defects in wall strength (weakness) – Marfan’s Syndrome 4.

Pathophysiology Clinical Manifestations Depends on the extent and site of occurrence Mild Diverticulitis o Moderate Left Lower Abdominal Pain (LLQ) o Low grade fever o Leukocytosis (↑WBC) Severe Diverticulitis o Abdominal Rigidity o Left Lower Quadrant PAIN! LLQ o High fever. HTN from septic shock o Microscopic massive hemorrhage o Diminished bowel sounds o N/V Treatment No Often Treatment is needed Hydration ↑ Fiber in diet (20 – 35 grams/day) Removing factors resulting in constipation If diverticulas are greater than 1 inch with other severe symptoms – SURGERY is NEEDED jcmendiola_Achievers2013 . chills.

These lie BELOW the internal anal sphincter . Prolapse. prolonged sitting or standing (Due to virtue of gravity).These distended veins lie ABOVE the internal anal sphincter . Doxycycline ACUTE DIVERTICULITIS o NPO Status o NGT o Parenteral fluids o Antibiotics (Until signs and symptoms of inflammation subsides) o When acute episodes subsides More inclusive diet Health teaching about diet changes Surgical Management Surgery – Indicated if such complications are present: o Hemorrhage o Obstruction o Abscess o Perforation Ligation and removal of the sac or resection of involved bowel In Abscess or Obstruction – Colon resection with temporary colonostomy Vasopressin Infusion – If bleeding continues Possible Nursing Diagnoses Constipation Hyperthermia Pain Diarrhea Low self-esteem Infection Risk for infection Anorectal Disorders Hemorrhoids Abnormal distention and weakening of the veins of the anal canal Variously classified as Internal or External. Thrombosed and Reducible Risk Factors • ↑ Intra-abdominal pressure caused by pregnancy. CHF. cirrhosis with portal hypertension (Damage in liver) o CHF due to decreased venous return because of congestion = VENOUS POOLING Pathophysiology HEMORRHOIDS  Wala XD (Di ko nacopy) INTERNAL HEMORRHOIDS . obesity. Cephalexin. Ciprofloxacin.Medical Management Chlordiazepoxide (Librium). Deocyclomine (Bentyl).Usually the condition is PAINLESS EXTERNAL HEMORRHOIDS .Usually the condition is PAINFUL jcmendiola_Achievers2013 . constipation with prolonged straining. Donnatal and Hyoscyamine (Levsin) – For bloated and abdominal pain All drugs are ANTISPASMODIC Oral antibiotics – Metronidazole.

Hazel soaps Diagnostic Tests 3. Daily bowel movement 3. Clean area with WARM water after defecation (Hot SITZ BATH) Clinical Manifestations ¥ Same with Crohn’s Disease Predisposing is rectal bleeding Diarrhea of 20 or more stools a day ¥ Same MEDS and MANAGEMENT (Medical and Surgical) of Crohn’s Disease jcmendiola_Achievers2013 . Cryosurgery (FREEZING!) d. External Hemorrhage – CAN BE SEEN! 3. Ligation (Removing the vein) c. Hemorrhage 2. Keep the stool soft (Metamucil. Stool softeners as prescribed 2. Rectal / Perianal pain Nursing Interventions: 5. Urinary retention (Constipation blocks bladder!) PostOp! Care for Hemorrhoidectomy 1.Assessment Findings 1. Hemorrhoidectomy (most common) Post-Operative Complications 1. Rectal itching 1. Position: PRONE / SIDE LYING! Maintain dressing over the surgical site Monitor for bleeding Administer analgesics and stool softeners Administer the use of SITZ BATH 3 – 4 times a day Anal Fissure Ulceration or tear of the lining og the anal canal Usually posterior wall Causes: 1) Excessive stretching 2) Frequent passage of hard and large stool Types: Acute Chronic Management 1. Docusate Sodium) 2. Sclerotherapy b. Digital Rectal Examination Clinical Manifestation Enlarged mass at the anus Rectal itching Constipation Pain (Associated with thrombosis) Bright red blood in stool / tissue Surgical Management a. Mineral Oil. Laser (Burning) e. 2. 3. ↑ Fiber 1. Skin tags rectal area 2. Anoscopy / Proctoscopy 4. 4. Advise client to apply cold packs to the anal / 6. 5. Bright red bleeding with each defecation 4. Internal Hemorrhage – Cannot be seen on the perianal area 2.

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