Nursing Care & Interventions for Clients with Inflammatory Intestinal Disorders

1. Nursing Care & Interventions for Clients with Inflammatory Intestinal Disorders Keith Rischer RN, MA, CEN

2. 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.

3. 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.

4. Assessment Physical assessment Clinical manifestations Psychosocial assessment Laboratory assessment Radiographic assessment

5. 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.

6. 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.

7. Drug Therapy Salicylate compounds Corticosteroids Immunosuppressive drugs Antidiarrheal drugs Other drugs

8. 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

9. 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

10. 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.

11. 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

12. 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

13. Assessment • Physical assessment • Clinical manifestations • Psychosocial assessment • Diagnostic assessment

14. Nonsurgical Management Drug therapy Nutritional management Complication management Fluid and electrolyte therapy Skin care Prevention of infection Complementary and alternative therapy

15. Surgical Management Laparoscopy Small bowel resection and ileocecal resections Stricturoplasty Preoperative care Operative procedure Postoperative care

16. 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.

17. Assessments • History • Physical assessment • Clinical manifestations • Diagnostic assessment

18. Nonsurgical Management • Drug therapy • Diet therapy • Rest • Intravenous fluids to correct dehydration • Intravenous antibiotics • Anticholinergics • Analgesics (

19. Nonsurgical Management Avoid laxatives Rest Nothing by mouth in the hospital

20. Surgical Management • Preoperative care • Operative procedure • Postoperative care • Drain care • Care of the ostomy • Nothing by mouth followed by clear liquids

21. 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