Stomatitis Painful condition characterized by inflammation and ulcerations of the mouth Cultures may be taken to determine if infectious process present

Stomatitis

• Painful condition characterized by inflammation and ulcerations of the mouth

• Cultures may be taken to determine if infectious process present

• Use ordered topical anesthetics (xylocaine) and analgesics prn

• Restrict diet to what is tolerable to pt.

• Ensure adequate hydration/nutrition

Intestinal Disorders

• Gastroenteritis• Irritable bowel syndrome (IBS)• Inflammatory bowel disease (IBD)

• Crohn’s disease• Ulcerative colitis

• Appendicitis• Diverticulitis• Intestinal obstruction

• Intussusception• Volvulus• Ileus• Hemorrhoids

Disorders of the Intestines

• Infection• Etiology/pathophysiology

• Invasion of the alimentary canal by pathogenic microorganisms

• Most commonly enters through the mouth in food or water

• Person-to-person contact

• Fecal-oral transmission

• Long-term antibiotic therapy can cause an overgrowth of the normal intestinal flora (C. difficile)


• Infection (continued)• Clinical manifestations/assessment

• Diarrhea• Rectal urgency• Tenesmus• Nausea and vomiting• Abdominal cramping• Fever


• Infection (continued)• Diagnostic tests

• Stool culture

• Medical management/nursing interventions• Antibiotics

• Fluid and electrolyte replacement

• Kaopectate

• Pepto-Bismol

E. Coli 0157-H7

• Not normal human bacterial flora• Present in 1% of the guts of cattle, thus may be in ground

meat• Bloody diarrhea and cramping – DO NOT GIVE

ANTIDIARRHEALS!!!• Anti-motility meds and abx are sometimes not

recommended because they increase the likelihood of of developing the complication of kidney pathology; HUS

Diarrhea

• When the contents of the intestines move so quickly through the bowel that excess water is not absorbed.

• If an infection is present in the intestinal mucosa directly invaded, the feces may contain blood and mucus.

Assessment

• Fever greater than 102°F

• Vomiting

• Obtain history of number and consistency of BM’s, recent use of antibiotics, recent travel, food intake and exposure to noninfectious causes of diarrhea

Diagnostic Tests

• Stool cultures

• Blood chemistry to monitor changes in fluid and electrolyte status.

• What might these changes be?

Medical Management

• Allow body to limit infection

• Antibiotics may be given incases of prolonged or severe diarrhea with a stool positive for leukocytes.

• The use of anti-diarrheals and antispasmodics actually increases the severity the infection by prolonging the contact time of the microbe to the intestinal wall.


• Irritable bowel syndrome• Etiology/pathophysiology

• Episodes of alteration in bowel function

• Spastic and uncoordinated muscle contractions of the colon

• Clinical manifestations/assessment• Abdominal pain

• Frequent bowel movements

• Sense of incomplete evacuation

• Flatulence, constipation, and/or diarrhea


• Irritable bowel syndrome (continued)• Diagnostic tests

• History and physical examination• Medical management/nursing interventions

• Diet and bulking agents• Medications

• Anticholinergics• Milk of Magnesia, fiber, or mineral oil• Opioids• Antianxiety drugs

Medical Management

• MOM may be prescribed if constipation does not respond to increased fiber – Mineral Oil is cheaper

• Opioids may help

• Anti-depressants may help

• Alternative therapies such as acupuncture, Chinese herbal therapy, chiropractic techniques and yoga may help


• Inflammatory Bowel Disease (IBD) is used to describe both Crohn’s disease and Ulcerative Colitis.• Ulcerative Colitis (UC) is characterized by lesions in the

rectal area and sigmoid colon progressing throughout colon

• Crohn’s disease is characterized by lesions, pain, diarrhea w/o blood, fever, anorexia, weight loss and steatorrhea

Disorders of the Intestine

• Ulcerative Colitis• Etiology/Pathophysiology

• Ulceration of the mucosa and submucosa of the colon

• Tiny abscesses form which produce purulent drainage, slough the mucosa, and ulcerations occur

• Clinical manifestations/assessment• Diarrhea – about 15-20 stools per day

• Abdominal cramping

• Involuntary leakage of stool


• Ulcerative colitis (continued)• Diagnostic tests

• Barium studies, colonoscopy, stool for occult blood

• Medical management/nursing interventions• Medications

• Azulfidine, Dipentum, Rowasa, corticosteroids, Imodium

• Diet: No milk products or spicy foods; high-protein, high-calorie; total parenteral nutrition

• Stress control

• Assist patient to find coping mechanisms (!)


• Ulcerative colitis (continued)• Medical management/nursing interventions

• Surgical interventions• Colon resection

• Ileostomy

• Ileoanal anastomosis

• Proctocolectomy

• Kock pouch

Koch pouch

Ileostomy with absence of resected bowel.

Disorders of the Intestines• Crohn’s disease

• Etiology/pathophysiology• Inflammation, fibrosis, scarring, and thickening of the bowel wall

• Clinical manifestations/assessment• Weakness; loss of appetite

• Diarrhea: 3-4 daily; contain mucus and pus

• Right lower abdominal pain

• Steatorrhea

• Anal fissures and/or fistulas

• Crohn’s Disease – is an inflammatory bowel condition. The most common site where Crohn’s may be seen is in the ileocecal region. Some of the symptoms include constant diarrhea, abdominal pain, and rectal bleeding. The mode of treatment includes anti-inflammatory agents. In more severe cases bowel resection may be needed.


• Crohn’s disease (continued)• Medical management/nursing interventions

• Diet• High-protein• Elemental• Hyperalimentation• Avoid

• Lactose-containing foods, brassica vegetables, caffeine, beer, monosodium glutamate, highly seasoned foods, carbonated beverages, fatty foods


• Crohn’s disease (continued)• Medical management/nursing interventions

• Medications• Corticosteroids• Azulfidine• Antibiotics• Antidiarrheals; antispasmodics• Enteric-coated fish oil capsules• B12 replacement

• Surgery• Segmental resection of diseased bowel


• Appendicitis• Etiology/pathophysiology

• Inflammation of the vermiform appendix

• Lumen of the appendix becomes obstructed, the E. coli multiplies, and an infection develops

• Clinical manifestations/assessment• Rebound tenderness over the right lower quadrant of the abdomen

(McBurney’s point)

• Vomiting

• Low-grade fever

• Elevated WBC

• Appendicitis – is an inflammation of the appendix. The veriform appendix is connected to the cecum in the right lower quadrant of the abdomen. When inflamed the appendix is at risk of rupturing. The goal is surgery to remove the appendix before this occurs causing severe peritonitis.


• Appendicitis (continued)• Diagnostic tests

• WBC

• Roentgenogram

• Ultrasound

• Laparoscopy

• Medical management/nursing interventions• Appendectomy


• Diverticular disease• Etiology/pathophysiology

• Diverticulosis• Pouch-like herniations through the muscular layer

of the colon

• Diverticulitis• Inflammation of one or more diverticula

• Diverticulitis – is a condition in which a series of diverticula's appearing on the outer wall of the colon get inflamed. The problem comes in when one of these diverticulum's rupture. The mode of treatment is conservative antibiotic therapy for diverticulitis. An exploratory Lap with bowel resection is needed in the event one ruptures and causes peritonitis.

Diverticulosis.

Disorders of the Intestines• Diverticular disease

• Clinical manifestations/assessment• Diverticulosis

• May have few, if any, symptoms

• Constipation, diarrhea, and/or flatulence

• Pain in the left lower quadrant

• Diverticulitis• Mild to severe pain in the left lower quadrant

• Elevated WBC; low-grade fever

• Abdominal distention

• Vomiting

• Blood in stool

• Diverticular disease (continued)• Medical management/nursing interventions

• Diverticulosis with muscular atrophy• Low-residue diet; stool softeners

• Bedrest

• Diverticulosis with increased intracolonic pressure and muscle thickening• High-fiber diet

• Sulfa drugs

• Antibiotics; analgesics


• Diverticular disease • Medical management/nursing interventions

(continued)• Surgery

• Hartmann’s pouch

• Double-barrel transverse colostomy

• Transverse loop colostomy

• Small Bowel / Colon Resection – There are many indications to perform a bowel resection. Today laparoscopy provides a less invasive approach.


• Peritonitis• Etiology/pathophysiology

• Inflammation of the abdominal peritoneum

• Bacterial contamination of the peritoneal cavity from fecal matter or chemical irritation

• Clinical manifestations/assessment• Severe abdominal pain; nausea and vomiting

• Abdomen is tympanic; absence of bowel sounds

• Chills; weakness

• Weak rapid pulse; fever; hypotension


• Peritonitis • Diagnostic tests

• Flat plate of the abdomen

• CBE

• Medical management/nursing interventions • Position patient in semi-Fowler’s position

• Surgery• Repair cause of fecal contamination

• Removal of chemical irritant

• Parenteral antibiotics

• NG tube to prevent GI distention

• IV fluids


• External hernias• Etiology/pathophysiology

• Congenital or acquired weakness of the abdominal wall or postoperative defect• Abdominal

• Femoral or inguinal

• Umbilical


• External hernias (continued)• Clinical manifestations/assessment

• Protruding mass or bulge around the umbilicus, in the inguinal area, or near an incision

• Incarceration

• Strangulation

• Diagnostic tests• Radiographs

• Palpation


• External hernias • Medical management/nursing interventions

• If no discomfort, hernia is left unrepaired, unless it becomes strangulated or obstruction occurs

• Truss

• Surgery• Synthetic mesh is applied to weakened area of the abdominal wall


• Hiatal hernia• Etiology/pathophysiology

• Protrusion of the stomach and other abdominal viscera through an opening in the membrane or tissue of the diaphragm

• Contributing factors: obesity, trauma, aging

• Clinical manifestations/assessment• Most people display few, if any, symptoms

• Gastroesophageal reflux


• Hiatal hernia • Medical management/nursing

interventions• Head of bed should be slightly elevated

when lying down• Surgery

• Posterior gastropexy• Transabdominal fundoplication (Nissen)

• Hiatal Hernia - When the stomach has protruded up through the diaphragm into the chest a hiatal hernia has occurred. The symptoms of hiatal hernia are mainly GERD. Hiatal Hernia may result due to a sudden increase in intra-abdominal pressure.

Hiatal hernia. A, Sliding hernia. B, Rolling hernia.


• Intestinal obstruction• Etiology/pathophysiology

• Intestinal contents cannot pass through the GI tract

• Partial or complete

• Mechanical

• Non-mechanical

• Clinical manifestations/assessment• Vomiting; dehydration

• Abdominal tenderness and distention

• Constipation

Intestinal obstructions. A, Adhesions. B, Volvulus.

• Volvulus – Often due to adhesions, volvulus is a twisting of bowel. Bowel obstruction in this case is almost certain. The mode of treatment is exploratory laparotomy with possible bowel resection if a lysis of adhesive bands is unsuccessful.

• Intussusception – is defined as a telescoping of bowel. This is a severe medical condition that often leads to bowel obstruction. Although the cause isn’t really known, the symptoms include severe cramping, abdominal swelling, fever, and vomiting. The mode of treatment is exploratory laparotomy with bowel resection.


• Intestinal obstruction

• Diagnostic tests

• Radiographic examinations

• BUN, sodium, potassium, hemoglobin, and hematocrit

• Medical management/nursing interventions

• Evacuation of intestine

• NG tube to decompress the bowel

• Nasointestinal tube with mercury weight

• Surgery

• Required for mechanical obstructions

Non-Mechanical Bowel Obstruction

• This may result from a neuromuscular or vascular disorder

• Paralytic ileus is the most common form. It may occur after any abdominal surgery.

• Other causes include inflammatory responses, electrolyte abnormalities, and thoracic or lumbar spinal trauma from either fractures or surgical interventions.

• Vascular obstructions are rare. The most common causes are emboli and atherosclerosis of the mesenteric arteries

• Emboli may originate from patients who have atrial fibrillation, diseases heart valves, and prosthetic valves.


• Hemorrhoids• Etiology/pathophysiology

• Varicosities (dilated veins)

• External or internal

• Contributing factors

• Straining with defecation, diarrhea, pregnancy, CHF, portal hypertension, prolonged sitting and standing

• Clinical manifestations/assessment

• Varicosities in rectal area

• Bright red bleeding with defecation

• Pruritus

• Severe pain when thrombosed

Disorders of the Intestines• Hemorrhoids (continued)

• Medical management/nursing interventions• Bulk stool softeners; hydrocortisone cream• Analgesic ointment• Sitz baths• Ligation• Sclerotherapy; cryotherapy• Infrared photocoagulation• Laser excision• Hemorrhoidectomy

• Hemorrhoidectomy – An indication to remove hemorroids is when they become symptomatic. Hemorroids develop in people who have conditions that obstruct the venous return of the anal veins. Examples are pregnant women, individuals with portal hypertension, and people who have jobs which require long hours of sitting.


• Anal fissure

• Linear ulceration or laceration of the skin of the anus

• Usually caused by trauma

• Lesions usually heal spontaneously

• May be excised surgically

• Anal fistula

• Abnormal opening on the surface near the anus

• Usually from a local abscess

• Common in Crohn’s disease

• Treated by a fistulectomy or fistulotomy

• Excision of an Anal Fissure – When patients develop fissures in the rectum the chance that an infection will occur is usually moderate. If an anal fissure does get infected however the body will more then likely develop sinus tracts to relieve the pressure of pus building up in the region. The goal of surgery is to assist this process by identifying and excising the sinus tracts.

Documents

Stomatitis Painful condition characterized by inflammation and ulcerations of the mouth Cultures may be taken to determine if infectious process present