disturbances in absorption and elimination

• CONSTIPATION


  • Fewer than three bowel movements weekly

  or bowel movements that are hard, dry,

  small or difficult to pass.

  • Is a symptom, not a disease.
• Factorsof constipation


  • Medication- ex. Anticholinergic agents, antidepressants
  • Weakness
  • Immobility
  • Debility
  • Fatigue
  • Inability to increase intra-abdominal pressure to facilitate the

  passage of stool

  • Do not take the time to defecate/ ignoring the urge to defecate
  • Dietary habits- low fiber diet and inadequate fluid intake
  • Lack of exercise
  • Stress
• Classes of Constipation


  • Functional Constipation- normal transit mechanism of mucosal

  transport.

  • Slow-transit constipation- caused by inherent disorders of the motor

  functions of the colon, characterized by infrequent bowel

  movements.

  • Defecatory disorder- caused by dysfunctional motor coordination

  between the pelvic floor and anal sphincter.
• Pathophysiology of Constipation


  1. The urge to defecate

  is ignored.

  2. Fecal retention

  3. Atony or

  decreased

  muscle tone
• Assessment of Constipation


  • Fewer than three bowel movements per week
  • Abdominal distention
  • Pain and bloating
  • Sensation of incomplete evacuation
  • Straining at stool
  • Elimination of small-volume, lumpy, hard and dry stool
• diagnostics for Constipation

  • Patient history
  • Physical examination
  • Barium enema
  • Sigmoidoscopy
  • Fecal occult blood testing
  • Anorectal Manometry, defecography, Pelvic Floor MRI
• Nursing Management of Constipation

  • Provide patient education on;
  • Restoring or maintaining a regular pattern of

  elimination.

  • Adequate fluid and high-fiber food intake
  • Methods to avoid constipation
• DIARRHEA


  An increase frequency of bowel movements (more than 3 per day)

  with altered consistency of stool.

  
• Classifications of Diarrhea


  • Acute- self-limiting, lasting 1-2 days. Caused by viral infection.
  • Persistent- typically last 2-4 weeks. Caused by viral infection.
  • Chronic- persist for more than 4 weeks and may return

  sporadically.
• Factors causing Diarrhea


  • Viral infection
  • Medications- antibiotics and magnesium containing antacids.
  • Chemotherapy
  • Antiarrhythmic agents
  • Antihypertensive agents
  • Metabolic and endocrine disorders
  • Malabsorptive disorders
  • Sphincter defect
  • AIDS
  • Parasitic infections (Clostridium difficile)
• Assessment of Diarrhea


  • Increased frequency and fluid content of stool
  • Abdominal cramps
  • Distention
  • Borborygmus (rumbling noise caused by the movement of gas through

  the intestine)

  • Anorexia
  • Thirst
  • Painful spasmodic contractions of anus
  • Tenesmus (ineffective, sometimes painful straining with a strong urge)
  • Dehydration
  • Fluid and electrolyte imbalance

  
• diagnostics of Diarrhea

  • CBC
  • Serum chemistries
  • Urinalysis
  • Routine fecalysis
  • Endoscopy
  • Barium Enema
• Nursing Management of Diarrhea

  • Monitor characteristics and pattern of diarrhea.
  • Health assessment
  • Encourage patient to increase intake of fluids and foods low in bulk

  until the symptom subsides.

  • The patient should avoid caffeine, alcoholic

  beverages, dairy

  products and fatty foods.

  • Advise patient to apply perianal skin care routine if anal area

  becomes excoriated.
• FECAL INCONTINENCE


  Recurrent involuntary passage of stool from the rectum for

  the last 3 months.
• Factors causing Fecal Incontinence

  • Anal sphincter weakness
  • Disorder of the pelvic floor
  • Inflammation
  • CNS Disorder
  • Diarrhea
  • Fecal impaction
  • Vaginal birth injury
  • Age
• Assessment of Fecal Incontinence

  • Minor soiling, occasional urgency and loss of control or complete

  continence

  • Poor control of flatus
  • Diarrhea
  • Constipation
  • Urge to defecate but cannot reach the toilet in time
• diagnostics of Fecal Incontinence

  • Rectal exam
  • Endoscopy (sigmoidoscopy)
• Nursing Management of Fecal Incontinence

  • Assist patient with bowel training program.
  • Advise foods that thicken stool and fiber supplements.
  • Foods that loosen stool should be avoided.
  • Maintain skin integrity.
• IRRITABLE BOWEL SYNDROME


  A chronic functional disorder characterized by recurrent abdominal

  pain associated with disordered bowel movements, which may

  include diarrhea, constipation or both.
• Factors causing Irritable Bowel Syndrome

  • Genetic
  • Environment
  • Psychological
  • Chronic stress
  • Sleep deprivation
  • Infections
  • Foods (milk, yeast, eggs, wheat products, red meat)
• Pathophysiology of Irritable Bowel Syndrome

  1. Neuroendocrine

  dysregulation,

  infections,

  inflammatory disorders

  2. Disorganized/spastic

  contractions of the

  bowel
• primary symptoms of irritable bowel syndrome

  • Alteration in bowel patterns – constipation (C), diarrhea (D) ,both (M) or Unknown (U)

  • Pain, bloating and abdominal distention

  • Pain precipitated by eating and is relieved by defecation.
• diagnostics of Irritable Bowel Syndrome

  • Barium enema
  • Colonoscopy (spasm, distention, mucus accumulation in intestinal tract)
  • Manometry
  • Electromyography (Shows spasticity)
• Nursing Management of Irritable Bowel Syndrome

  • Provide patient and family education.
  • Encourage self care activities
  • Emphasize good sleeping habits and good dietary

  habits

  • Encourage to eat at regular time and avoid trigger

  foods

  • Adequate fluid intake and should not be taken with

  meals

  • Alcohol use and cigarette smoking is discouraged.
• MALABSORPTION SYNDROME

  Inability of the digestive system to absorb one or more of the major

  vitamins, minerals and nutrients.
• Assessment of Malabsorption Syndrome

  • Hallmark Sign: Diarrhea or frequent, loose, bulky, grayish,

  steatorrheic, foul-smelling stools.
• Medical Management of Malabsorption Syndrome

  • Endoscopy with biopsy (diagnostic)
  • Treatment of underlying cause
  • Medications usually upon appearance of symptoms.
• Nursing Management of Malabsorption Syndrome

  • Instruct patient to avoid eating food that contribute to aggravation of malabsorption and to take nutritional supplementation for deficits.
• PERITONITIS


  Inflammation of the peritoneum, which is the serous membrane

  lining the abdominal cavity and covering the viscera.
• Categories of Peritonitis


  • Primary

  Peritonitis

  (Spontaneous

  Bacterial

  Peritonitis)-

  Spontaneous bacterial infection of ascitic fluid.

  • Secondary Peritonitis- secondary to perforation of abdominal

  organs with spillage that infects the serous peritoneum.

  • Tertiary Peritonitis- result of a suprainfection in a patient who is

  immunocompromised.
• Pathophysiology of Secondary Peritonitis

  1. Inflammation,

  Infection, Ischemia,

  Trauma or tumor

  perforation

  2. Leakage of contents

  from abdominal

  organs into the

  abdominal cavity

  3. Bacterial

  proliferation occurs
• Assessment of Peritonitis


  • Diffused pain then becomes constant, localized and more intense
  • Pain aggravates by movement
  • Extreme abdominal tenderness and distension
  • Abdominal muscle rigidity
  • Anorexia
  • Nausea and Vomiting
  • Diminished peristalsis
  • Paralytic Ileus
  • Fever 37.8-38.3C, increased PR
  • Hypotension
  • Manifestation of septic shock and sepsis
• Diagnostic Findings for Peritonitis

  • Elevated WBC (increased neutrophils)
  • Low hgb and hct if with blood loss.
  • Altered S. electrolyte levels (K, Na, Cl)
  • Abd. Xray- may show air and fluid levels as well as distended bowel

  loops

  • Abd. UTZ reveal abscesses and fluid collection
• Serous peritoneum


  The outermost layer of the peritoneum
• Tertiary Peritonitis


  Result of a suprainfection in a patient who is immunocompromised
• Pathophysiology: Secondary Peritonitis


  1. inflammation, infection, ischemia, trauma or tumor perforation
  2. leakage of contents from abdominal organs into the abdominal cavity
  3. bacterial proliferation occurs
• Clinical Manifestations of Secondary Peritonitis

  • Diffused pain then becomes constant, localized and more intense
  • Pain aggravates by movement
  • Extreme abdominal tenderness and distension
  • Abdominal muscle rigidity
  • Anorexia
  • Nausea and Vomiting
  • Diminished peristalsis
  • Paralytic Ileus
  • Fever 37.8-38.3C, increased PR
  • Hypotension
  • Manifestation of septic shock and sepsis
• Diagnostic Findings for Secondary Peritonitis

  • Elevated WBC (increased neutrophils)
  • Low hgb and hct if with blood loss
  • Altered S. electrolyte levels (K, Na, Cl)
  • Abd. Xray- may show air and fluid levels as well as distended bowel loops
  • Abd. UTZ reveal abscesses and fluid collections
  • CT scan of abdomen may show abscess formation
  • C&S studies may reveal infection and causative organisms
  • MRI may be used for diagnosis of intra-abdominal abscess
• Medical Management of Secondary Peritonitis

  1. Fluid, colloid and electrolyte replacement

  2. Analgesic medication- pain

  3. Antiemetic- N&V

  4. Intestinal intubation and suction

  5. O2 therapy

  6. Antibiotic therapy (broad-spectrum antibiotic)

  7. Surgical treatment – excision, resection without anastomosis, repair and drainage
• Nursing Management of Secondary Peritonitis

  1. Intensive care and monitoring

  2. Assess for subsiding peritonitis signs (decrease in temp., PR, softening of the abd., return of peristaltic sounds, passing of flatus and bowel movements)

  3. Increase fluid and food intake gradually

  4. Reduce parenteral fluid as prescribed

  5. Worsening clinical condition may indicate complication- PREPARE PATIENT FOR EMERGENCY SURGERY!!!