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NURSING CARE CLIENT WITH Motility & Bowel Elimination Disorders
By Ni Ketut Alit A
Faculty Of Nursing Airlangga University
REFERENCES
Black, J.M. & Matassarin E, (1997). Medical Surgical Nursing: Clinical Management for continuity of care. J.B. Lippincott.co.
Barbara C.L & Wilma J.P. (2006). Essentials of Medical Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins.
Smeltzer, S.C., & Bare, B. (2003). Brunner and Suddarth's Textbook of Medical-Surgical Nursing (10th ed.). Philadelphia: Lippincott Williams & Wilkins.
Ignativicius & Bayne. (2001). Medical and Surgical Nursing. Philadelphia: W.B. Saunders Company.
Luckman & Sorensen. (2000). Medical Surgical Nursing. Philadelphia: W.B. Saunders Company.
Journals and article related to..
Review Intestine(Small – Large Intestine)
Longest segment of GI tract, 7000 cm surface area for absorption of nutrients into bloodstream through intestinal walls.
3 anatomic parts: duodenum, jejunum, ileum)
Digestive enzymes and bile in the duodenum come from pancreas, liver, gallbladder and glands within the intestines
Intestinal glands secrete mucus, hormones, electrolytes and enzymes
2 types of contractions: Small Intestine– Segmentation contractions: mixing waves of contents, churning motion– Intestinal peristalsis: propels the contents of the small intestine towards colon
Colonic Function: (Ascending, Transverse, Descending, Sigmoid, and Rectum)
– Within 4 hrs of eating residual waste material passes through ileocecal valve into colon.
– Each peristaltic wave of sm. Intestine opens the valve briefly to allow some contents to pass into colon
– Bacteria make up a major part of the contents of large intestine, assist in breakdown of waste material
– 2 types of secretions: bicarbonate (neutralize) and mucus (protects colonic mucosa)
Small intestine
Large Intestine
Assessment of Bowel Function
Subjective– onset– characteristics– course– severity– precipitating factor– relieving factors– associated symptoms
Sample Interview Questions
Can you describe the type of cramping and abdominal pain you are having?
Have you every had bleeding from your rectum?
Have you noticed any changes in your bowel habits?
Blood and Stool
Melena - black tarry stool Blood on Stool - bleeding sigmoid colon, rectum Blood in Stool - colon, ulcerative colitis,
– diverticulitis, tumor, ulcer Stool black, hard = oral iron Strong odor = blood of high fat content
Disorders of Intestinal Motility
Diarrhea – serious in the young and elderly– increase in the frequency, volume and fluid
content of the stool
Causes– bacteria, or parasitic infections, malaborption,
medications, diseases, allergies or pyschological
Diarrhea
Clinical Manifestations– vary widely from several large watery stool to very
frequent small stools– result in severe electrolyte imbalances
hypokalemia - Low K+ hypomagnesemia - low Mg+
– hypovolemia - fluid volume deficit - hypovolemic shock with vascular collapse
Diarrhea Collaborative Care
– treat underlying cause– Labs
stool specimen - for WBC’s, parasitic infections culture
electrolytes - imbalance
– Diagnostic tests sigmoidoscopy - direct exam of bowel
Dietary management– fluid replacement, pedialyte– bowel rest for 24 hours
Pharmacology– absorbents, anticholinergics, antibiotics
CRITICAL CARE : DEHYDRATION SYOK HIPOVELIEMIK
Children are more susceptible to dehydration due to greater % or portion of their body weight being water
Signs and Symptoms– poor skin turgor– sunken fontanel– decreased urine out-put (1-2ml/uo/kg/hr)– decreased body weight– dry mucous membranes, lips– no tears
The Client with Constipation
The infrequent or difficult passage of stool– two or less BM’s per week– affects elders - impaired health, medications,
decrease physical activity
Diagnostics– Barium enema
- tumors, diverticular disease
– colonoscopy - tumor, obstruction
Constipation
Dietary Management– high fiber - vegetable fiber– adequate fluids
Pharmacology– laxatives for short term use– bulk form agents for long term use– enemas - acute short term or as prep
Irritable Bowel Syndrome
Disorder characterized by alternating periods of constipation and diarrhea
Cause - no organic cause found– related to food ingestion, meds.,
stress, hormones– looking at motor activity of the
G.I. tract
IBS….
Clinical Manifestations– Colic-like abdominal pain– Altered bowel elimination
mucous in stool, change in frequency, straining, urgency, incomplete emptying
– Tenderness Labs and Diagnostics
– stool specimen, colonoscopy, UGI with SBFT Dietary management
– add fiber and water content
The Client with Fecal Incontinence
Loss of voluntary control of defecation Causes
– interfere with sensory or motor control of rectum and anal sphincters
neuro -spinal cord injury, head injury local trauma - anal-rectal injury, surgery Other - radiation, impaction, tumors, confusion
Fecal Incontinence
Collaborative Care– dx made by history– digital exam - poor sphincter tone– treatment
bowel training program - establish regular pattern– dietary changes– stimulant - coffee, suppository.
surgery - colostomy
Malabsorption Syndrome
Clinical manifestations– anorexia, abd bloating, diarrhea, weight loss,
weakness, malaise, muscle cramps, anemia signs of malnutrition
Celiac Disease– hypersensitivity to gluten, protein found in cereal– Tx - gluten free diet
Malabsorption Syndrome
Lactose Intolerance– deficiency of lactase the enzymes needed for
digestion and absorbtion of lactose the primary carbohydrate in milk
– affects 90% of Asians, 75% of African Americans, high incidence among Hispanic populations
– usually hereditary, symptoms occur in adolescence or early adulthood
Malabsorption Syndrome
Short Bowel Syndrome– from resection of significant portions of the small
intestine CA, mesenteric thrombosis with bowel infarction,
Crohn’s disease or trauma
– Treatment frequent small, high caloric and high protein meals multivitamin and mineral supplements
QUIZ
Please writedown nursing alert & nursing education for client with :
1.Diarhea
2. Constipation
3. Malabsorption syndrom
4. Fecal Incontinence
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