UNDERSTANDING LOWER UNDERSTANDING LOWER BOWEL DISEASEBOWEL DISEASE

Knowing Inflammatory Bowel Knowing Inflammatory Bowel DiseaseDisease

Ulcerative ColitisUlcerative Colitis Crohn’s DiseaseCrohn’s Disease SimilaritiesSimilarities

Cause unknownCause unknown Geographic distributionGeographic distribution Genetic componentGenetic component Chronic recurring inflammation of the Chronic recurring inflammation of the

intestinal tractintestinal tract

Inflammatory Bowel Disease ComparisonInflammatory Bowel Disease Comparison

Ulcerative ColitisUlcerative Colitis Usual onset – young to middle ageUsual onset – young to middle age

Affects mucosa and submucosa of the Affects mucosa and submucosa of the colon and rectumcolon and rectum

Common symptomsCommon symptoms weight lossweight loss rectal bleedingrectal bleeding diarrheadiarrhea severe tenesmussevere tenesmus

ComplicationsComplications PerforationPerforation MegacolonMegacolon HemorrhageHemorrhage

Crohn’s DiseaseCrohn’s Disease Usual onset – youngUsual onset – young

Can affect any portion of the GI tract and Can affect any portion of the GI tract and the entire thickness of the bowel wallthe entire thickness of the bowel wall

Common symptomsCommon symptoms diarrheadiarrhea crampingcramping feverfever malabsorptionmalabsorption

ComplicationsComplications FistulasFistulas StricturesStrictures Abscesses Abscesses PerforationPerforation

Inflammatory Bowel DiseaseInflammatory Bowel Disease

Ulcerative Colitis

Crohns

Cobblestoning

Collaborative CareCollaborative Care

DiagnosticsDiagnostics MedicationsMedications NutritionNutrition SurgerySurgery

MedicationsMedications

AntimicrobialsAntimicrobials CorticosteroidsCorticosteroids SedativesSedatives AntidiarrhealsAntidiarrheals Hematinics and VitaminsHematinics and Vitamins

NutritionNutrition

IndividualizedIndividualized GoalsGoals

Adequate nutrition without exacerbating Adequate nutrition without exacerbating

symptomssymptoms Correct and prevent malnutritionCorrect and prevent malnutrition Replace fluid and electrolytes lossesReplace fluid and electrolytes losses Prevent weight lossPrevent weight loss

Nursing DiagnosisNursing Diagnosis Diarrhea Diarrhea related to irritated bowel and intestinal hyperactivityrelated to irritated bowel and intestinal hyperactivity Anxiety Anxiety related to possible social embarrassment, diagnostic tests, and related to possible social embarrassment, diagnostic tests, and

treatmentstreatments Imbalanced Nutrition: Less than Body Requirements Imbalanced Nutrition: Less than Body Requirements

related to decreased intake, decreased absorption, and increased nutrient loss related to decreased intake, decreased absorption, and increased nutrient loss through diarrheathrough diarrhea

Impaired Skin Integrity Impaired Skin Integrity related to diarrhea and altered nutritional related to diarrhea and altered nutritional statusstatus

Ineffective CopingIneffective Coping related to chronic disease, lifestyle changes, stress related to chronic disease, lifestyle changes, stress and pain and pain

Ineffective Therapeutic Regimen Management Ineffective Therapeutic Regimen Management related to related to lack of knowledge of disease course, lifestyle adjustments, nutritional and drug lack of knowledge of disease course, lifestyle adjustments, nutritional and drug

therapytherapy

Colorectal CancerColorectal Cancer

Risk factorsRisk factors Age over 50Age over 50 PolypsPolyps Family HistoryFamily History Inflammatory Bowel DiseaseInflammatory Bowel Disease Exposure to RadiationExposure to Radiation High animal Fat and calorie intakeHigh animal Fat and calorie intake

Colon PolypsColon Polyps

Sessile (villous)Sessile (villous) Pedunculated (tubular)Pedunculated (tubular) FamilialFamilial

Collaborative CareCollaborative Care

ScreeningScreening Diagnostic testsDiagnostic tests SurgerySurgery Radiation Radiation ChemotherapyChemotherapy

Surgical InterventionsSurgical Interventions

Performed when necessitated by complicationsPerformed when necessitated by complications

or failure of conservative treatment measuresor failure of conservative treatment measures Crohns: resection with end to end anastomosisCrohns: resection with end to end anastomosis Ulcerative colitisUlcerative colitis

Total ColectomyTotal Colectomy Ostomy Ostomy

o PermanentPermanento Temporary or loopTemporary or loopo Continent (Kock’s) ileostomyContinent (Kock’s) ileostomy

Ileostomy FactsIleostomy Facts

Stool consistency is liquid to semi-liquidStool consistency is liquid to semi-liquid Fluid requirements may be increasedFluid requirements may be increased No bowel regulationNo bowel regulation Use of pouch and skin barriersUse of pouch and skin barriers No irrigationNo irrigation Indications for surgery: Indications for surgery: ulcerativeulcerative colitis, crohns, diseased colitis, crohns, diseased

or injured colon, birth defetcs, familial polypois, trauma, canceror injured colon, birth defetcs, familial polypois, trauma, cancer

Nursing Diagnosis for Patients with Nursing Diagnosis for Patients with a Colostomy/Ileostomya Colostomy/Ileostomy

Risk for Impaired Skin Integrity – Risk for Impaired Skin Integrity – related to irritation from fecal related to irritation from fecal drainage, irritation from appliance, and lack of knowledgedrainage, irritation from appliance, and lack of knowledge

Disturbed Body ImageDisturbed Body Image – related to presence of ostomy and odor – related to presence of ostomy and odor

Imbalanced Nutrition: Less than Body RequirementsImbalanced Nutrition: Less than Body Requirements - - related to lack of knowledge of appropriate foods and decreased appetiterelated to lack of knowledge of appropriate foods and decreased appetite

Ineffective Sexuality PatternsIneffective Sexuality Patterns - related to perceived loss of sexual - related to perceived loss of sexual appeal and possibility of seepage of fecal material during sexual activityappeal and possibility of seepage of fecal material during sexual activity

Risk for Deficient Fluid VolumeRisk for Deficient Fluid Volume - related to excess fluid loss - related to excess fluid loss from ileostomy or diarrhea with colostomy and decreased intakefrom ileostomy or diarrhea with colostomy and decreased intake

Stoma CharacteristicsStoma Characteristics

CharacteristicCharacteristic ColorColor

Rose to redRose to red PalePale Blanching, dark red to Blanching, dark red to purplepurple

EdemaEdema Mild to moderateMild to moderate

Moderate to severeModerate to severe

BleedingBleeding Small amountSmall amount Moderate to largeModerate to large

CauseCause

Viable stomaViable stoma AnemiaAnemia Inadequate blood supplyInadequate blood supply

Normal initial postopNormal initial postop Trauma to stoma, medical causeTrauma to stoma, medical cause ObstructionObstruction Allergic reactionAllergic reaction GastroenteritisGastroenteritis

Small amount normalSmall amount normal Coag deficiency, varices, GI bleedCoag deficiency, varices, GI bleed

Colostomy ComparisonsColostomy Comparisons Ascending Ascending

Stool consistency semiliquidStool consistency semiliquid Fluid requirement increasedFluid requirement increased No bowel regulationNo bowel regulation Pouch ans skin barriersPouch ans skin barriers Irrigation noIrrigation no Indications: perforating diverticulitis, tumorsIndications: perforating diverticulitis, tumors

Transverse: semiliquid to semiformed, irrigation noTransverse: semiliquid to semiformed, irrigation no Sigmoid: formed stool , no change in fluids, bowel regulation Sigmoid: formed stool , no change in fluids, bowel regulation

possible, may need irrigation, cancer of the rectum or possible, may need irrigation, cancer of the rectum or perforating diverticulumperforating diverticulum

Other Bowel DisordersOther Bowel Disorders

Celiac DiseaseCeliac Disease HerniasHernias Intestinal ObstructionIntestinal Obstruction Diverticular DiseaseDiverticular Disease Irritable BowelIrritable Bowel Lactase DeficiencyLactase Deficiency