Chapter 56

Care of Patients with Noninflammatory

Intestinal Disorders

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 Concepts
 The priority concepts in this chapter are
 ELIMINATION
 CELLULAR REGULATION
• ELIMINATION EXEMPLAR IS INTESTINAL OBSTRUCTION
• CELLULAR REGULATION EXEMPLAR IS COLORECTAL
CANCER
 The interrelated concepts in this chapter are
 NUTRITION
 COMFORT
 FLUID AND ELECTROLYTE BALANCE

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Elimination Concept Exemplar: Intestinal
Obstruction
 Types
 Nonmechanical
 Mechanical
 Complications
 Etiology
 Intussusception
 Volvulus

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Mechanical Obstruction

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Interprofessional Collaborative Care
 Assessment: Noticing
 Physical Assessment
• Obstipation
• Abdominal distension
• Peristaltic waves
• Bobborygmi
 Diagnostic Assessment

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 Analysis: Interpreting
 The priority collaborative problems for patients
with intestinal obstruction include
 Potential for injury (e.g., peritonitis, acute kidney
injury, etc.) due to obstruction
 Acute pain due to obstruction

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 Interventions: Responding
 Nonsurgical Management
 Nasogastric tubes
 IV Fluid replacement
 Surgical Management
 Exploratory laparotomy
 Care Coordination and Transition Management

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Cellular Regulation Exemplar:
Colorectal Cancer

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 Colorectal Cancer (Cont.)
 Colorectal—refers to colon and rectum, which
together make up large intestine
 Most CRCs are adenocarcinomas
 Etiology
 Age > 50 years
 Genetic predisposition
 Personal/family history of cancer
 Familial adenomatous polyposis

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Interprofessional Collaborative Care
 Assessment: Noticing
 Physical Assessment
• Bleeding and change in stool (most common signs)
 Psychosocial Assessment
 Laboratory Assessment
• Fecal occult blood test (FOBT)
• Carcinoembryonic antigen (CEA)
 Imaging Assessment
• Sigmoidoscopy
• Colonoscopy

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 Analysis: Interpreting
 The priority collaborative problems for patients
with colorectal cancer (CRC) include
 Potential for metastasis due to colorectal cancer
 Potential for grieving due to cancer diagnosis

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 Planning and Implementation:
Responding
 Prevent/Control Metastasis
 Radiation Therapy
 Chemotherapy
 Surgical Management
 Assist with Grieving Process
 Care Coordination and Transition Management

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Colostomies

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 Colostomy Care
 Normal appearance of stoma
 Signs and symptoms of complications
 Measurement of stoma
 Choice, use, care, application of appropriate
appliance to cover stoma
 Measures to protect skin
 Dietary measures to control gas and odor
 Resumption of normal activities

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 Irritable Bowel Syndrome
 Most common digestive disorder
 One in five people in the U.S.
 Classifications
 IBS-D (diarrhea)
 IBS-C (constipation)
 IBS-A (alternating diarrhea/constipation)
 IBS-M (mix of diarrhea/constipation)
 Etiology: Unclear

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 Irritable Bowel Syndrome (Cont.)
 Health teaching
 30 to 40 g of fiber daily
 Promote normal bowel function
 Drug therapy
 Symptom specific
 Stress reduction
 Relaxation
 Meditation
 Yoga

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Common Abdominal Hernias

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Hemorrhoids

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 Malabsorption Syndrome
 The nutrient involved in malabsorption depends
on the type and location of the abnormality in the
intestinal tract.

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