NURSING CARE CLIENT WITH Motility & Bowel Elimination Disorders

1. NURSING CARE CLIENT WITH Motility & Bowel Elimination Disorders By Ni Ketut Alit A Faculty Of Nursing Airlangga University

2. 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..

3. 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

4. 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)

5. Small intestine

7. Large Intestine

8. Assessment of Bowel Function • Subjective • onset • characteristics • course • severity • precipitating factor • relieving factors • associated symptoms

9. 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?

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. QUIZ Please writedown nursing alert & nursing education for client with : 1.Diarhea 2. Constipation 3. Malabsorption syndrom 4. Fecal Incontinence

26. Care For Better Health ....