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