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Constipation
• Abnormal infrequency or irregularity of defecation; any variation from normal habits may be a
problem
• Causes include medications, chronic laxative use, weakness, immobility, fatigue, inability to
increase intraabdominal pressure, diet, ignoring urge to defecate, and lack of regular exercise
• Increased risk in older age
• Perceived constipation: a subjective problem in which the patient’s elimination pattern is not
consistent with what he or she believes is normal
Complications
• Hypertension
• Fecal impaction
• Hemorrhoids
• Fissures
• Megacolon
Diarrhea
• Increased frequency of bowel movements (more than 3 per day), increased amount of stool (more
than 200 g per day), and altered consistency (ie, looseness) of stool
• Usually associated with urgency, perianal discomfort, incontinence, or a combination of these
factors
• May be acute or chronic
• Causes include infections, medications, tube feeding formulas, metabolic and endocrine
disorders, and various disease processes
Manifestations
Malabsorption
• The inability of the digestive system to absorb one or more of the major vitamins, minerals, and
nutrients
• Conditions: see Table 38-2
– Mucosal (transport) disorders
– Infectious disease
– Luminal disorders
– Postoperative malabsorption
– Disorders that cause malabsorption of specific nutrients
Diverticular Disease
• Diverticulum: sac-like herniations of the lining of the bowel that extend through a defect in the
muscle layer
• May occur anywhere in the intestine, but are most common in the sigmoid colon
• Diverticulosis: multiple diverticula without inflammation
• Diverticulitis: infection and inflammation of diverticula
• Diverticular disease increases with age and is associated with a low-fiber diet
• Diagnosis is usually by colonoscopy
• Constipation
• Acute pain
• Major goals include attainment and maintenance of normal elimination patterns, pain, relief, and
absence of complications
• Perform health history to identify onset, duration, and characteristics of pain, diarrhea, urgency,
tenesmus, nausea, anorexia, weight loss, bleeding, and family history
• Discuss dietary patterns, alcohol, caffeine, and nicotine use
• Assess bowel elimination patterns and stool
• Perform abdominal assessment
Colorectal Cancer
• The third most common cause of U.S. cancer deaths
• Risk factors: see Chart 38-8
• Importance of screening procedures
• Manifestations include change in bowel habits; blood in stool—occult, tarry, bleeding; tenesmus;
symptoms of obstruction; pain, either abdominal or rectal; feeling of incomplete evacuation
• Treatment depends upon the stage of the disease
Gastritis
Manifestations of Gastritis
• Acute
– Refrain from alcohol and food until symptoms subside
– If due to strong acid or alkali treatment to neutralize the agent, avoid emetics and lavage
due to danger of perforation and damage to the esophagus
– Supportive therapy
• Chronic
– Modify diet, promote rest, reduce stress, and avoid alcohol and NSAIDs
– Pharmacologic therapy: see Table 37-1
Peptic Ulcer
• Anxiety
• Imbalanced nutrition
• Risk for fluid volume imbalance
• Deficient knowledge
• Acute pain
• Major goals include reduced anxiety, avoidance of irritating foods, adequate intake of nutrients,
maintenance of fluid balance, increased awareness of dietary management, and relief of pain
Interventions
• Reduce anxiety; use calm approach and explain all procedures and treatments
• Promote optimal nutrition. For acute gastritis, the patient should take no food or fluids by mouth;
introduce clear liquids and solid foods as prescribed. Evaluate and report symptoms. Discourage
caffeinated beverages, alcohol, and cigarette smoking. Refer patient for alcohol counseling and
smoking cessation.
• Promote fluid balance; monitor I&O for signs of dehydration, electrolyte imbalance, and
hemorrhage
• Measures to relieve pain: diet and medications
• See Chart 37-1
• Acute pain
• Anxiety
• Imbalanced nutrition
• Deficient knowledge
•
Nursing Process—Planning the Care of the Patient With Peptic Ulcer
• Major goals for the patient may include relief of pain, anxiety reduction, maintenance of
nutritional requirements, knowledge about the management and prevention of ulcer recurrence,
and absence of complications
Anxiety
• Assess anxiety
• Maintain calm manner
• Explain all procedures and treatments
• Help identify stressors
• Explain various coping and relaxation methods such as biofeedback, hypnosis, and behavior
modification
•
Patient Teaching
• Medication usage
• Dietary restrictions
• Lifestyle changes
• See Chart 37-2
• Management of hemorrhage
– Assess for evidence of bleeding, hematemesis, or melena, and symptoms of
shock/impending shock and anemia
– Treatment includes IV fluids, NG, and saline or water lavage; oxygen; treatment of
potential shock including monitoring of VS and UO; may require endoscopic coagulation
or surgical intervention
• Pyloric obstruction
– Symptoms include nausea, vomiting, constipation, epigastric fullness, anorexia, and
(later) weight loss
– Insert NG tube to decompress the stomach and provide IV fluids and electrolytes; balloon
dilation or surgery may be required
• Management of perforation or penetration
– Signs include severe upper abdominal pain that may be referred to the shoulder, vomiting
and collapse, tender board-like abdominal, and symptoms of shock/impending shock
– Patient requires immediate surgery
Hepatitis A (HAV)
• Fecal-oral transmission
• Spread primarily by poor hygiene; hand-to-mouth contact, close contact, or through food and
fluids
• Incubation: 15-50 days
• Illness may last 4-8 weeks.
• Mortality is 0.5% for younger than age 40 and 1-2% for those over age 40.
• Manifestations: mild flu-like symptoms, low-grade fever, anorexia, later jaundice and dark urine,
indigestion and epigastric distress, enlargement of liver and spleen
• Anti-HAV antibody in serum after symptoms appear
Management
• Prevention
– Good handwashing, safe water, and proper sewage disposal
– Vaccine
– See Chart 39-7
– Immunoglobulin for contacts to provide passive immunity
• Bed rest during acute stage
• Nutritional support
See Chart 39-8
Hepatitis B (HBV)
• Transmitted through blood, saliva, semen, and vaginal secretions, sexually transmitted,
transmitted to infant at the time of birth
• A major worldwide cause of cirrhosis and liver cancer
• Risk factors
See Chart 39-9
• Long incubation period: 1-6 months
• Manifestations: insidious and variable, similar to hepatitis A
• The virus has antigenic particles that elicit specific antibody markers during different stages of
the disease.
Management
• Prevention
– Vaccine: for persons at high risk, routine vaccination of infants
– Passive immunization for those exposed
– Standard precautions/infection control measures
– Screening of blood and blood products
• Bed rest
• Nutritional support
• Medications for chronic hepatitis type B include alpha interferon and antiviral agents: lamivudine
(Epivir), adefovir (Hepsera).
Hepatitis C
• Transmitted by blood and sexual contact, including needlesticks and sharing of needles
• The most common bloodborne infection
• A cause of 1/3 of cases of liver cancer and the most common reason for liver transplant
• Risk factors
See Chart 39-10
• Incubation period is variable.
• Symptoms are usually mild.
• Chronic carrier state frequently occurs.
Management
• Prevention
• Screening of blood
• Prevention of needlesticks for health care workers
• Measures to reduce spread of infection as with hepatitis B
• Alcohol encourages the progression of the disease, so alcohol and medications that affect the liver
should be avoided.
• Antiviral agents: interferon and ribavirin (Rebetol)
Hepatitis D and E
• Hepatitis D
– Only persons with hepatitis B are at risk for hepatitis D.
– Transmission is through blood and sexual contact.
– Symptoms and treatment are similar to hepatitis B, but patient is more likely to develop
fulminant liver failure and chronic active hepatitis and cirrhosis.
• Hepatitis E
– Transmitted by fecal-oral route
– Incubation period 15-65 days
– Resembles hepatitis A and is self-limited, with an abrupt onset. No chronic form.