16 Chapter 40 Lower Digestive Tract Disorders ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
50-Minute Lesson Plan
Lecture Outline 20 minutes
3
Slide 39
Intestinal Obstruction
• Causes
• Strangulated hernia, tumor, paralytic ileus, stricture, volvulus (twisting of the bowel),
intussusception (telescoping of the bowel into itself), and postoperative adhesions
• Signs and symptoms
Slide 40
Intestinal Obstruction (cont.)
• Complications
• Gangrene and perforation of the bowel
• Shock and death if untreated
Intestinal Obstruction (cont.)
• Medical diagnosis
4
Intestinal Obstruction (cont.)
• Assessment
• Symptoms, including pain and nausea
TALKING POINTS:
• Take vital signs to detect signs of infection (fever, tachycardia) and impending shock
Slide 43
Intestinal Obstruction (cont.)
• Interventions
• Acute pain
• Deficient fluid volume
3
Appendicitis
• Pathophysiology
• Inflammation of the appendix
TALKING POINTS:
___________________________________________________ Chapter 40 Lower Digestive Tract Disorders 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
Slide 45
Appendicitis (cont.)
• Signs and symptoms
• Pain at McBurney’s point, midway between the umbilicus and the iliac crest
• Temperature elevation, nausea, and vomiting
Slide 46
Appendicitis (cont.)
• Medical treatment
• Nothing by mouth
• A cold pack to the abdomen may be ordered
4
Slide 47
Appendicitis (cont.)
• Assessment
• Location, severity, onset, duration, precipitating factors, and alleviating measures in
Appendicitis (cont.)
• Preoperative interventions
• Semi-Fowler or side-lying position with the hips flexed
Appendicitis (cont.)
• Postoperative interventions
• Administer antibiotics, intravenous fluids, and possibly gastrointestinal decompression
18 Chapter 40 Lower Digestive Tract Disorders ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
3
Slide 50
Peritonitis
• Pathophysiology
• Inflammation of peritoneum caused by chemical or bacterial contamination of the
peritoneal cavity
• Signs and symptoms
TALKING POINTS:
• Chemical contamination may follow rupture of a digestive tract structure, including the
appendix.
Slide 51
Peritonitis (cont.)
• Medical diagnosis
• History and physical
• Complete blood cell count, serum electrolyte measurements, abdominal radiography,
computed tomography, and ultrasound
• Paracentesis
Slide 52
Peritonitis (cont.)
• Medical treatment
• Gastrointestinal decompression, intravenous fluids, antibiotics, and analgesics
• Surgery to close a ruptured structure and remove foreign material and fluid from the
peritoneal cavity
4
Peritonitis (cont.)
• Assessment
• Onset, location, and severity of the pain and any related symptoms
Peritonitis (cont.)
• Interventions
• Acute pain
___________________________________________________ Chapter 40 Lower Digestive Tract Disorders 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
Slide 55
Abdominal Hernia
• Pathophysiology
• Weakness in the abdominal wall that allows a portion of the large intestine to push
through
TALKING POINTS:
• A reducible hernia slips back into the abdominal cavity with gentle pressure or when the
3
Abdominal Hernia (cont.)
Slide 57
Abdominal Hernia (cont.)
• Medical diagnosis
• Health history and physical examination
4
Abdominal Hernia (cont.)
• Assessment
• Chief complaint
Abdominal Hernia (cont.)
• Preoperative interventions
• Risk for injury
20 Chapter 40 Lower Digestive Tract Disorders ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
3
Inflammatory Bowel Disease
• Pathophysiology
• Ulcerative colitis and Crohn’s disease
TALKING POINTS:
• With ulcerative colitis, the inflammation typically begins in the rectum and gradually
Slide 61
Inflammatory Bowel Disease (cont.)
• Signs and symptoms
• Ulcerative colitis
• Diarrhea with frequent bloody stools, abdominal cramping
• Crohn’s disease
Inflammatory Bowel Disease (cont.)
• Complications
TALKING POINTS:
• What systemic complications may occur?
Slide 63
Inflammatory Bowel Disease (cont.)
• Medical diagnosis
• History and physical examination
• Abdominal radiography
TALKING POINTS:
• What drugs may be used to treat IBD?
___________________________________________________ Chapter 40 Lower Digestive Tract Disorders 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
4
Slide 64
Inflammatory Bowel Disease (cont.)
• Assessment
• Onset, location, severity, and duration of pain
• Note factors that contribute to the onset of pain
• Onset and duration of diarrhea; presence of blood
Slide 65
Inflammatory Bowel Disease (cont.)
• Interventions
• Acute pain
3
Diverticulosis
• Pathophysiology
• Small saclike pouches in intestinal wall: diverticula
TALKING POINTS:
• Where are most diverticula found?
Slide 67
Diverticulosis (cont.)
• Signs and symptoms
• Often asymptomatic, but many people report constipation, diarrhea, or periodic bouts
Diverticulosis (cont.)
• Complications
• Diverticulitis
22 Chapter 40 Lower Digestive Tract Disorders ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
Diverticulosis (cont.)
• Medical treatment
• High-residue diet without spicy foods
• Surgical intervention may be necessary
TALKING POINTS:
• During periods of acute inflammation, the patient is placed on bedrest and given nothing
3
Diverticulosis (cont.)
• Assessment
• Assess patient’s comfort and stool characteristics; note nausea and vomiting
4
Diverticulosis (cont.)
• Deficient fluid volume
Slide 72
Diverticulosis (cont.)
• Interventions
• Fluids as permitted; monitor intake and output
• Antiemetics, analgesics, anticholinergics as ordered
• Be alert for signs of perforation
• Teach patient about diverticulosis, including the pathophysiology, treatment, and
symptoms of inflammation
Slide 73
Colorectal Cancer
• Pathophysiology
• Cancer of the large intestine
• People at greater risk for colorectal cancer are those with histories of inflammatory
TALKING POINTS:
• Where does colorectal cancer develop?
___________________________________________________ Chapter 40 Lower Digestive Tract Disorders 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
3
Slide 74
Colorectal Cancer (cont.)
• Signs and symptoms
• Right side of the abdomen
• Vague cramping until the disease is advanced
4
Colorectal Cancer (cont.)
• Medical and surgical treatment
3
Colorectal Cancer (cont.)
• Assessment
4
Colorectal Cancer (cont.)
• Interventions
3
Polyps
• Small growths in the intestine
• Most benign but can become malignant
24 Chapter 40 Lower Digestive Tract Disorders ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
3
Slide 79
Hemorrhoids
• Internal or external dilated veins in the rectum
• Thrombosed
• Blood clots form in external hemorrhoids; become inflamed and very painful
• Risk factors
TALKING POINTS:
• They may be above the sphincter muscles of the anus (internal hemorrhoids) or below
Slide 80
Hemorrhoids (cont.)
• Medical diagnosis and treatment
• Diagnosed by visual inspection
• Nonsurgical treatment
4
Hemorrhoids (cont.)
• Assessment
3
Anorectal Abscess
• An infection in the tissue around the rectum
TALKING POINTS:
4
Anorectal Abscess (cont.)
• Postoperatively, pain treated with opioid analgesics
___________________________________________________ Chapter 40 Lower Digestive Tract Disorders 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
3
Slide 84
Anal Fissure
• Laceration between the anal canal and the perianal skin
• May be related to constipation, diarrhea, Crohn’s disease, tuberculosis, leukemia, trauma,
or childbirth
• Signs and symptoms include pain before and after defecation and bleeding on the stool or
tissue
Slide 85
Anal Fistula
• Abnormal opening between anal canal and perianal skin
• Develops from anorectal abscesses or related to inflammatory bowel disease or
tuberculosis
Pilonidal Cyst
4
Patient Education to Promote Normal Bowel Function
• Good handwashing and proper food-handling
• People who recognize that stress affects their gastrointestinal function may benefit from
TALKING POINTS:
26 Chapter 40 Lower Digestive Tract Disorders ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
Activities
Classroom Choose from below to make 30 minutes
3
DISCUSS
• Discuss the pathophysiology and signs and
symptoms of obesity. Describe the medical
diagnosis and treatment.
• Discuss the pathophysiology and symptoms
of abdominal hernia. Describe the medical
• Discuss the pathophysiology, signs and
symptoms, and complications of
inflammatory bowel disease. Describe the
medical diagnosis and treatment.
• Discuss the pathophysiology and signs and
symptoms of diverticulosis. Describe the
medical diagnosis and treatment.
___________________________________________________ Chapter 40 Lower Digestive Tract Disorders 27
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
3
PRACTICE
• Divide the class into groups and assign a
digestive disorder to each. Have each group
create a table that describes the
pathophysiology, signs and symptoms, and
4
DISCUSS
• Discuss the nursing care of the obese
patient. What are some common
interventions for this condition?
• Discuss the nursing care of the patient with
• Discuss the nursing care of the patient with
peritonitis. What are some common
interventions for this condition?
• Discuss the nursing care of the patient with
intestinal obstruction. What are some
common interventions for this condition?
• Discuss the nursing care of the patient with
inflammatory bowel disease. What are some
common interventions for this condition?
• Discuss the nursing care of the patient with
28 Chapter 40 Lower Digestive Tract Disorders ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 40.2
4
PRACTICE
• Divide the class into small groups. Have
each group refer to the nursing diagnoses,
goals, and outcome criteria for selected
disorders of the lower digestive system and
Critical Thinking Question
A patient has been diagnosed with inflammatory bowel disease. The patient asks the nurse,
“How can I expect to ever have a social life, much less find an intimate relationship? All I do is
go to the bathroom. The last date I had, I had to leave the dinner table six times during the
meal. My date wanted to take me home immediately. My friends tease me because I have to
leave the movies several times during the show.” How can the nurse respond to this patient?
Discussion Guidelines: The nurse should listen attentively and provide emotional support during
Instructor Notes/Student Feedback
___________________________________________________ Chapter 40 Lower Digestive Tract Disorders 29
Introduction to Medical-Surgical Nursing, 6th ed.
40
Assessments for
Disorders of the Lower Digestive Tract
CHAPTER OBJECTIVES
Lesson 40.1:
2. Describe the nursing care of patients with lower gastrointestinal tract surgery, and drug therapy for
lower digestive tract disorders.
Lesson 40.2:
3. Describe the pathophysiology, signs and symptoms, complications, and treatment of selected lower
digestive tract disorders. (Cont.)
4. Assist in developing nursing care plans for patients receiving treatment for lower digestive tract
disorders. (Cont.)
Assessments by Lesson & Objective
Lesson 40.1
1
Study Guide
• Part IID: 1, 2, 13 (pp. 256-257)
Evolve Instructor Resources
Evolve Student Resources
2
Evolve Instructor Resources
• Test Bank: 2
Study Guide
• Part IID: 8-10, 12, 14, 17, 18 (p. 257)
Evolve Instructor Resources
• Test Bank: 5, 10
• Open Book Quiz: 2, 3
Evolve Student Resources
30 Chapter 40 Lower Digestive Tract Disorders ____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
4
Evolve Instructor Resources
• Test Bank: 4, 8, 12
Evolve Student Resources
• NCLEX Review: 1, 5, 7
• Prioritization: 2, 3, 5
3
Study Guide
• Part IB: 1-4 (p. 256)
• Part IC: 1-5 (p. 256)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 9
4
Study Guide
• Part IID: 15 (p. 257)
• Part IIIE: 2 (p. 258)
Evolve Instructor Resources
• Prioritization: 4
Instructor’s Notes/Student Feedback