Chapter 40 Homework What Measures Help Prevent Accumulation Fluid And

Introduction to Medical-Surgical Nursing, 6th ed.

40

Lesson Plans for

Lower Digestive Tract Disorders

CHAPTER LESSON PLANS & OBJECTIVES

Lesson 40.1:

2. Describe the nursing care of patients with lower gastrointestinal tract surgery, and drug therapy for

lower digestive tract disorders.

4. Assist in developing nursing care plans for patients receiving treatment for lower digestive tract

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.)

CHAPTER TEACHING FOCUS

• In this chapter, the student is introduced to topics related to lower digestive tract disorders.

• Nursing assessment of the digestive tract, diagnostic tests and procedures, and common therapeutic

measures are discussed.

CONCEPTS

The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).

Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for

each concept have been tailored specifically to correspond to the Linton textbook.

THEME: Homeostasis and Regulation

• Concept: Nutrition

o Exemplar: Obesity, p. 825

o Box 40-1: Defining Obesity, p. 826

• Concept: Elimination

o Exemplar: Diarrhea, p. 829

THEME: Protection and Movement

• Concept: Inflammation

o Exemplar: Inflammatory Bowel Disease, p. 837

o Cultural Considerations: What does culture have to do with Inflammatory Bowel Disease?

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Introduction to Medical-Surgical Nursing, 6th ed.

CHAPTER PRETEST

Have the students answer these questions prior to covering this chapter to understand where they stand

in relation to the content.

1) How is a person’s body mass index (BMI) calculated?

a) Multiply the person’s weight in kg by height in meters squared.

b) Divide the person’s weight in kg by height in meters squared.

c) Add the person’s weight in kg to height in meters squared.

d) Subtract the person’s weight in kg from height in meters squared.

2) Which aspects of patient teaching should be included for obesity?

a) Weighing food portions helps awareness of portion sizes.

b) Increasing physical activity is not necessary if calories are reduced.

c) Surgical treatment is the first treatment recommended for obesity.

d) The person wishing to lose weight should lose 5 to 6 pounds a week.

3) Which racial/cultural/religious group is most likely to experience inherited lactase deficiency?

a) Hispanics

b) Western European

c) Jewish

d) African American

4) Which dietary changes can be recommended to prevent constipation?

a) Reduced water intake

b) A diet high in lean meat

c) Increased intake of raw vegetables

d) Increased intake of dairy products

5) What is a common symptom of intestinal obstruction?

a) Flat-shaped abdomen

b) Projectile vomiting

c) Profuse diarrhea

d) Bloody emesis

6) Where is the pain located in appendicitis?

a) McBurney’s point

b) Korsakoff’s point

c) Wernicke’s point

d) Trousseau’s point

7) Which is a sign and symptom of peritonitis?

a) Bloody stools

b) Strain with defecation

c) Abdominal rigidity

d) Bradycardia

8) Which portion(s) of the gastrointestinal system are affected by Crohn’s disease?

a) The large intestine only

b) The small intestine only

c) The duodenum only

d) Both the large and small intestines

9) Which nursing diagnosis is common with inflammatory bowel disorders?

a) Imbalanced nutrition: More than body requirements

b) Excess fluid volume

c) Deficient fluid volume

d) Low risk for injury

10) Which is a common sign or symptom of colorectal cancer?

a) Narrow, pencil-like stools

b) Left-sided abdominal pain

c) Bloody emesis

d) Rigid, boardlike abdomen

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Introduction to Medical-Surgical Nursing, 6th ed.

Chapter Pretest Answers

CHAPTER BACKGROUND ASSESSMENT

Discuss these questions with your students prior to covering this chapter to understand where they stand

in relation to the content.

Question: What aspects of care should be provided to a patient who has inflammatory bowel disease?

Question: Which signs and symptoms will a patient experience with colorectal cancer?

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Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 40.1

Textbook Objectives Covered

1. Identify the nursing responsibilities in the care of patients undergoing diagnostic tests and

procedures for disorders of the lower digestive tract.

2. Describe the nursing care of patients with lower gastrointestinal tract surgery, and drug therapy

for lower digestive tract disorders.

lower digestive tract disorders.

4. Assist in developing nursing care plans for patients receiving treatment for lower digestive tract

disorders.

Lesson Preparation Checklist

• Prepare lecture from TEACH lecture slides available on Evolve.

Materials and Supplies

• computer and PowerPoint

projector

Key Terms

Student Preparation

Assignments 2 hours

1

READ – Textbook (pp. 821-825)

REVIEW

ANSWER – Text

• Review Questions for the NCLEX Examination: 1 (p. 846)

2

READ – Textbook (pp. 824-825)

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Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 40.1

3

READ – Textbook (pp. 825-832)

REVIEW

• Box 40-1: Defining Obesity (p. 826)

ANSWER – Study Guide

4

READ – Textbook (pp. 825-832)

50-Minute Lesson Plan

Lecture Outline 20 minutes

Slide 1

Chapter 40

Disorders of the Lower Digestive Tract

Slide 2

Anatomy and Physiology of the Digestive Tract

• Small intestine

• Chemical digestion and absorption of nutrients take place

TALKING POINTS:

1

Slide 3

Anatomy and Physiology of the Lower Digestive Tract

• Assist in breakdown of food into molecules to be used by body cells

Small Intestine

• Gastric secretions and food become chyme, which enters the small intestine

Slide 5

Liver, Gallbladder, and Pancreas

• Liver and pancreatic secretions enter the digestive tract in the duodenum

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LESSON 40.1

Slide 6

Tissue Layers

• Mucous membrane layer

• Inner layer

• Muscle layer

TALKING POINTS:

• What is the purpose and function of each tissue layer?

Large Intestine and Anus

• Chyme enters large intestine through ileocecal valve

• Cecum, where appendix is located

TALKING POINTS:

• What is the purpose and function of the large intestine?

Age-Related Changes

• No significant changes in the small intestine; some vitamin/mineral absorption changes

TALKING POINTS:

• What are some factors associated with constipation?

Physical Examination

• Abdomen

• Inspection

TALKING POINTS:

• Why is the abdomen inspected and auscultated prior to percussion and palpation?

Slide 10

Rectum and Anus

• Inspection

• Position, drape and comfort the patient

• Examiner palpates for lumps and tenderness in the rectum

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Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 40.1

Diagnostic Tests and Procedures

• Radiographic studies

TALKING POINTS:

• Which precautions may be necessary for an older adult who is undergoing lower GI

studies?

Slide 12

Laboratory Studies

• Occult blood test

• Stool examination

TALKING POINTS:

• What are important aspects of stool sample collection?

3

Slide 13

Obesity

• Increased weight caused by excessive body fat

• Causes

• Heredity, body build/metabolism, psychosocial factors

TALKING POINTS:

• When fat cells reach a certain size, they divide to form new fat cells. Fat cells decrease in

Slide 14

Obesity (cont.)

• Medical diagnosis

• Standard weight tables

• Measuring skinfold thickness

TALKING POINTS:

• What drug therapy may be used to treat obesity?

Types of Bariatric Surgery

• Roux-en-Y gastric bypass

TALKING POINTS:

• What are the benefits of each type of surgery?

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LESSON 40.1

4

Slide 16

Obesity (cont.)

• Assessment

• Identify factors that contribute to obesity

• Ask about usual dietary practices

TALKING POINTS:

• Inquire about interpersonal relationships, stresses, and coping strategies.

• What procedure may make auscultating heart, lung, and bowel sounds for the obese

patient easier?

Obesity (cont.)

• Interventions for the obese patient managed nonsurgically

Obesity (cont.)

• Interventions after bariatric surgery

2

Slide 19

Gastrointestinal Surgery

• Preoperative care

• Radiographic examinations

• Digestive tract cleansing

TALKING POINTS:

• What are the causes of the temporary loss of peristalsis?

• What measures help prevent accumulation of fluid and gas?

Postoperative Care

• Postoperative care (see Chapter 17)

Drug Therapy

• Laxatives and cathartics

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Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 40.1

3

Malabsorption

• One or more nutrients are not digested or absorbed

TALKING POINTS:

• What are the two types of malabsorption?

Malabsorption (cont.)

• Signs and symptoms

• Steatorrhea

Slide 24

Malabsorption (cont.)

• Medical diagnosis

• Sprue: based on laboratory studies, endoscopy with biopsy, and radiologic imaging

studies

Slide 25

Malabsorption (cont.)

• Medical treatment

• Sprue: diet and drug therapy; foods that aggravate symptoms eliminated from the diet

• Celiac disease: avoid products that contain gluten

4

Slide 26

Malabsorption (cont.)

• Nursing care

• Document the patient’s symptoms

• Note stool characteristics

• In the case of celiac sprue, teach the patient how to eliminate gluten from the diet

3

Slide 27

Diarrhea

• The passage of loose, liquid stools with increased frequency

• May have cramps, abdominal pain, and a feeling of urgency before bowel movements

Diarrhea (cont.)

• Causes

• Spoiled foods, allergies, infections, diverticulosis, malabsorption, cancer, stress, fecal

• Complications

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Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 40.1

Slide 29

Diarrhea (cont.)

• Medical treatment

• Acute diarrhea usually treated by resting the digestive tract and giving antidiarrheal

drugs

• Severe, persistent diarrhea may require TPN

4

Slide 30

Diarrhea (cont.)

• Assessment

• Diarrhea and onset, severity, precipitating factors, and measures that bring relief

• Ask about stool characteristics, including amount, color, odor, and unusual contents,

TALKING POINTS:

• Important aspects of the physical examination include vital signs, weight, and tissue

turgor.

• How is tissue turgor assessed?

• Self-care deficit, toileting

Diarrhea (cont.)

• Interventions

• Deficient fluid volume

Slide 32

slide 33

Constipation (cont.)

• Causes

• Frequently ignoring the urge to defecate

• Frequent use of laxatives or enemas

• Inactivity

___________________________________________________ Chapter 40 Lower Digestive Tract Disorders 11

LESSON 40.1

Slide 34

Constipation (cont.)

• Complications

• Valsalva maneuver

• The rapid changes in blood flow can be fatal to a patient with heart disease

• Hemorrhoids

TALKING POINTS:

• Stool softeners, as the name suggests, promote normal elimination by allowing more

water to be held in the stool so that it is softer and more easily passed.

• What are examples of stool softeners?

4

Slide 35

Constipation (cont.)

• Assessment

• Usual pattern of bowel elimination, including frequency, amount, color, unusual

contents, and pain associated with defecation

Slide 36

Constipation (cont.)

• Interventions

• Maintained with diet, fluids, exercise, and regular toilet habits

• Megacolon

TALKING POINTS:

• If detected early, constipation may be treated easily with a mild laxative or suppository.

• Severe constipation may require repeated enemas and laxatives for relief.

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LESSON 40.1

Slide 37

Question 1

• Liver and pancreatic secretions enter the digestive tract in the ________.

A. duodenum

B. jejunum

C. ilium

D. stomach

TALKING POINTS:

Slide 38

Question 2

• Which is an age related change in the lower digestive tract?

A. Increased muscle tone

B. Muscle layer atrophy

C. Increased speed of movements of intestinal contents

D. Increased anal sphincter tone

Activities

Classroom Choose from below to make 30 minutes

Online

1

ASSESS BASELINE

• Have the class complete the Pretest. Collect

their work and use the results to guide how

you teach the class.

DISCUSS

• Discuss the anatomy and physiology of the

lower digestive tract.

• Discuss the changes that occur with aging.

PRACTICE

• Ask students to form pairs and practice

obtaining information for the health history

and functional assessment for a patient with

a lower digestive tract disorder.

ASSESS BASELINE

• Post the Pretest and the Background

Assessment online and have your class

complete them. Use the results to guide how

you teach the class.

POST AND COMMENT

• Post the following discussion topic online

and have students comment. Discuss the

___________________________________________________ Chapter 40 Lower Digestive Tract Disorders 13

Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 40.1

2

DISCUSS

• Discuss the preoperative and postoperative

care of a patient undergoing gastrointestinal

surgery

PRACTICE

POST AND COMMENT

• Post the following discussion topic online

and have students comment. Ask students

to post a video depicting a nurse providing

preoperative and postoperative instructions

to a patient who will be undergoing

3

DISCUSS

• Discuss the pathophysiology, signs and

symptoms, and complications of obesity.

Describe the medical diagnosis and

treatment.

• Discuss the various types of surgical

procedures to treat obesity.

• Discuss the pathophysiology, signs and

symptoms, and complications of

malabsorption. Describe the medical

diagnosis and treatment.

PRACTICE

• Ask students to form groups to explain the

different types of bariatric surgery. The

POST AND COMMENT

• Post the following discussion topic online

and have students comment. Differentiate

between various types of absorption

disorders.

• Post the following discussion topic online

and have students comment. Explain the

possible complications and medical

treatment of diarrhea.

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Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 40.1

4

DISCUSS

• Discuss the nursing care of the patient with

obesity. What are some important elements

of the patient teaching plan?

• Discuss the nursing care of the patient with

elements of the patient teaching plan?

POST AND COMMENT

• Post the following discussion topic online

and have students comment. Discuss the

effect obesity has on a person’s self-image.

Ask students to provide constructive

Critical Thinking Question

A patient with a BMI of 40 is scheduled for laparoscopic banding bariatric surgery this

morning. The patient is very anxious and says she cannot remember the preoperative

instructions provided yesterday. She says she can’t remember what kind of surgery she is

having today. What actions should the nurse take?

Discussion Guidelines: The nurse should acknowledge the patient’s fears and provide emotional

Instructor Notes/Student Feedback

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Introduction to Medical-Surgical Nursing, 6th ed.

LESSON 40.2

Instructor Preparation

Textbook Objectives Covered

3. Describe the pathophysiology, signs and symptoms, complications, and treatment of selected

Lesson Preparation Checklist

• Prepare lecture from TEACH lecture slides available on Evolve.

Materials and Supplies

• computer and PowerPoint

projector

Key Terms

Student Preparation

Assignments 2 hours

3

READ – Textbook (pp. 832-845)

REVIEW

• Figure 40-4: Causes of mechanical bowel obstruction (p. 832)

• Figure 40-5: McBurney’s point (p. 834)

ANSWER – Text

• Review Questions for the NCLEX Examination: 2, 3, 5, 6, 10, 11 (pp. 846-847)

ANSWER – Study Guide

• Part IB: 1-4 (p. 256)

4

READ – Textbook (pp. 832-845)

ANSWER – Text

ANSWER – Study Guide