IBS, Constipation & Diarrhea

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Information about IBS, Constipation & Diarrhea
Health & Medicine

Published on November 24, 2008

Author: txnurse

Source: slideshare.net

Description

IBS, constipation and diarrhea - disorders of the gastrointestinal tract

MARIA G. NELSON BATCH 17 - PCN IRRITABLE BOWEL SYNDROME

What is IBS? Also known as spastic colon, spastic colitis, mucous colitis and irritable colon Most common functional disorder of the GIT Causes increased motility of the small or large intestine Affects the intestine’s structure, but cause is unknown Does not lead to or cause ulcerative colitis or cancer

Also known as spastic colon, spastic colitis, mucous colitis and irritable colon

Most common functional disorder of the GIT

Causes increased motility of the small or large intestine

Affects the intestine’s structure, but cause is unknown

Does not lead to or cause ulcerative colitis or cancer

Signs and Symptoms Causes alternately tense and flaccid bowel segments Symptoms vary in intensity and pattern Aggravated by foods, alcohol ingestion, stress and fatigue Resulting symptoms include: Nausea Abdominal pain Cramps Flatulence (gas) Altered bowel function (constipation or diarrhea) Hypersecretion of colonic mucus

Causes alternately tense and flaccid bowel segments

Symptoms vary in intensity and pattern

Aggravated by foods, alcohol ingestion, stress and fatigue

Resulting symptoms include:

Nausea

Abdominal pain

Cramps

Flatulence (gas)

Altered bowel function (constipation or diarrhea)

Hypersecretion of colonic mucus

Diagnosis Upper GI series Barium enema Colonoscopy appropriate for older adults Tests that eliminate other pathologies with similar symptoms Nursing Alert! Rectal Bleeding and fever are not associated symptoms of IBS. The person with these symptoms should report to a physician for evaluation.

Upper GI series

Barium enema

Colonoscopy appropriate for older adults

Tests that eliminate other pathologies with similar symptoms

Nursing Alert!

Rectal Bleeding and fever are not associated symptoms of IBS. The person with these symptoms should report to a physician for evaluation.

Treatment Lifestyle changes Counseling Biofeedback and relaxation training High-fiber diet and agents that add bulk like Metamucil and Effersyllium Adequate oral fluids and regular meal patterns Limitation of dairy products if lactose intolerant Medications for symptomatic relief

Lifestyle changes

Counseling

Biofeedback and relaxation training

High-fiber diet and agents that add bulk like Metamucil and Effersyllium

Adequate oral fluids and regular meal patterns

Limitation of dairy products if lactose intolerant

Medications for symptomatic relief

Types of Medications Sedatives or tranquilizers such as alprazolam (Xanax) Help quiet the bowel’s activity Provide relaxation Antispasmodic agents like dicylclomine hydrochloride (Bentyl) and hyoscyamine (Donnatal) Relieve pain and cramping symptoms Common side effects: Dry mouth Blurred vision dizziness Antidiarrheal agents like loperamide (Imodium) to maintain normal activity

Sedatives or tranquilizers such as alprazolam (Xanax)

Help quiet the bowel’s activity

Provide relaxation

Antispasmodic agents like dicylclomine hydrochloride (Bentyl) and hyoscyamine (Donnatal)

Relieve pain and cramping symptoms

Common side effects:

Dry mouth

Blurred vision

dizziness

Antidiarrheal agents like loperamide (Imodium) to maintain normal activity

Nursing Considerations Consistency Follow prescribed treatment plan. Keep a log or diary to track progress or identify changes.

Consistency

Follow prescribed treatment plan.

Keep a log or diary to track progress or identify changes.

MARIA G. NELSON BATCH 17 CONSTIPATION

What is Constipation? Infrequent, hard bowel movements accompanied by mucus May be acute or chronic Fecal impaction Loose, watery stool and mucus traveling around the constipated stool Prolonged constipation Sign of serious difficulty – intestinal obstruction or paralytic ileus Immediate action needed!

Infrequent, hard bowel movements accompanied by mucus

May be acute or chronic

Fecal impaction

Loose, watery stool and mucus traveling around the constipated stool

Prolonged constipation

Sign of serious difficulty – intestinal obstruction or paralytic ileus

Immediate action needed!

Causes Dehydration Cancer Chemical dependency Mechanical obstruction Psychosomatic disorder

Dehydration

Cancer

Chemical dependency

Mechanical obstruction

Psychosomatic disorder

Treatment Enemas for removal of feces and flatus Diagnostic test or surgery To alleviate symptoms of constipation or distension To administer specific medications or fluids Digital removal of fecal impaction for severely constipated or paralyzed clients Done only when stool softeners and enemas fail Fecal impaction as a possible complication of barium enema or barium swallow

Enemas for removal of feces and flatus

Diagnostic test or surgery

To alleviate symptoms of constipation or distension

To administer specific medications or fluids

Digital removal of fecal impaction for severely constipated or paralyzed clients

Done only when stool softeners and enemas fail

Fecal impaction as a possible complication of barium enema or barium swallow

Nursing Considerations Warn client not to strain while defecating. Client should quit worrying – compounds the problem Lots of fluids – drink prune juice Increase dietary bulk Exercise Regular schedule for defecation Postponing urge to defecate desensitizes the bowel to the presence of feces

Warn client not to strain while defecating.

Client should quit worrying – compounds the problem

Lots of fluids – drink prune juice

Increase dietary bulk

Exercise

Regular schedule for defecation

Postponing urge to defecate desensitizes the bowel to the presence of feces

Constipation in Older Adults Multiple medications may decrease peristalsis, cause water loss and interfere with intestinal absorption. Limited mobility or exercise Low intake of dietary fiber Difficulty with chewing, swallowing or ingesting Daily stool softeners suggested but regular laxatives should be avoided. Caution: Loose watery stools may not be diarrhea – could be severe constipation with leakage of H2O around blockage. Assess for fecal impaction.

Multiple medications may decrease peristalsis, cause water loss and interfere with intestinal absorption.

Limited mobility or exercise

Low intake of dietary fiber

Difficulty with chewing, swallowing or ingesting

Daily stool softeners suggested but regular laxatives should be avoided.

Caution: Loose watery stools may not be diarrhea – could be severe constipation with leakage of H2O around blockage.

Assess for fecal impaction.

MARIA G. NELSON BATCH 17 DIARRHEA

What is Diarrhea? Liquid or semi-liquid stools, often light colored May be foul smelling, contain mucus, pus, blood or fats Often accompanied by flatus and severe, painful abdominal cramps or spasms (tenesmus) that defecation relieves Complications of severe or chronic diarrhea include: Dehydration Electrolyte disturbances Cardiac dysrhytmias Hypovolemic shock

Liquid or semi-liquid stools, often light colored

May be foul smelling, contain mucus, pus, blood or fats

Often accompanied by flatus and severe, painful abdominal cramps or spasms (tenesmus) that defecation relieves

Complications of severe or chronic diarrhea include:

Dehydration

Electrolyte disturbances

Cardiac dysrhytmias

Hypovolemic shock

Signs and Symptoms Bacterial invasion by S. dysenteriae or Salmonella Clostridium botulinum Anaerobic bacterium often the cause of nosocomial diarrhea Infection that occurs in acutely ill patients who have received countless courses of antibiotics Inflammatory bowel disease (IBD) Often cause of diarrhea Medications Can cause diarrhea that stops when treatment stops

Bacterial invasion by S. dysenteriae or Salmonella

Clostridium botulinum

Anaerobic bacterium often the cause of nosocomial diarrhea

Infection that occurs in acutely ill patients who have received countless courses of antibiotics

Inflammatory bowel disease (IBD)

Often cause of diarrhea

Medications

Can cause diarrhea that stops when treatment stops

Diagnosis Evaluation of possible causes before client self-medicates If it awakens the client from normal sleep – indicates intestinal pathology; bacterial infection, IBS or IBD should be ruled out. Stool tests including cultures, occult blood tests, and O & P smears are performed. Hematology studies indicate infection of inflammatory processes. Lower GI barium exams to rule out pathologic causes

Evaluation of possible causes before client self-medicates

If it awakens the client from normal sleep – indicates intestinal pathology; bacterial infection, IBS or IBD should be ruled out.

Stool tests including cultures, occult blood tests, and O & P smears are performed.

Hematology studies indicate infection of inflammatory processes.

Lower GI barium exams to rule out pathologic causes

Treatment Elimination of the cause IV fluids and electrolytes Medications

Elimination of the cause

IV fluids and electrolytes

Medications

Medications for Diarrhea All contraindicated in poisoning unless poison is removed from GIT) Motility reduction: loperamide (Imodium), diphenoxylate (Lomotil) Potential for drug dependence; may cause dizziness, constipation and drying of mucous membranes Lomotil cannot be used when pregnant Bile salt-binding agent: cholestyramine (Questran) May cause constipation, nausea, bloating, abdominal pain, rash Cannot be mixed with other medications because it blocks their absorption Antibiotics: to treat bacterial/microbial diarrhea

All contraindicated in poisoning unless poison is removed from GIT)

Motility reduction: loperamide (Imodium), diphenoxylate (Lomotil)

Potential for drug dependence; may cause dizziness, constipation and drying of mucous membranes

Lomotil cannot be used when pregnant

Bile salt-binding agent: cholestyramine (Questran)

May cause constipation, nausea, bloating, abdominal pain, rash

Cannot be mixed with other medications because it blocks their absorption

Antibiotics: to treat bacterial/microbial diarrhea

Nursing Considerations Assess client’s fluid I&O and weight. Monitor for s/s of electrolyte disturbances and electrolyte levels – can disrupt electrolyte balance Record exact time, amount and character (TAC) of each stool. Restrict client’s diet to clear liquids. Reintroduce food and fluids slowly to observe for improvement or worsening. Client teaching that includes prevention of food contamination with S. aureus and Salmonella , often sources of diarrhea.

Assess client’s fluid I&O and weight.

Monitor for s/s of electrolyte disturbances and electrolyte levels – can disrupt electrolyte balance

Record exact time, amount and character (TAC) of each stool.

Restrict client’s diet to clear liquids.

Reintroduce food and fluids slowly to observe for improvement or worsening.

Client teaching that includes prevention of food contamination with S. aureus and Salmonella , often sources of diarrhea.

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