Care of patients with bowel disorders

Factors affecting bodily function of elimination

A. GI tract
1. Food intake
2. Bacterial flora in bowel
B. Indirect
1. Psychologic stress
2. Voluntary postponement of defecation
C. Normal bowel elimination pattern
1. Varies with the individual
2. 2 – 3 times daily to 3 stools per week
Definition
a. Functional GI tract disorder without identifiable cause characterized by abdominal pain and
constipation, diarrhea, or both
b. Affects up to 20% of persons in Western civilization; more common in females
Irritable bowel (IBS) spastic bowel, functional colitis
Pathophysiology
a. Appears there is altered CNS regulation of motor and sensory functions of bowel
[Link] bowel activity in response to food intake, hormones, stress
[Link] sensations of chyme movement through gut
[Link] of colonic mucus
b. Lower visceral pain threshold causing abdominal pain and bloating with normal levels of gas
c. Some linkage of depression and anxiety
Manifestations
a. Abdominal pain relieved by defecation; may be colicky, occurring in spasms, dull or continuous
b. Altered bowel habits including frequency, hard or watery stool, straining or urgency with
stooling, incomplete evacuation, passage of mucus; abdominal bloating, excess gas
c. Nausea, vomiting, anorexia, fatigue, headache, anxiety
d. Tenderness over sigmoid colon upon palpation
4. Collaborative Care
a. Management of distressing symptoms
b. Elimination of precipitating factors, stress reduction
Diagnostic Tests: to find a cause for client’s abdominal pain, changes in feces elimination
a. Stool examination for occult blood, ova and parasites, culture
[Link] with differential, Erythrocyte Sedimentation Rate (ESR): to determine if anemia, bacterial
infection, or inflammatory process
c. Sigmoidoscopy or colonoscopy
[Link] bowel mucosa, measure intraluminal pressures, obtain biopsies if indicated
[Link] with IBS: normal appearance increased mucus, intraluminal pressures,
marked spasms, possible hyperemia without lesions
d. Small bowel series (Upper GI series with small bowel-follow through) and barium enema:
examination of entire GI tract; IBS: increased motility
Medications
a. Purpose: to manage symptoms
b. Bulk-forming laxatives: reduce bowel spasm, normalize bowel movement in number and form
c. Anticholinergic drugs (dicyclomine (Bentyl), hyoscyamine) to inhibit bowel motility; given before
meals
d. Antidiarrheal medications (loperamide (Imodium), diphenoxylate (Lomotil): prevent diarrhea
prophylactically
e. Antidepressant medications
f. Research: medications altering serotonin receptors in GI tract
Dietary Management
a. Often benefit from additional dietary fiber: adds bulk and water content to stool reducing
diarrhea and constipation
b. Some benefit from elimination of lactose, fructose, sorbitol
c. Limiting intake of gas-forming foods, caffeinated beverages
8. Nursing Care
a. Contact in health environments outside acute care
b. Home care focus on improving symptoms with changes of diet, stress management,
medications; seek medical attention if serious changes occur

Nursing process for care of client with constipation page 675

Nursing process for the Client with Diarrhea page 679
Client with inflammatory bowel disorder
Definition
a. Includes 2 separate but closely related conditions: ulcerative colitis and Crohn’s disease; both
have similar geographic distribution and genetic component
b. Etiology is unknown but runs in families; may be related to infectious agent and altered immune
responses
c. Peak incidence occurs between the ages of 15 – 35; second peak 60 – 80
d. Chronic disease with recurrent exacerbations
Pathophysiology
1. Inflammatory process usually confined to rectum and sigmoid colon
2. Inflammation leads to mucosal hemorrhages and abscess formation, which leads to necrosis and
sloughing of bowel mucosa
3. Mucosa becomes red, friable, and ulcerated; bleeding is common
4. Chronic inflammation leads to atrophy, narrowing, and shortening of colon
Ulcerative colitis
Pathophysiology
1. Inflammatory process usually confined to rectum and sigmoid colon
2. Inflammation leads to mucosal hemorrhages and abscess formation, which leads to
necrosis and sloughing of bowel mucosa
3. Mucosa becomes red, friable, and ulcerated; bleeding is common
4. Chronic inflammation leads to atrophy, narrowing, and shortening of colon
Manifestations
1. Diarrhea with stool containing blood and mucus; 5 – 10 stools per day leading to anemia,
hypovolemia, malnutrition
2. Fecal urgency, tenesmus, LLQ cramping
3. Fatigue, anorexia, weakness
4. Severe cases: arthritis, uveitis
Complications
1. Hemorrhage: can be massive with severe attacks
2. Toxic megacolon: usually involves transverse colon which dilates and lacks peristalsis
(manifestations: fever, tachycardia, hypotension, dehydration, change in stools, abdominal
cramping)
 3. Colon perforation: rare but leads to peritonitis and 15% mortality rate
4. Increased risk for colorectal cancer (20 – 30 times); need yearly colonoscopies
5. Sclerosing cholangitis

Crohn's disease
Pathophysiology
1. Can affect any portion of GI tract, but terminal ileum and ascending colon are more
commonly involved
2. Inflammatory aphthoid lesion (shallow ulceration) of mucosa and submucosa develops into
ulcers and fissures that involve entire bowel wall
3. Fibrotic changes occur leading to local obstruction, abscess formation and fistula
formation
4. Fistulas develop between loops of bowel (enteroenteric fistulas); bowel and bladder
(enterovesical fistulas); bowel and skin (enterocutaneous fistulas)
5. Absorption problem develops leading to protein loss and anemia
Manifestations
1. Often continuous or episodic diarrhea; liquid or semi-formed; abdominal pain and tenderness
in RLQ relieved by defecation
2. Fever, fatigue, malaise, weight loss, anemia
3. Fissures, fistulas, abscesses
Complications
1. Intestinal obstruction: caused by repeated inflammation and scarring causing fibrosis and
stricture
2. Fistulas lead to abscess formation; recurrent urinary tract infection if bladder involved
3. Perforation of bowel may occur with peritonitis
4. Massive hemorrhage
5. Increased risk of bowel cancer (5 – 6 times)
Collaborative Care
a. Establish diagnosis
b. Supportive treatment
c. Many clients need surgery
Diagnostic Tests
a. Colonoscopy, Sigmoidoscopy: determine area and pattern of involvement, tissue
biopsies; small risk of perforation
b. Upper GI series with small bowel follow-through, barium enema
[Link] examination and stool cultures to rule out infections
d. CBC: shows anemia, leukocytosis from inflammation and abscess formation
e. Serum albumin, folic acid: lower due to malabsorption
f. Liver function tests may show enzyme elevations
Medications: goal is to stop acute attacks quickly and reduce incidence of relapse
a. Sulfasalazine (Azulfidine): sulfonamide antibiotic with topical effect in colon; used with
ulcerative colitis
b. Corticosteroids: reduce inflammation and induce remission; with ulcerative colitis may be given
as enema; intravenous steroids are given with severe exacerbations
c. Immunosuppressive agents (azathioprine (Imuran), cyclosporine) for clients who do not
respond to steroid therapy
d. New therapies including immune response modifiers, anti-inflammatory cytokines
e. Metronidazole (Flagyl) or Ciprofloxacin (Cipro)
f. Anti-diarrheal medications
Dietary Management
a. Individualized according to client; eliminate irritating foods
b. Dietary fiber contraindicated if client has strictures
c. With acute exacerbations, client may be made NPO and given enteral or total parenteral
nutrition (TPN)
Surgery: performed when necessitated by complications or failure of other measures
Crohn’s disease
1. Bowel obstruction leading cause; may have bowel resection and repair for obstruction,
perforation, fistula, abscess
2. Disease process tends to recur in an area remaining after resection
Ulcerative colitis
1. Total colectomy to treat disease, repair complications (toxic megacolon, perforation,
hemorrhage, prophylactic for cancer risk)
2. Total colectomy with an ileal pouch-anal anastomosis (initially has temporary
 Compare Crohn's disease and ulcerative colitis page 682

Inflammatory disorders of abdomen

Appendicitis
Most common in adolescents and young adults
Inflammation of vermiform appendix, with digestive juices or hard mass of feces called fecalith
Pain, over abdomen or around umbilicus, localizing in RLQ/Mc'Burney's point
Rebound tenderness, release of pressure of palpation in area
Fever , nausea and vomitting. elevation in WBC's, common
Appendix can perforate, cause peritonitis, or become gangrenous.
Surgical management
Precautions when assessing client for appendicitis page 699
Peritonitis
Definition
a. Inflammation of peritoneum, lining that covers wall (parietal peritoneum) and organs (visceral
peritoneum) of abdominal cavity
b. Enteric bacteria enter the peritoneal cavity through a break of intact GI tract (e.g. perforated
ulcer, ruptured appendix)
Pathophysiology
a. Peritonitis results from contamination of normal sterile peritoneal cavity with infections or
chemical irritant
b. Release of bile or gastric juices initially causes chemical peritonitis; infection occurs when bacteria
enter the space
c. Bacterial peritonitis usually caused by these bacteria (normal bowel flora): Escherichia coli,
Klebsiella, Proteus, Pseudomonas
d. Inflammatory process causes fluid shift into peritoneal space (third spacing); leading to
hypovolemia, then septicemia
Manifestations
a. Depends on severity and extent of infection, age and health of client
b. Presents with “acute abdomen”
[Link] onset of diffuse, severe abdominal pain
 [Link] may localize near site of infection (may have rebound tenderness)
[Link] with movement
c. Entire abdomen is tender with boardlike guarding or rigidity of abdominal muscle
d. Decreased peristalsis leading to paralytic ileus; bowel sounds are diminished or absent with
progressive abdominal distention; pooling of GI secretions lead to nausea and vomiting
e. Systemically: fever, malaise, tachycardia and tachypnea, restlessness, disorientation, oliguria with
dehydration and shock
f. Older or Immunosuppressed client may have
1. Few of classic signs
2. Increased confusion and restlessness
3. Decreased urinary output
4. Vague abdominal complaints
5. At risk for delayed diagnosis and higher mortality rates
Complications
a. May be life-threatening; mortality rate overall 40%
b. Abscess
c. Fibrous adhesions
d. Septicemia, septic shock; fluid loss into abdominal cavity leads to hypovolemic shock
Collaborative Care
a. Diagnosis and identifying and treating cause
b. Prevention of complications
Diagnostic Tests
a. WBC with differential: elevated WBC to 20,000; shift to left
b. Blood cultures: identify bacteria in blood
c. Liver and renal function studies, serum electrolytes: evaluate effects of peritonitis
d. Abdominal x-rays: detect intestinal distension, air-fluid levels, free air under diaphragm (sign of
GI perforation)
e. Diagnostic paracentesis
Medications
a. Antibiotics
[Link]-spectrum before definitive culture results identifying specific organism(s)
causing infection
 [Link] antibiotic(s) treating causative pathogens
b. Analgesics
Surgery
a. Laporotomy to treat cause (close perforation, removed inflamed tissue)
b. Peritoneal Lavage: washing out peritoneal cavity with copious amounts of warm isotonic fluid
during surgery to dilute residual bacterial and remove gross contaminants
c. Often have drain in place and/or incision left unsutured to continue drainage
Treatment
a. Intravenous fluids and electrolytes to maintain vascular volume and electrolyte balance
b. Bed rest in Fowler’s position to localize infection and promote lung ventilation
c. Intestinal decompression with nasogastric tube or intestinal tube connected to suction
1. Relieves abdominal distension secondary to paralytic ileus
2. NPO with intravenous fluids while having nasogastric suction
Nursing Diagnoses
a. Pain
b. Deficient Fluid Volume: often on hourly output; nasogastric drainage is considered when
ordering intravenous fluids
c. Ineffective Protection
d. Anxiety
Home Care
a. Client may have prolonged hospitalization
b. Home care often includes
Wound care
2. Home health referral
3. Home intravenous antibiotics
Intestinal obstruction
Definition
a. May be partial or complete obstruction
b. Failure of intestinal contents to move through the bowel lumen; most common site is small
intestine
c. With obstruction, gas and fluid accumulate proximal to and within obstructed segment causing
bowel distention
 d. Bowel distention, vomiting, third-spacing leads to hypovolemia, hypokalemia, renal insufficiency,
shock
Pathophysiology
Mechanical (Table 46-2)
1. Problems outside intestines: adhesions (bands of scar tissue), hernias
2. Problems within intestines: tumors, IBD
3. Obstruction of intestinal lumen (partial or complete)
a. Intussusception: telescoping bowel
b. Volvulus: twisted bowel
c. Foreign bodies
d. Strictures
Functional
1. Failure of peristalsis to move intestinal contents: adynamic ileus (paralytic ileus,
ileus) due to neurologic or muscular impairment
2. Accounts for most bowel obstructions
3. Causes include
a. Post gastrointestinal surgery
[Link] anoxia or peritoneal irritation from hemorrhage, peritonitis, or perforation
c. Hypokalemia
d. Medications: narcotics, anticholinergic drugs, antidiarrheal medications
e. Renal colic, spinal cord injuries, uremia
Manifestations Small Bowel Obstruction
Vary depend on level of obstruction and speed of development
Cramping or colicky abdominal pain, intermittent, intensifying
Vomiting
[Link] intestinal distention stimulates vomiting center
2. Distal obstruction vomiting may become feculent
Bowel sounds
1. Early in course of mechanical obstruction: borborygmi and high-pitched tinkling, may
have visible peristaltic waves
2. Later silent; with paralytic ileus, diminished or absent bowel sounds throughout
Signs of dehydration
 Complications
a. Hypovolemia and hypovolemic shock can result in multiple organ dysfunction (acute
renal failure, impaired ventilation, death)
b. Strangulated bowel can result in gangrene, perforation, peritonitis, possible septic shock
c. Delay in surgical intervention leads to higher mortality rate
Large Bowel Obstruction
Only accounts for 15% of obstructions
Causes include cancer of bowel, Volvulus, diverticular disease, inflammatory disorders, fecal
impaction
Closed-loop obstruction: competent ileocecal valve causes massive colon dilation
Manifestations: deep, cramping pain; severe, continuous pain signals bowel ischemia and possible
perforation; localized tenderness or palpable mass may be noted
Collaborative Care
a. Relieving pressure and obstruction
b. Supportive care
Diagnostic Tests
a. Abdominal X-rays and CT scans with contrast media
1. Show distended loops of intestine with fluid and /or gas in small intestine, confirm mechanical
obstruction; indicates free air under diaphragm
2. If CT with contrast media meglumine diatrizoate (Gastrografin), check for allergy to iodine,
need BUN and Creatinine to determine renal function
b. Laboratory testing to evaluate for presence of infection and electrolyte imbalance: WBC, Serum
amylase, osmolality, electrolytes, arterial blood gases
c. Barium enema or colonoscopy/sigmoidoscopy to identify large bowel obstruction
Gastrointestinal Decompression (nursing guidelines 46-2) also handout on Upper GI NG's
a. Treatment with nasogastric or long intestinal tube provides bowel rest and removal of
air and fluid
b. Successfully relieves many partial small bowel obstructions
Surgery
a. Treatment for complete mechanical obstructions, strangulated or incarcerated obstructions
of small bowel, persistent incomplete mechanical obstructions
b. Preoperative care
 1. Insertion of nasogastric tube to relieve vomiting, abdominal distention, and to prevent
aspiration of intestinal contents
2. Restore fluid and electrolyte balance; correct acid and alkaline imbalances
3. Laporotomy: inspection of intestine and removal of infarcted or gangrenous tissue
4. Removal of cause of obstruction: adhesions, tumors, foreign bodies, gangrenous portion of
intestines and anastomosis or creation of colostomy depending on individual case
Nursing Care
a. Prevention includes healthy diet, fluid intake
b. Exercise, especially in clients with recurrent small bowel obstructions
Nursing Diagnoses
a. Deficient Fluid Volume
b. Ineffective Tissue Perfusion, gastrointestinal
c. Ineffective Breathing Pattern
Home Care
a. Home care referral as indicated
b. Teaching about signs of recurrent obstruction and seeking medical attention
Diverticular disease
Definition
a. Diverticula are saclike projections of mucosa through muscular layer of colon mainly in
sigmoid colon
b. Incidence increases with age; less than a third of persons with diverticulosis develop symptoms
Risk Factors
a. Cultural changes in western world with diet of highly refined and fiber-deficient foods
b. Decreased activity levels
[Link] of defecation
Pathophysiology
a. Diverticulosis is the presence of diverticula which form due to increased pressure within
bowel lumen causing bowel mucosa to herniate through defects in colon wall, causing
outpouchings
b. Muscle in bowel wall thickens narrowing bowel lumen and increasing intraluminal pressure
[Link] of diverticulosis include hemorrhage and diverticulitis, the inflammation of the
diverticular sac
 d. Diverticulitis: diverticulum in sigmoid colon irritated with undigested food and bacteria forming
a hard mass (fecalith) that impairs blood supply leading to perforation
e. With microscopic perforation, inflammation is localized; more extensive perforation may lead
to peritonitis or abscess formation
Manifestations
a. Pain, left-sided, mild to moderate and cramping or steady
b. Constipation or frequency of defecation
c. May also have nausea, vomiting, low-grade fever, abdominal distention, tenderness and
palpable LLQ mass
d. Older adult may have vague abdominal pain
Complications
a. Peritonitis
b. Abscess formation
c. Bowel obstruction
d. Fistula formation
e. Hemorrhage
Collaborative Care: Focus is on management of symptoms and complications
Diagnostic Tests
a. Abdominal Xray: detection of free air with perforation, location of abscess, fistula
b. Barium enema contraindicated in early diverticulitis due to risk of barium leakage into
peritoneal cavity, but will confirm diverticulosis
c. Abdominal CT scan, Sigmoidoscopy or colonscopy used in diagnosis of diverticulosis
d. WBC count with differential: leukocytosis with shift to left in diverticulitis
e. Hemoccult or guiac testing: determine presence of occult blood
Medications
a. Broad spectrum antibiotics against gram negative and anaerobic bacteria to treat acute
diverticulitis, oral or intravenous route depending on severity of symptoms
b. Analgesics for pain (non-narcotic)
c. Stool softener but not cathartic may be prescribed (nothing to increase pressure within bowel)
Dietary Management
a. Diet modification may decrease risk of complications
 b. High-fiber diet (bran, commercial bulk-forming products such as Psyllium seed (Metamucil) or
methylcellulose)
c. Some clients advised against foods with small seeds which could obstruct diverticula
Treatment for acute episode of diverticulitis
a. Client initially NPO with intravenous fluids (possibly TPN)
b. As symptoms subside reintroduce food: clear liquid diet, to soft, low-roughage diet psyillium
seed products to soften stool and increase bulk
c. High fiber diet is resumed after full recovery
Surgery
a. Surgical intervention indicated for clients with generalized peritonitis or abscess that does not
respond to treatment
b. With acute infection, 2 stage Hartman procedure done with temporary colostomy; re-
anastomosis performed 2 – 3 months later
Nursing Care: Health promotion includes teaching high-fiber foods in diet generally, may be
contraindicated for persons with known conditions
Nursing Diagnoses
a. Impaired Tissue Integrity, gastrointestinal
b. Pain
c. Anxiety, related to unknown outcome of treatment, possible surgery
Home Care
a. Teaching regarding prescribed diet, fluid intake, medications
b. Referral for home health care agency, if new colostomy client

Neoplastic disorders
Background
1. Large intestine and rectum most common GI site affected by cancer
2. Colon cancer is second leading cause of death from cancer in U.S.
Client with Polyps
Definition
a. Polyp is mass of tissue arising from bowel wall and protruding into lumen
b. Most often occur in sigmoid and rectum
c.30% of people over 50 have polyps
 Pathophysiology
a. Most polyps are adenomas, benign but considered premalignant; < 1% become malignant but all
colorectal cancers arise from these polyps
b. Polyp types include tubular, villous, or tubular villous
[Link] polyposis is uncommon autosomal dominant genetic disorder with hundreds of
adenomatous polyps throughout large intestine; untreated, near 100% malignancy by age 40
Manifestations
a. Most asymptomatic
b. Intermittent painless rectal bleeding is most common presenting symptom
Collaborative Care
a. Diagnosis is based on colonoscopy
b. Most reliable since allows inspection of entire colon with biopsy or polypectomy if indicated
c. Repeat every 3 years since polyps recu
Nursing Care
a. All clients advised to have screening colonoscopy at age 50 and every 5 years thereafter (polyps
need 5 years of growth for significant malignancy)
b. Bowel preparation ordered prior to colonoscopy with cathartics and/or enemas
Colorectal cancer
Definition
a. Third most common cancer diagnosed
b. Affects sexes equally
c. Five-year survival rate is 90%, with early diagnosis and treatment
Risk Factors
a. Family history
b. Inflammatory bowel disease
c. Diet high in fat, calories, protein
Pathophysiology
a. Most malignancies begin as adenomatous polyps and arise in rectum and sigmoid
b. Spread by direct extension to involve entire bowel circumference and adjacent organs
c. Metastasize to regional lymph nodes via lymphatic and circulatory systems to liver, lungs, brain,
bones, and kidneys
 Manifestations
a. Often produces no symptoms until it is advanced
b. Presenting manifestation is bleeding; also change in bowel habits (diarrhea or constipation);
pain, anorexia, weight loss, palpable abdominal or rectal mass; anemia
Complications
a. Bowel obstruction
b. Perforation of bowel by tumor, peritonitis
c. Direct extension of cancer to adjacent organs; reoccurrences within 4 years
Collaborative Care: Focus is on early detection and intervention
Screening
a. Digital exam beginning at age 40, annually
b. Fecal occult blood testing beginning at age 50, annually
[Link] or sigmoidoscopies beginning at age 50, every 3 – 5 years
Diagnostic Tests
a. CBC: anemia from blood loss, tumor growth
b. Fecal occult blood (guiac or Hemoccult testing): all colorectal cancers bleed intermittently
[Link] antigen (CEA): not used as screening test, but is a tumor marker and used to
estimate prognosis, monitor treatment, detect reoccurrence
d. Colonoscopy or Sigmoidoscopy; tissue biopsy of suspicious lesions, polyps
e. Chest xray, CTscans, MRI, ultrasounds: to determine tumor depth, organ involvement,
metastasis
Surgery
a. Surgical resection of tumor, adjacent colon, and regional lymph nodes is treatment of
choice
b. Whenever possible anal sphincter is preserved and colostomy avoided; anastomosis of
remaining bowel is performed
[Link] of rectum are treated with abdominoperineal resection (A-P resection) in which sigmoid
colon, rectum, and anus are removed through abdominal and perineal incisions and permanent
colostomy created
Radiation Therapy
a. Used as adjunct with surgery; rectal cancer has high rate of regional recurrence if tumor outside
bowel wall or in regional lymph nodes
 b. Used preoperatively to shrink tumor
Chemotherapy:
Used postoperatively with radiation therapy to reduce rate of rectal tumor recurrence and prolong
survival
Nursing Care
a. Prevention is primary issue
b. Client teaching
1. Diet: decrease amount of fat, refined sugar, red meat; increase amount of fiber; diet high in fruits
and vegetables, whole grains, legumes
2. Screening recommendations
3. Seek medical attention for bleeding and warning signs of cancer
4. Risk may be lowered by aspirin or NSAID use
Nursing Diagnoses for post-operative colorectal client
a. Pain
b. Imbalanced Nutrition: Less than body requirements
c. Anticipatory Grieving
d. Alteration in Body Image
e. Risk for Sexual Dysfunction
Home Care
a. Referral for home care
b. Referral to support groups for cancer or ostomy

Ostomy
1. Surgically created opening between intestine and abdominal wall that allows passage of fecal
material
2. Stoma is the surface opening which has an appliance applied to retain stool and is emptied at
intervals
3. Name of ostomy depends on location of stoma
4. Ileostomy: opening in ileum; may be permanent with total proctocolectomy or temporary (loop
ileostomy)
5. Ileostomies: always have liquid stool which can be corrosive to skin since contains digestive
enzymes
 6. Continent (or Kock’s) ileostomy: has intra-abdominal reservoir with nipple valve formation to
allow catheter insertion to drain out stool
Nursing Care: Focus is effective management of disease with avoidance of complications
Nursing Diagnoses
a. Diarrhea
b. Disturbed Body Image; diarrhea may control all aspects of life; client has surgery with ostomy
c. Imbalanced Nutrition: Less than body requirement
d. Risk for Impaired Tissue Integrity: Malnutrition and healing post surgery
e. Risk for sexual dysfunction, related to diarrhea or ostomy
Home Care
a. Inflammatory bowel disease is chronic and day-to-day care lies with client
b. Teaching to control symptoms, adequate nutrition, if client has ostomy: care and resources for
supplies, support group and home care referral
c. Referral to hospice as needed for advanced disease
d. Lactose intolerance may occur
e. Limit liquids with meals if output is high
f. Oral rehydration formulas, such as Gatorade, may help maintain fluid and electrolyte balance.

Characteristics of Healthy and Unhealthy Stomas Table 48-2 page 736

Post op care for the ileostomy patient 48-1 page 737

Colostomy
1. Ostomy made in colon if obstruction from tumor
a. Temporary measure to promote healing of anastomosis
b. Permanent means for fecal evacuation if distal colon and rectum removed
2. Named for area of colon is which formed
a. Sigmoid colostomy: used with A-P resection formed on LLQ/ Single-barrel
b. Double-barrel colostomy: 2 stomas: proximal for feces diversion; distal is mucous fistula
c. Transverse loop colostomy: emergency procedure; loop suspended over a bridge; temporary
d. Hartman procedure: Distal portion is left in place and oversewn; only proximal colostomy is
brought to abdomen as stoma; temporary; colon reconnected at later time when
client ready for surgical repair
Nutrition:
Fiber is restricted to prevent irritation to surgical area/ slows transit time.. immediately postop.
Eventually can increase fiber to improve stool consistency.
Primary concerns postop-6 months is fluid and electrolyte intake. Do not limit fluids to control
liquid feces .
Small frequent meals; eating larger meal earlier in day, may help decrease stools at night
Small bites of food and chew thoroughly
Some foods may help decrease odors. A number of foods have a tendency to increase odors.
Banana flakes, applesauce, pasta, potatoes, smooth peanut butter and cheese may help thicken
stools
Foods that can cause obstructions: nuts, corn, cabbage, coconut, dried fruit, unpeeled apples,
and grapes.

Performing colostomy irrigation table 48-2

Nursing process for Colostomy patient
Nutrition notes 48-1