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NSG 326 Adult Health IAppendicitisSlide 3Symptoms of AppendicitisSlide 5Slide 6ColostomySlide 8OstomiesIleostomyOstomy Postoperative careHealthy New StomaOstomy Postoperative CareOstomy CareIrritable Bowel Syndrome (IBS)Clinical ManifestationsSlide 17Psychosocial Factors in IBSIBS DiagnosticsCare ManagementIBS Nutritional ManagementInflammatory Bowel Disease [IBD]Slide 23IBDIBD DescriptionUlcerative ColitisSlide 27Crohn’s DiseaseSlide 29Slide 30Slide 31CD Clinical ManifestationsClinical Manifestations CD (cont.)Complications of Crohn’s DiseaseComplications of CD (cont.)Slide 36Slide 37IBD DiagnosticsSlide 39IBD Surgical TherapyIBD SurgeryIBD & Nutritional TherapiesNursing DiagnosesNursing ManagementNursing Management (cont.)Slide 46Slide 47Slide 48Gallbladder DiseaseSlide 50Slide 51GallstonesSubjective AssessmentObjective AssessmentClinical Manifestations GB DiseaseChronic CholecystitisCholelithiasisCholelithiasis (cont.)Complications of GB DiseaseComplications (cont.)GB Disease DiagnosticsX-ray GB with GallstonesGB Disease Diagnostics (cont.)GB Disease Care ManagementGB Disease Care ManagementSurgery TherapySurgery (cont.)GB Disease Nutritional TherapiesNutritional Therapies (cont.)Slide 70DiverticulosisSlide 72Slide 73Slide 74Slide 75What Are the Symptoms?DiverticulitisSlide 78DiverticulitisSlide 80What Is the Cause of Diverticular Disease?How Is Diverticular Disease Treated?How Is Diverticulitis Treated?Diverticulitis (Cont)Slide 85How Is Diverticular Disease Treated?PancreatitisPancreatitis (cont.)Slide 89Slide 90Clinical Manifestations (cont.)Pancreatitis DiagnosticsSlide 93Nutritional TherapyPancreatitis: Nursing ManagementSlide 96Chronic PancreatitisSlide 98Slide 99DiagnosticsSlide 101Slide 102Slide 103Slide 104Slide 105Slide 106NSG 326 Adult Health IWeek #12Spring 2011Problems of Digestion & Absorption Part 2Appendicitis•Reginald Fitz first described acute appendicitis in 1886–Recognized as one of the most common causes of acute abdominal pain worldwide•Characterized by inflammation of the appendix•Mild cases may resolve without treatment•Most cases require removal of appendix–Laparotomy or Laparoscopy•Untreated mortality is high–Peritonitis & shockAppendicitisSymptoms of Appendicitis•Pain in the abdomen, first around the belly button, then moving to the lower right area•The pain intensifies and worsens when moving, taking deep breaths, coughing, or sneezing. The area becomes very tender. •People may have a sensation called "downward urge," also known as "tenesmus," which is the feeling that a bowel movement will relieve their discomfort. •Loss of appetite•Nausea & vomiting•Constipation or diarrhea; inability to pass gas•Low-grade fever that begins after other symptomsColostomy•Colostomy–The surgically created opening of the colon (large intestine) which results in a stoma.–A colostomy is created when a portion of the colon or the rectum is removed and the remaining colon is brought to the abdominal wall. –It may further be defined by the portion of the colon involved and/or its permanence.OstomiesIleostomy•Ileostomy–A surgically created opening in the small intestine, usually at the end of the ileum.–The intestine is brought through the abdominal wall to form a stoma. –Ileostomies may be temporary or permanent, and may involve removal of all or part of the entire colon.Ostomy Postoperative care•Monitoring of –Stoma viability–Mucocutaneous juncture–Peristomal skin integrity – Enterostomal therapy nurse should help with problemsHealthy New StomaOstomy Postoperative Care•Self-care instructions given and reviewed before discharge•Output may be as high as 1500 to 2000 ml per 24 hours•Observe for hemorrhage, abdominal abscess, small bowel obstruction, dehydration•Initial drainage will be liquid•Transient incontinence of mucus from manipulation of anal canal•Perianal skin careOstomy CareIrritable Bowel Syndrome (IBS)•Common problem affecting 10% to 15% of Western populations•2 to 2.5 times as many women as men seek health care services•Characterized by intermittent and recurrent abdominal pain and stool pattern irregularitiesClinical Manifestations•Symptoms–Diarrhea–Constipation–Alternating diarrhea/constipation–Abdominal distention–Excessive flatulence–Bloating–Continual defecation urge, urgency –Sensation of incomplete evacuationPsychosocial Factors in IBS•Common in patients with IBS–Anxiety, panic disorder–Depression–Post-traumatic stress disorder–Abuse history•Stress can exacerbate stress symptoms•May influence health care seeking behaviorIBS Diagnostics•No specific findings•Diagnosis made based on symptoms and ruling out other conditions•Physical examination•Past health history–Psychosocial factors–Family history–Drug/diet historyCare Management•Diet modification•Fiber therapy (20 g/day)•Antispasmodics•Antidiarrheals •Laxatives•Serotonergic agents•Antidepressants•Education and reassurance •Relaxation•Stress management techniques•Alternative therapiesIBS Nutritional Management•Eliminate gas-producing foods–Brown beans–Brussels sprouts, cabbage, cauliflower, raw onions–Grapes, plums, raisins •Eliminate fructose, sorbitol•Determine if lactose intolerantInflammatory Bowel Disease [IBD]•Characterized by chronic, recurrent inflammation of the intestinal tract–Periods of remission interspersed with periods of exacerbation•Cause is unknown•No cure•Treatment relies on medications to treat inflammation and maintain remissionIBD •Ulcerative colitis: inflammation and ulceration of the colon and rectum•Crohn’s disease: inflammation of segments of the GI tract•May occur at any age•Peaks between ages 15 and 25 years•Equally affects both sexesIBD Description•Autoimmune disease•Antigen initiates the inflammation; actual tissue damage is from inappropriate sustained immune response•Genetic and environmental factors play a role•Commonly occurs during teenage years and early adulthood, but have a second peak in 50s•More prevalent in whites and in industrialized regions of worldUlcerative Colitis•Diffuse inflammation beginning in the rectum and spreading up the colon in a continuous pattern–Inflammation and ulcerations occur in mucosa and submucosa•Multiple abscesses develop in the intestinal glands–Abscesses break through into the submucosa, leaving ulcerations •Ulcerations destroy the mucosal


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UNCW NSG 326 - NSG 326 WK #12 Ostomy Surgery & Diverticulitis

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