Initially periumbilical pain • Warm sitz baths to ease pain and swelling

• Later localizes to McBurney’s point • Stool softeners, high fiber diet

• Mild fever, elevated WBC count • Avoid straining
• Abdominal rigidity • Surgery: ligation, sclerotherapy or surgical
• Rebound tenderness excision
ANALYSIS TOPICAL MEDICATIONS
• Risk of perforation > peritonitis • Anti-inflammatory: hydrocortisone cream
IMPLEMENTATION • Astringents: witch hazel cream
• Maintain bed rest POSTOPERATIVE
• Keep client NPO if surgery is likely • Watch for rectal bleeding
• Semi-Fowler’s position decreases pain • Good anal hygiene – keep dry
• Monitor for signs of perforation and INFLAMMATORY BOWEL DISEASE
systemic infection CROHN’S DISEASE
POSTOPERATIVE: (regional enteritis)
• Monitor vital signs • Cramping abdominal pain
• Monitor fluid intake and output • Fever, anorexia, weight loss
• Monitor bowel sounds PATHOLOGY
• Monitor dressing for drainage or signs of • Transmural thickening
infection • Granulomas
DIVERTICULITIS • Usually involves ileum
Diverticula = bulging pouches of mucosa • Rectum often spared
through sorrounding muscle • Affects several bowel segments
Diverticulosis: presence of diverticula COMPLICATIONS
Diverticulitis: inflammation of diverticula • Perianal disease
ASSESSMENT • Fistulas
• Pain in lower left quadrant • Perforation
• May be relieved by bowel movement OUTCOME
• Bowel irregularities • Many patients will have disease
• Rectal bleeding recurrence a few years after surgery
• Mild fever ULCERATIVE COLITIS
• Elevated WBC • Less abdominal pain
• Diagnosis: Barium enema, Sigmoidoscopy, • More bloody diarrhea
colonoscopy PATHOLOGY
IMPLEMENTATION • Mucosal ulceration
• NPO if peritonitis or massive bleeding • Begins at rectum and progresses
• Liquid or soft diet during acute phase • Towards ileocecal junction
• High fiber and bulk-forming diet after pain • Limited to colon (but involve terminal
subsides ileum)
• Stool softeners COMPLICATIONS
• Temporary colostomy necessary: • Increased risk for colon carcinoma
perforation, peritonitis or obstruction OUTCOME
POSTOPERATIVE • Surgery is curative
• Monitor vital signs Note: The cause of Crohn’s disease and
• Monitor fluid intake and output ulcerative colitis are unknown. These
• Watch for bleeding: hemoratic and patients often have additional chronic
hemoglobin inflammations such as sacroiliitis, iritis or
• Watch for signs of infection: pus or foul conjunctivitis.
odor ASSESMENT
HEMORRHOIDS • Abdominal pain and cramping
Varicosities of anal and rectal veins • Malaise, weakness
Predisposing factors: • Anxiety
• Hereditary • Chronic diarrhea with blood, pus or mucus
• Chronic constipation • Fever , elevated WBC count
• Pregnancy • Weight loss
• Liver cirrhosis • Diagnoosis: Baruim enema, endoscopy
ASSESSMENT with biopsy
• Rectal pain and itching ANALYSIS
• Bleeding (bright red blood on stool) • Adequate nutritional intake?
IMPLEMENTATION • Fluid and electrolyte balance?
IMPLEMENTATION
• Watch for dehydration
• Monitor stool frequency and consistency
• Monitor hemoglobin and hematocrit
• Watch for signs of gastrointestinal
obstruction
• Provide psychological support and
counseling
DIET:
• Acute phase: bowel rest > NPO > low-
residue diet
• Low-fat diet for steatorrhea
• Avoid milk (lactose deficiency of chronic
diarrhea)
MEDICATIONS:
• Sulfasalazine, Steroids, Analgesics
SURGERY
• Indicated it perforation, obstruction or
cancer develops
INTESTINAL OBSTRUCTON
MECHANICAL OBSTRUCTION:
• Due to adhesions, tumors, vovulus
(twisting)
• Increased bowel sounds
PARALYTIC ILEUS:
• Due to toxins, infections or postoperative
• Absent bowel sounds
ASSESMENT
• Nausea
• Colicky pain
• Constipation
• Vomiting (fecal vomiting in severe lower
bowel obstruction)
• Diagnosis: abdominal film: intestinal gas,
endoscopy