Gastrointestinal and Digestive Care Plans

Chapter 8


Gastrointestinal and Digestive Care Plans



Bariatric Surgery


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Overweight; Obesity; Gastric Banding; Gastric Bypass


Overweight and obesity are major health problems in the United States, and their prevalence is growing globally. Bariatric surgical procedures are usually used for those patients considered morbidly obese with a body mass index (BMI) greater than 40. Patients with a BMI between 35 and 40 may be candidates for this type of surgery if they have other chronic health problems related to their obesity, such as diabetes mellitus, sleep apnea, hypertension, or heart failure. Evidence indicates that these surgical approaches to weight management provide the patient with more long-lasting weight loss compared to nonsurgical approaches such as diet and exercise. In addition, patients usually experience significant improvement in their obesity-related health problems. Gastric banding or stapling surgical techniques restrict the volume of the stomach and therefore decrease the amount of food the patient consumes. Gastric bypass procedures reroute the passage of food through the small intestine to reduce the absorption of food intake. Most bariatric surgery programs include a long-term postoperative program of lifestyle modifications such as eating habits, physical activity, and psychological support.




Bowel Diversion Surgery: Colostomy, Ileostomy


Fecal Diversion; Stoma


Bowel diversion surgery creates an opening into the small or large intestine that is brought to the external surface of the abdominal wall (stoma). These surgeries are done for the purpose of diverting the fecal stream past an area of obstruction or disease, protecting a distal surgical anastomosis, or providing an outlet for stool in the absence of a functioning intact rectum. The procedures may be performed to promote wound healing of an intestinal injury such as a gunshot wound. Diverted fecal material is directed away from the wound to promote wound healing. Depending on the purpose of the surgery and the integrity and function of anatomical structures, stomas may be temporary or permanent. Peristomal irritation, body image, self-care, and knowledge deficit are important nursing concerns. This care plan focuses primarily on the person with a new stoma who is being cared for in the hospital environment.




Cholecystectomy: Laparoscopic/Open, Postoperative Care


Cholecystitis is an inflammation of the gallbladder. Most patients who develop cholecystitis have cholelithiasis or gallstones. The most common manifestation of acute cholecystitis is right upper quadrant pain that occurs after eating a high-fat meal. Although eating a fat-free diet will decrease the patient’s symptoms temporarily, surgical removal of the gallbladder and gallstones (cholecystectomy) is usually recommended. The preferred method for cholecystectomy is laparoscopic surgery using small abdominal incisions in combination with telescopic visualization of the abdominal cavity. The abdominal cavity is inflated with carbon dioxide to facilitate visualization of the abdominal organs generally and the gallbladder specifically. Once the gallbladder is dissected away from surrounding tissue, it is removed through one of the puncture wounds. The carbon dioxide is evacuated, and the multiple puncture wounds are closed. If the surgeon is not able to successfully remove the gallbladder using a laparoscopic approach, a larger open incision is made in the right upper quadrant for direct visualization and removal of the gallbladder.




Cirrhosis


Laënnec’s Cirrhosis; Hepatic Encephalopathy; Ascites; Liver Failure


Cirrhosis is a chronic and progressive inflammatory disease of the liver. The inflammatory process results in irreversible fibrosis and scarring of hepatic tissue. The scarring produces changes not only in the size and shape of the liver but also in its function and blood flow. Worldwide the most common cause of cirrhosis is viral infection such as hepatitis B and C. Alcohol abuse is the primary cause of Laënnec’s cirrhosis. Other causes include biliary obstruction, prolonged right-sided heart failure, and metabolic defects such as alpha-1 antitrypsin deficiency. The incidence of cirrhosis is highest in men between 40 and 60 years old. The development of cirrhosis occurs over many years before the person presents with characteristic symptoms. Malnutrition contributes to the development of cirrhosis in people who abuse alcohol. The disruption of hepatic function in cirrhosis can lead to the development of end-stage liver disease with ascites, portal hypertension, hepatic encephalopathy, and liver failure.


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Dec 3, 2016 | Posted by in NURSING | Comments Off on Gastrointestinal and Digestive Care Plans

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