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1 management of patient with management of patient with GI disorder GI disorder PRESENTED BY PRESENTED BY Mr. Maneesh Sharma Mr. Maneesh Sharma AIIMS, Rishikesh AIIMS, Rishikesh

Maneesh sharma

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management of patient management of patient with GI disorder with GI disorder

PRESENTED BY PRESENTED BY

Mr. Maneesh SharmaMr. Maneesh Sharma

AIIMS, RishikeshAIIMS, Rishikesh

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The Anatomy & physiology of Digestive System

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Digestive System Organization

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Anatomy of the Mouth and Throat

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Human Deciduous and Permanent Teeth

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Dorsal Surface of the Tongue

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The Major Salivary Glands

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Peristalsis and Segmentation

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Anatomy of the Stomach

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Stomach

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Small Intestine

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Structure of the Villi in the Small Intestine

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Anatomy of the Large Intestine

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Liver

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Liver

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Liver

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The Duodenum and Related Organs

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The Organs and Positions in the Abdominal Cavity

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Structures of the Alimentary Canal

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•DIAGNOSTIC EXAMINATION OF

GI DISORDER

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Diagnostic evaluation

• LIST OF EXAMINATIONS

• STOOL TESTS• BREATH TESTS• ABDOMINAL ULTRASONOGRAPHY• DNA TESTING• IMAGING STUDIES• UPPER GASTROINTESTINAL TRACT

STUDY

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• LOWER GASTROINTESTINAL TRACT STUDY

• COMPUTED TOMOGRAPHY• MAGNETIC RESONANCE IMAGING• SCINTIGRAPHY• GASTROINTESTINAL MOTILITY STUDIES • ENDOSCOPE PROCEDURE• UPPER GASTROINTESTINAL

FIBROSCOPY/

To be cont….

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To be cont….

• ESOPHAGOGASTRODUDENOSCOPY• ANOSCOPY, PROCTOSCOPY,

SIGMOIDSCOPY• FIBEROPTIC COLONOSCOPY• SMALL BOWEL ENTEROSCOPY• ENDOSCOPY THROUGH OSTOMY• MANOMETRY AND

ELECTROPHYSIOLOGIC STUDIES• DEFECOGRAPHY• LAPAROSCOPY(PERITONEOSCOPY)

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Management of patient with Upper Gastrointestinal Disorders

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Care of Clients with Disorder of the Mouth

Disorder includes inflammation, infection, neoplastic lesions

PATHOPHYSIOLOGY 1. Causes include mechanical trauma,

irritants such as tobacco, chemotherapeutic agents

2. Oral mucosa is relatively thin, has rich blood supply, exposed to environment

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Cont…….

•manifestation

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Cont…….

•Nursing care

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•ORAL CANCER

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Client with Oral Cancer

1.Background

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cont……………….

2. Pathophysiology• a. Squamous cell carcinomas• b. Begin as painless oral ulceration or

lesion with irregular, ill-defined borders• c. Lesions start in mucosa and may

advance to involve tongue, oropharynx, mandible, maxilla

• d. Non-healing lesions should be evaluated for malignancy after one week of treatment

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cont……………..

4. a. Nursing Care b. Nursing Diagnoses• 1. Risk for ineffective airway clearance• 2. Imbalanced Nutrition: Less than body

requirements• 3. Impaired Verbal Communication:

establishment of specific communication plan and method should be done prior to any surgery

• 4. Disturbed Body Image

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•DISEASE OF ESOPHAGEOUS

• 1. G.E.R.D.

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Gastroesophageal Reflux Disease (GERD)

1. Definition

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cont……………..

2. Pathophysiology• a. Gastroesophageal reflux results from transient

relaxation or incompetence of lower esophageal sphincter, sphincter, or increased pressure within stomach

• b. Factors contributing to gastroesophageal reflux 1.Increased gastric volume (post meals) 2.Position pushing gastric contents close to

gastroesophageal juncture (such as bending or lying down) 3.Increased gastric pressure (obesity or tight clothing) 4.Hiatal hernia

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cont……………..

• c. Normally the peristalsis in esophagus and bicarbonate in salivary secretions neutralize any gastric juices (acidic) that contact the esophagus; during sleep and with gastroesophageal reflux esophageal mucosa is damaged and inflamed; prolonged exposure causes ulceration, friable mucosa, and bleeding; untreated there is scarring and stricture

3. Manifestations

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cont………………

4. Complication

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Cont…..

5. Diagnostic examination

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cont…………….

6. Medications

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cont………………..

7.Dietary management

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cont……………..

8.Surgery indicated for persons not improved by diet and life style changes

• a. Laparoscopic procedures to tighten lower esophageal sphincter

• b. Open surgical procedure

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2. HITAL HERNIA

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Hiatal Hernia

1.Definition

2.Predisposing factors include: – Increased intra-abdominal pressure– Increased age– Trauma– Congenital weakness– Forced recumbent position

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cont…………………

TYPES• d. Sliding hiatal hernia: gastroesophageal

junction and fundus of stomach slide through the esophageal hiatus

• e. Paraesophageal hiatal hernia: the gastroesophageal junction is in normal place but part of stomach herniates through esophageal hiatus; hernia can become strangulated; client may develop gastritis with bleeding

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CONT…………CONT…………

3. Manifestations: Similar to GERD

4. Diagnostic Test5. Treatment

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3.ESOPHAGEAL CANCER

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2. Pathophysiology• a. Squamous cell carcinoma

1.Most common affecting middle or distal portion of esophagus

2.More common in African Americans than Caucasians

3.Risk factors cigarette smoking and chronic alcohol use

• b. Adenocarcinoma1.Nearly as common as squamous cell

affecting distal portion of esophagus2.More common in Caucasians3.Associated with Barrett’s esophagus,

complication of chronic GERD and achalasia

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CONT………

3. Manifestations

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CONT……………

4. Diagnostic Tests

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CONT……………

6. TREATMENTS

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4.Impaired esophageal motility

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5.UPPER GI BLEED

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6.Nursing process of esophageal

disorder

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•DISORDER OF GASTRIC AND

DUDENAL ULCER

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1.GASTRITIS

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Gastritis

1. Definition

2. Types

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CONT……………

3. Causes of acute gastritis

5. Manifestations

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CONT……………6.Treatment• a. NPO status to rest GI tract for 6 – 12

hours, • b. Medications: proton-pump inhibitor or

H2-receptor blocker; sucralfate (carafate) acts locally; coats and protects gastric mucosa

• c. If gastritis from corrosive substance: immediate dilution and removal of substance by gastric lavage (washing out stomach contents via nasogastric tube), no vomiting

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Chronic Gastritis

1.Definition2. Manifestations3. Treatment:

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CONT……………

4. Diagnostic Tests

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Cont…….

5.Nursing process of gastritis & gastrostomy

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2.PEPTIC ULCER

DISEASE

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Peptic Ulcer Disease (PUD)

1. Definition and Risk factors

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CONT……..

2. Pathophysiology• a. Ulcers or breaks in mucosa of GI tract occur

with 1.H. pylori infection (spread by oral to oral,

fecal-oral routes) damages gastric epithelial cells reducing effectiveness of gastric mucus

2.Use of NSAIDS: interrupts prostaglandin synthesis which maintains mucous barrier of gastric mucosa

• b. Chronic with spontaneous remissions and exacerbations associated with trauma, infection, physical or psychological stress

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CONT……..

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CONT……..

3. Diagnosis3. Diagnosis3. Diagnosis3. Diagnosis3. Diagnosis

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CONT……..

3.Manifestations

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CONT……..

4. Treatment

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CONT……..

1. Pharmacological management

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CONT……..

•NG suction

•Surgical intervention

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Billroth I(GASTRO-DUODNEOSTOMY)

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Billroth II (GASTRO-JEJUNOSTOMY)

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CONT……..

5.Complications

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6.Nursing process of peptic ulcer disease

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•CANCER OF STOMACH

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Cancer of Stomach

1. Incidence

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Colon Cancer

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CONT……..

3. Risk Factors4.Manifestations

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CONT……..

6. Diagnostic Tests

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CONT……..

7.Treatment

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CONT……..

8. dietary management:

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Cancer of the Stomach

9. Common post-op complications

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•MANAGEMENT OF PATIENT WITH

LOWER GI DISORDER

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•1. abnormalities of fecal elimination

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2. PATIENT WITH BOWEL DISORDERS

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Irritable Bowel Syndrome (IBS) (spastic bowel, functional colitis)

1. Definition

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CONT………

2. Pathophysiology• a. Appears there is altered CNS regulation of

motor and sensory functions of bowel1.Increased bowel activity in response to food

intake, hormones, stress2.Increased sensations of chyme movement

through gut3.Hypersecretion 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

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CONT………

3. Manifestations

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CONT………

4. Diagnostic Tests:

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CONT……..

5. Medications

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CONT……..

6. Dietary Management

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•PATIENT WITH INFLAMMATORY

DISORDER

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Client with Inflammatory Bowel Client with Inflammatory Bowel DiseaseDisease

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

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CONT………

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•CROHN’S DISEASE

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Crohn’s disease

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CONT……….

1. Manifestations

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CONT….

2. Complications

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CONT……….

3. Diagnostic Tests

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CONT……….

4. Medications

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CONT……….

5. Dietary Management

6. Surgery

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•Ulcerative Colitis

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Ulcerative Colitis

1. 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

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CONT……..

2. Manifestations

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CONT……..

3. Complications

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CONT……..

4. Diet therapy

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CONT……

5. SURGICAL MANAGEMENT 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

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CONT……• Surgical Management

– 25% of patients require a colectomy– Total proctocolectomy with a permanent

ileostomy• Colon, rectum, anus removed

• Closure of anus

• Stoma in right lower quadrant

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CONT……

•7. Treatment– Medications similar to treatment for

Crohn’s disease

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8. Nursing process of inflammatory bowel disease

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• ACUTE INFLAMMATORY

INTESTINAL DISORDER

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•APPENDICITIS

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• Appendicitis:

• most common reason for abdominal surgery, appendix becomes inflamed from obstruction, may become pus filled– Clinical manifestations: – Assessment and Diagnostic

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CONT…………

– Complications: – Medical Management: – Nursing Management: – Surgery may be outpatient, if complications of

peritonitis are suspected pt may remain in hospital for several days

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•DIVERTICULAR DISEASE

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Client with Diverticular Disease

1. 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

2. Risk Factors

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CONT………….

3. 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

• c. Complications of diverticulosis include hemorrhage and diverticulitis, the inflammation of the diverticular sac

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CONT………..

• 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

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Diverticulits

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Diverticulitis

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CONT………..

5. Manifestations

6. Complications

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CONT………..

7. Diagnostic Tests

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CONT………..

8. Medications

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CONT………..

9. Dietary Management

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CONT………..

10. 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

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Cont……..

11. Nursing process of Diverticulitis

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•Patient with intestinal obstruction

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•Small & large intestine disorder

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•NEOPLASTIC DISORDER

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Neoplastic DisordersNeoplastic 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 Polyps1. Definition

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CONT……..

2. Manifestations

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CONT……..

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

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•COLORECTAL CANCER

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Client with 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

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CONT……..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

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Colon Cancer

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CONT……..

Complications

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CONT……..

Diagnostic Tests

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CONT……..

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

• c. Tumors 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

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•Nursing process of colorectal cancer