Lower GI, gallbladder and pancreas

Ulcerative colitis or Crohn's disease

Both: Fever, a fast heart rate and dehydration; both flare and settle. Diarrhea drains potassium and magnesium; blood loss causes anemia. Drugs are individualized: mesalamine for selected colitis, not Crohn's, plus steroids, immune modifiers and biologics. Many raise the risk of infection.

IBD nursing care

• Track intake and output, stools, daily weight, potassium and magnesium.
• Fever, a rising pulse, more pain or a rising white count can mean perforation.
• Severe flare: IV fluids or parenteral nutrition may be needed.
• In a flare, avoid dairy, caffeine, alcohol, and high-fat and high-fiber foods.
• Teach: no anti-inflammatory pain relievers; regular colonoscopies for cancer risk.

Diverticulitis

• Pouches where the colon wall is weak. Often silent, but they can bleed.
• Inflamed: left lower belly pain, fever, nausea, a high white count.
• A CT scan confirms it. Colonoscopy waits 6 to 8 weeks: it could perforate the colon.
• Bowel rest, fluids, antibiotics, pain control: NPO in hospital, clear liquids at home.
• No fiber during the flare; once it settles, a high-fiber diet helps prevent more pouches.

Bowel obstruction

• Contents back up; the bowel swells and leaks fluid: dehydration, electrolyte loss and, if blood flow fails, perforation.
• Pain, distension, vomiting that may smell like stool. No gas, and no stool or only liquid stool.
• Bowel sounds may be loud early, then quiet or absent later.
• Potassium falls with vomiting. A high white count or lactic acid suggests necrosis or perforation.
• NPO, IV fluids, electrolytes, walking, fewer opioids. Some need surgery, which may create a stoma.
• Signs of improvement: bowel sounds return and the client passes gas.

NG decompression (Salem sump)

• Decompresses the stomach, prevents vomiting and measures the output.
• Large double-lumen tube; drains by gravity or suction, as ordered.
• The blue pigtail is the vent: never instill anything through it.
• Check placement before using the tube. Document drainage amount and color every shift.
• Turn the suction off before listening for bowel sounds.
• Suction drains sodium, potassium and magnesium: watch the labs. Frequent mouth care; check the skin where the tube rests.

Appendicitis or peritonitis

Before appendectomy: Urgent evaluation comes first: comfort measures like ice must not delay care, and heat is avoided. No enemas or laxatives. Rupture risk rises sharply 24 to 36 hours after symptoms start: report a change in pain or vital signs.

Ostomy care

Gallbladder or pancreas?

After gallbladder surgery

• Low-fat diet before and soon after surgery.
• Right shoulder pain after laparoscopy is common, from the gas. Walking helps; it eases within 2 to 3 days.
• Report jaundice: yellow eyes, light stools or dark urine can mean a stone was left behind.

Pancreatitis

• Mild: low-fat solid food usually within 24 to 48 hours, in small, frequent meals. Can't eat: nutrition by tube.
• Chronic: greasy, foul-smelling stools and weight loss; diabetes can develop. Give enzyme pills and vitamins A, D, E and K.
• Teach every client to stop alcohol completely, even after a mild attack, and to stop smoking.