SYMPTOM MANAGEMENT

DIARRHEA an increase in stool volume and

liquidity resulting in 3 or more bowel movements
per day.
NURSING DIAGNOSES:
Associated Symptoms include:

CAUSES:
Fecal impaction with overflow diarrhea
Overuse of laxative therapy, dietary fiber
and/or hyperosmolar preparations
Pelvic or lower abdominal radiation therapy
Malabsorption

Enterocolic fistula
Infection by intestinal or other organisms

Surgical shortening of bowel

Tumour type

Medications

Concurrent diseases

Metabolic abnormalities

INTERVENTIONS:
Non-Pharmacologic:
Provide psychosocial support
Monitor skin breakdown and treat
appropriately
Maintain hydration and electrolyte balance
Consider dietary measures

Treat any reversible causes

Pharmacologic:
Anti-diarrheals
Octreotide
Cholestyramine capsules

ASSESSMENT:
History Onset, duration, frequency,
aggravating and alleviating factors, stool
volume and description, fluid and dietary
intake, presence of nausea, vomiting and/or
pain. Review medications, imaging and
surgical history.

Physical assessment

SYMPTOM MANAGEMENT

Investigations stool specimen

BOWEL OBSTRUCTION occurs when the

intestines fail to propel forward through the
lumen, either as a result of
mechanical(obstruction) or functional(impaired
motility secondary to loss of propulsive peristalsis
or paralytic ileus) blockage.
CAUSES:
Mechanical Blockage from:
External tumor or nodal mass compressing
small or large bowel, rarely from tumor
within the bowel
Malignant adhesions or strictures

Impacted feces (obstipation)

Functional Blockage from:

Carcinomatosis, peritoneal seeding, bowel
wall invasion, or malignant adhesions within
the abdominal cavity
Diabetic neuropathy
Peritonitis or prolonged intestinal
inflammation
Autonomic dysfunction secondary to:
- Medication
- Metabolic abnormalities
- Spinal cord injury
- Post-operative ileus, ischemia or
intestinal edema
SIGNS AND SYMPTOMS:
Nausea and vomiting
-

Small bowel obstruction

Large bowel obstruction

Abdominal pain

Abdominal distention

Changes in bowel sounds

- Hyperactive and high-pitched tinkling
sounds

Succussion splash
Diminished or absent bowel sounds

Absence of flatus
Evidence of air/fluid levels

NURSING DIAGNOSES:

INTERVENTIONS:
Non-Pharmacologic:
Reduce intake and promote bowel rest
Continue with small amounts of liquid or soft
diet in the presence of an incomplete or
distal obstruction, if tolerated.
Provide good mouth care
Prevent DHN

Pharmacologic:
Decrease painful peristalsis with Hyosine
butylbromide (Buscopan)
Reduce GI secretions and bowel wall edema

If tumor or tumor-related edema is

suspected, give anti-inflammatory
medications

Control nausea and vomiting without

stimulating peristalsis antiemetics with no
promotility effects

Control visceral pain

Correct electrolyte imbalances, if

appropriate

If obstruction is due to fecal impaction,

aggressive administration of enemas and
oral laxatives is indicated.

Gastric outlet obstruction

INVASIVE INTERVENTIONS:
Decompress GI tract when there is
persistent, significant N & V, and abdominal
distension despite optimal medical
management.

Consult GI specialist to determine

appropriateness of a percutaneous venting
procedure that may provide longer term
symptom management.

If there is a well-defined locus of mechanical

intestinal obstruction secondary to
malignancy, consider correction via surgical
resection or stent insertion.