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 Catatonic schizophrenia is one feature of Not moving Not talking
a serious mental illness called
schizophrenia. Schizophrenia prevents
you from separating what’s real from Sluggish
what’s not, a state of mind called a response
Staring
psychosis.

 Catatonic schizophrenia affects the way

you move in extreme ways. You might
stay totally still and mute. Or you might get
hyperactive for no reason. The new name
for this condition is schizophrenia with Parroting Tapping feet
someone’s
catatonic features or schizophrenia with or other
movements or
repeated
catatonia. speech over and
movements
over
 BASED ON CLINICAL PRESENTATION

BASED ON DURATION
 It last for several days and occur in
conditions like cholera.
 It is the most common.
 It is a loose watery diarrhea that lasts one
to two days.

 It generally persists for several weeks –

two to four weeks
 There is blood in stool with or without
mucous, is known as Dysentery.
 It generally persists for several weeks –
two to four weeks
BASED ON MECHANISM

 It is the ingestion of osmotically active

solutes such as laxatives and sorbitol.

 It is the increased of cellular permeability

usually infectious such as cholera and viral
gastroenteritis.

 It is the cellular damage to intestinal

mucosa which may cause by
chemotherapy, radiation therapy, or
hypersensitivity.

 It is usually a diagnosis given to patients

with chronic diarrhea.
 COMPLETE BLOOD COUNT
Bloating
Abdominal Nausea or
cramps or pain Vomiting
SERUM CHEMISTRIES

URINALYSIS

ROUTINE STOOL EXAMINATION

Fever
Thirst

ENDOSCOPY

Mucus in the Urgent need to BARIUM ENEMA

Blood in the have a bowel
stool stool movement
Electroconvulsive therapy (ECT). This can lower your Encourage to drink a lot of fluids and
symptoms by half or even get rid of them altogether. Your
doctor may recommend it if medications haven’t helped. ECT
foods low in bulk until the acute attack
uses short bursts of electric current that go through a cap on subsides. Rehydrate with electrolyte
your head to reach your brain. The treatment can leave you balance fluids.
with confusion and temporary memory loss.
Advise patient to avoid foods such as
caffeinated beverages, alcohol, dairy
Transcranial magnetic stimulation (TMS). You wear a device and fatty/greasy foods.
on your head that sends out a magnetic pulse to activate nerve
cells in your brain. TMS can target specific regions of your
Administer perineal care routine as
brain better than ECT can. It also causes fewer thinking and ordered for patient’s skin integrity.
memory problems. But TMS is newer than ECT, and it’s not
Administer antidiarrheal medications as
as clear how well it works . prescribed.
Monitor serum electrolytes closely/
Medications can be very effective in easing catatonic symptoms. watch for signs of extreme dehydration.
They’re the first option for treating catatonia. Specifically, a class
of anti-anxiety drugs called benzodiazepines, or “benzos,” along Monitor heart rates periodically.
with ECT, is considered the first-line treatment for catatonic Immediately report evidence of
symptoms. Your doctor may prescribe:
Alprazolam (Xanax), an anti-anxiety drug dysrhythmias or a change in the level of
Lorazepam (Ativan, Lorazepan, Intensol), used to treat epilepsy consciousness.
and anxiety
 ANTIMOTILITY AGENTS
(Diphenoxylate with Atropine, Lomotil, and USE CLEAN WATER
Loperamide)
PROMOTE A WELL-BALANCED DIET
ANTISECRETORY DRUGS
Racecadotril and Diosmectite
WASHING AND CLEANING FOODS
ANTIBIOTICS
(Erythromycin, Ciprofloxacin, Vanomycin,
Doxycycline, Metronidazole, Albendazole, FRESH COOKED FOOD
Azithromycin)

PROBIOTICS HANDWASHING
Bacillus clausii

ORESOL
(homemade solution composed of 1
teaspoon of salt, 4 teaspoons of sugar
mixed in 1 Liter of water)
 ACUPUNCTURE
This typically occurs in patients with
bloating and water retention. Some
report changes in bowel movements.
This is all very normal as acupuncture
can stimulate metabolism, help
eliminate toxins, and bring the body
back to a state of equilibrium.
HERBAL MEDICINE
It can help to ease diarrhea. Such as:
 Sambong
 Tsaang-Gubat HOMEOPATHY
 Bayabas
Homeopathic medicines are highly
effective in treating acute digestive
conditions such as the stomach flu,
bloody diarrhea, and pancreatitis, as
well as chronic digestive conditions
such as inflammatory bowel disease to
hemorrhoids.
  reduce the symptoms of a stomach
illness. These symptoms typically include
Nutrition therapy for diarrhea is largely
nausea, diarrhea, and vomiting.
supportive and depends on the severity of
diarrhea and the underlying cause.
B ananas
AVOIDING FOODS THAT STIMULATE GI MOTILITY,
SUCH AS: R ice
 Alcohol A pple sauce
 Caffeine T oast
 Items high in simple sugars such as milk
 High-fiber and gas-producing foods such
as nuts, beans, and corns
 a food or dietary supplement that
 Sugar alcohols
contains live bacteria, which
replaces or adds to the beneficial
bacteria usually found in the
gastrointestinal tract
MEDICATIONS such as certain antibiotics that doesn’t
cause diarrhea, NSAIDs, antidiarrheals
COMMON CHANNEL LENGTHENING (CCL)
(Loperamide/Lomotil)
It is a surgical procedure to increase
absorption in the small intestine to decrease
USE OF PROBIOTICS diarrhea.

FREQUENT HANDWASHING

IV FLUID THERAPY

WATER OR ORAL REHYDRATION SALTS

CONSTIPATION
MAROHOM, HAFSAH S.
What is Constipation?

Constipation is defined by NANDA-I as, “A

decrease in normal frequency of defecation
accompanied by difficult or incomplete passage of
stool and/or passage of excessively hard, dry stool.”
Typically a patient is diagnosed with constipation if
they have less than three bowel movements per week.
 Etiology

Constipation can be attributed to many causes such

as mechanical factors, medications used, presence of
comorbidities, and impaired rectal sensory-motor dysfunction.
If left untreated, constipation may progress to a more serious
problem.
ASSESSMENT OF
FINDINGS
 CLINICAL
MANEFISTATION
 Infrequent passage of stool- fewer than three bowel movements per week
 Passage of dry, hard stool
 Passage of liquid fecal seepage
 Frequent but non-productive desire to defecate
 Straining at stools
 Pain upon defecation
 Abdominal pain or distention
 Anorexia
 Dull headache
 Nausea and vomiting
 Laboratory and Diagnostic Test
 Blood tests
 Stool studies
 X-rays of the abdomen
 Upper GI series (to look at the esophagus, stomach, and upper part of
the small intestines)
 Barium enema (to look at the colon)
 Proctosigmoidoscopy (an examination of the lower bowel) or,
depending on the symptoms, a colonoscopy (an examination of the
entire colon from the inside)
Pathophysiologic Mechanism of Action of
Disease
 3 Possible Nursing Diagnosis

 Constipation related to reduced muscle control.

 Constipation related to inflammatory process.
 Constipation related to adverse effect of
medication.
 Nursing Intervention
 Review medical, surgical, and social history to identify conditions commonly associated with
constipation.
 Note the client’s age. Constipation is more likely to occur in individuals older than 65 but can occur in
any age from infant to elderly.
 Note general oral/dental health issues. Dental problems can impact dietary intake (e.g., loss of teeth or
other oral conditions can force individuals to eat soft foods or liquids, mostly lacking in fiber).
 Determine fluid intake to note deficits.
 Identify areas of life changes or stressors (e.g., personal relationships, occupational factors, or financial
problems). Individuals may fail to allow time for good bowel habits and/or suffer gastrointestinal effects
from stress.
 Discuss usual elimination habits (e.g., normal urge time) and Problems
 Note the pharmacological agents the client has used (e.g., fiber pills, laxatives, suppositories, or enemas)
to determine the effectiveness of the current regimen, and whether laxative use is appropriate and
helpful.
 Provide information about relationship of diet, exercise, fluid, and healthy elimination, as indicated.
 Identify specific actions to be taken if problem does not resolve to promote timely intervention, thereby
enhancing client’s independence.
PHARMACOLOGICAL INTERVENTION

 Administer medications as indicated by the client’s

particular bowel dysfunction, such as stool softeners (e.g.,
docusate sodium [Colase, Surfak]), mild stimulants (e.g.,
bisacodyl [Dulcolax, Bisco-Lax], osmotic agents (e.g.,
polyethylene glycol [PEG, Miralax] opioid antagonist (e.g.,
methylanaltrexone [Relistor]
 Administer enemas (e.g., hyperosmolar agents [e.g., Fleet
enema] or suppositories), as indicated.
 Alternative Therapies
 Homeopathic therapies or homoeopathy is a pseudoscientific
system of alternative medicine.
 Biofeedback therapy is the process of gaining greater
awareness of many physiological functions of one's own body,
commercially by using electronic or other instruments, and with
a goal of being able to manipulate the body's systems at will. 
 Health Education
 Educated patient on new medication
 Advice the client to Stop taking certain medicines or dietary
supplements
 Teach the client to Change what he/she eat and drink
 Teach the client about bowel training
 Get regular physical activity it may help relieve your symptoms.
 Nutrition and diet therapy

 Eat three meals each day. Do not skip meals.

 Gradually increase the amount of high-fiber foods in your diet.
 Choose more whole grain breads, cereals, and rice.
 Select more raw fruits and vegetables -- eat the peel, if
appropriate.
 Read food labels and look for the "dietary fiber" content of
foods. Good sources have 2 grams of fiber or more.
 Drink six to eight glasses of water each day.
 Limit highly refined and processed foods.
 Medical management

The initial management of constipation should involve lifestyle modifications,

reassurance of their concept of a healthy or “regular” bowel movement, and
biofeedback. Identification of patients that need psychological support should be
undertaken because constipation may be aggravated by stress or may be a
manifestation of emotional disturbance. Patients should be encouraged to set aside a
regular time for defecation, to use proper sitting positions, and to monitor their bowel
habits by using a diary of the characteristics of their stools to assess and direct
treatment interventions. Dietary modifications include a high-fiber diet, water intake,
and fruits. Although exercise and water intake is of benefit for treating constipation,
there is no data to support that increases in physical activity and fluid intake appear
to improve chronic constipation except in situations of dehydration.
Surgical Management (IF ADVISED)
Colon resection – surgical removal of the colon with
connection of the small intestine to the remaining rectum.
Fecal Incontinence
Prepred by:
Johanna M. Methalicop
 What is fecal incontinence?
Fecal incontinence – also called anal incontinence – is the
term used when bowel movements cannot be controlled.
Stool (feces/waste/poop) leaks out of the rectum when you
don’t want it too, which means not during planned bathroom
breaks. This leakage occurs with or without your knowledge.
Fecal incontinence happens more often in women than in
men and also happens more often among older people.

The term fecal incontinence is used if any of these situations

occur:
• Stool leaks out when passing gas.
• Stool leaks out due to physical activity/daily life exertions.
• Feeling like you have to go and not being able to make it to
the bathroom in time.
• Stool is seen in the underwear after a normal bowel
movement.
• There is complete loss of bowel control.
Sign and Symptoms
• Fecal seepage (undesired leakage of stool after a bowel
movement with otherwise normal continence and
evacuation)
• Urge incontinence (discharge of feces and flatus in spite
of active attempts to retain these contents)
• Passive incontinence (involuntary passage of feces and
flatus without any awareness)
• Encopresis (a term used mostly for fecal incontinence in
children)
SYMPTOMS AND CAUSES
• Frequent diarrhea or constipation. These conditions cause the
muscles in the rectum and anus to weaken.
• Muscle damage. Muscle damage can occur during a difficult vaginal
childbirth, when doctors have to use forceps or make a small cut (an
episiotomy) to make a larger opening.
• Older age. Muscles in the rectum and anus naturally weaken with
age
• Damage to nerves. If the nerves that control the ability of the rectum
and anus muscles to contract are damaged, incontinence can result.
• Inability of the rectum to stretch. If the muscles of the rectum are not
as elastic as they should be, excess stool that builds up can leak out.
• Other medical conditions.
• Other causes: Laxative abuse, radiation treatments, certain nervous
system and congenital (inherited) defects, inflammation (swelling),
and inflammatory bowel disease may affect the ability to control
stool.
DIAGNOSIS AND TESTS
• Anal manometry: This test studies the strength of the anal sphincter
muscles. A short, thin tube, inserted up into the anus and rectum, is used
to measure the sphincter tightness.
• Endoluminal ultrasound or anal ultrasound: This test helps evaluate
the shape and structure of the anal sphincter muscles and surrounding
tissue.
• Pudendal nerve terminal motor latency test: This test measures the
function of the pudendal nerves, which are involved in bowel control.
• Anal electromyography (EMG): This test determines if nerve damage is
the reason why the anal sphincters are not working properly.
• Flexible sigmoidoscopy or proctosigmoidoscopy: This test evaluates
the end of the large bowel or colon, looking for any abnormalities — such
as inflammation, tumor or scar tissue — that may cause fecal
incontinence.
• Proctography (also called defecography): This test is done in the
radiology department. In this test, an X-ray video is taken that shows how
well the rectum is functioning.
• Magnetic resonance imaging (MRI): This test is done in the radiology
department. It is an imaging test sometimes used to evaluate the pelvic
organs.
Medical treatment/Management
• Diet modification for bowel incontinence.
 Avoid foods or drinks that may cause loose stools, including:Caffeine,
alcohol, some fruit juices and prunes, Beans and cabbage family
vegetables. Spicy foods and cured or smoked meats, Dairy products,
Artificial sweeteners.
 Foods help to fecal control:Bananas, Apple sauce, Peanut butter, Pasta,
Potatoes, Cheese.
• Bowel training- Stool consistence may be improved by dietary
modification.
• Medications
 Loperamide, may be used to treat diarrhea. This slows down the
movement of the stools and may be needed for long periods of time in
patients with diarrhea.
 Laxatives may be prescribed to treat constipation in patients with bowel
incontinence. Bulk-forming laxatives are usually recommended.
• Skin protection- since fecal leakage leads to anal skin irritation, moisture–
barrier creams such as those used for a baby's diaper rash are used to
protect the skin.
• Exercise programmes for bowel incontinence. Patients of bowel
incontinence may need pelvic floor muscle training.
 Nursing Management
• Provide a high-fiber diet under the direction of a registered dietician, unless
contraindicated.
• Ensure fluid consumption of at least 3000 mL/day, unless contraindicated.
• Perform removal of fecal impaction manually, if necessary.
• Keep bedside commode and assistive device on sight.
• Encourage the intake of natural bulking agents to thicken stools, for example, foods
such as banana, rice, and yogurt.
• Assist patient for mobility or exercise, if tolerated.
• Encourage bowel elimination at the same time each day.
• After breakfast or a warm drink, administer a suppository and perform digital
stimulation every 10 to 15.
• Discourage the use of pads, diapers, or collection devices for long-term management
of bowel incontinence.
• Use fecal collection systems selectively over pads and diapers
• Educate the patient and caregiver the importance of fluid and fiber in maintaining soft,
bulky stool.
• Educate the caregiver the use of a fecal device, if necessary.
• Educate the patient about proper hygiene and the use of soap and water and moisture
barrier containing zinc oxide or dimethicone.
• Educate the patient on the importance of establishing a regular schedule for bowel
elimination.
Surgical Management
• Sphincteroplasty, or overlapping sphincter repair, sews damaged
anal sphincter muscles back together (see below left).
• ACE procedure is occasionally appropriate for patients with fecal
incontinence. In this procedure, the surgeon creates a small
pathway from the skin on the abdomen to the bowel
• Artificial bowel sphincter involves implanting an artificial device
(prosthesis) around the anus. This device is designed to mimic
the normal anal muscle.
• Sacral nerve stimulation. Sacral nerve stimulation therapy uses a
small device (a neurotransmitter) that is implanted under the skin
in the upper buttock area.
• Colostomy. In this operation, an opening is made in the
abdomen, through which the colon is brought to the surface of
the skin.
 Lower
Gastrointestinal
Disorder: IBS
Allyssa Fawziyyah A. Matuan
 IRRITABLE BOWEL
SYNDROME
Irritable bowel syndrome is characterized by recurrent abdominal
discomfort or pain with at least two of the following
characteristics: relation to defecation, association with a change in
frequency of stool, or association with a change in consistency of
stool.
ETIOLOGY

The cause of irritable bowel syndrome (IBS) is unknown. No anatomic cause

can be found on laboratory tests, x-rays, and biopsies. Emotional factors, diet,
drugs, or hormones may precipitate or aggravate gastrointestinal symptoms.
Historically, the disorder was often considered as purely psychosomatic.
Although psychosocial factors are involved, IBS is better understood as a
combination of physiologic and psychosocial factors.

IBS can develop after a severe bout of diarrhea (gastroenteritis) caused by

bacteria or a virus. IBS might also be associated with a surplus of bacteria in
the intestines (bacterial overgrowth). In addition, experiencing early life
stress like being exposed to stressful events, especially in childhood, tend to
have more symptoms of IBS .
 CLINICAL MANIFESTATION
The signs and symptoms of IBS vary but are usually present for a
long time. The most common include:
• Abdominal pain or cramps, usually in the lower half of the
abdomen.
• Bloating.
• Bowel movements that are harder or looser than usual.
• Diarrhea, constipation or alternating between the two.
• Excess gas.
• Presence of mucus in the stool (may look whitish).
 LABORATORY & DIAGNOSTIC
There's no test to definitively diagnoseTESTS
IBS. The physician is likely to start with a complete
medical history, physical exam and tests to rule out other conditions, such as celiac
disease.

After other conditions have been ruled out, the physician is likely to use one of these sets of
diagnostic criteria for IBS:

• Rome criteria. These criteria include abdominal pain and discomfort lasting on average
at least one day a week in the last three months, associated with at least two of these
factors: Pain and discomfort are related to defecation, the frequency of defecation is
altered, or stool consistency is altered.

• Type of IBS. For the purpose of treatment, IBS can be divided into three types, based
on your symptoms: constipation-predominant, diarrhea-predominant or mixed.
 LABORATORY & DIAGNOSTIC
Additional tests TESTS
The physician may recommend several tests, including stool studies to check for infection or
problems with the intestine's ability to take in the nutrients from food (malabsorption). The
client may also have a number of other tests to rule out other causes for their symptoms.

Diagnostic procedures can include:

• Colonoscopy.
• X-ray or CT scan.
• Upper endoscopy.

Laboratory tests can include:

• Lactose intolerance tests.
• Breath test for bacterial overgrowth.
• Stool tests.
PATHOPHYSIOLOGIC
MECHANISM
Possible Nursing Diagnoses

1. Imbalanced Nutrition: Less than Body Requirements

related to altered absorption of nutrients secondary to
irritable bowel syndrome
2. Acute pain related to abdominal muscle spasms
3. Risk for Deficient Fluid Volume
 NURSING ACTIONS
• Create a daily weight chart and a food and fluid chart. Discuss with the
patient the short term and long-term nutrition and weight goals n related to
Irritable Bowel Syndrome.
• For an IBS patient with severe diarrhea, place the patient on a nothing by
mouth status, and gradually progress to clear liquids, followed by bland diet,
and the low residue diet. The patient can then have a low fat, low fiber diet
on a long-term basis. Foods that may cause indigestion, such as dried fruit
and beans, should be avoided.
• Administer prescribed medications that alleviate the symptoms of stomach
pain.
• Provide the client with reassurance and emotional support to help decrease
anxiety and increase his sense of control over the situation and its
management.
 PHARMACOLOGICAL TREATMENT

• Antispasmodics and peppermint oil - For bloating and

cramping pain,
• Laxatives - For constipation
• Anti-motility agent - For diarrhea
If these are not effective, tricyclic antidepressants should be
considered as a second-line treatment.
 ALTERNATIVE THERAPIES

In some cases, symptoms don’t respond to medical treatment.

Your provider may refer you for mental health therapies. Some
patients find relief through:

• Cognitive behavioral therapy (CBT).

• Hypnotherapy.
• Biofeedback.
 HEALTH EDUCATION
• Teach the patient on how to perform non pharmacological pain relief
methods such as deep breathing, massage, acupressure, biofeedback,
distraction, music therapy, and guided imagery.
• Encourage patient to eat a well balanced, high-fiber diet; avoiding gas-
forming foods; and avoiding fluid intake with meals because it causes
abdominal distention.
• Encourage patient to:
a) Adhere to a schedule of regular work and rest periods.
b) Participate in regular exercise, which reduces anxiety and increases
intestinal motility.
c) Avoid or minimize stress-producing situations.
d) Drink six to eight glasses of water daily (not at meals) to prevent
constipation
e) Adhere to a regular eating schedule and chewing food slowly and
thoroughly.
 NUTRITION AND DIET
THERAPY
• Increase fiber in the patient’s diet — eat more fruits, vegetables, grains
and nuts.
• Add supplemental fiber to the patient’s diet, such as Metamucil® or
Citrucel®.
• Drink plenty of water — eight 8-ounce glasses per day.
• Avoid caffeine (from coffee, chocolate, teas and sodas).
• Limit cheese and milk. Lactose intolerance is more common in people
with IBS. Make sure to get calcium from other sources, such as broccoli,
spinach, salmon or supplements.
• Try the low FODMAP diet, an eating plan that can help improve
symptoms.
THANK YOU FOR
LISTENING!