Konstipasi

DEFINISI
 Konstipasi adalah jarang BAB, dimana sering dikaitkan
dengan feces yang keras, disfungsi dalam pengosongan
termasuk mengejan berlebihan, sensasi incomplete
evacuation dan membutuhkan digital evakuasi. (American
College of Gastroenterology Chronic Constipation Task Force, 2005)

 Konstipasi merupakan gejala bukan penyakit (Blane and

Blagrave, 2011)
 Bisa terjadi pada semua umum, Insidensi perempuan
dibanding laki – laki 2: 1 diestimasi prevalensi 15 – 20% dari
seluruh populasi (Levitt et al, 2011)
ROME III diagnostic criteria (25%)
 Straining / Mengejan
 Lumpylengket /hard stools/ Feces Keras
 Sensation of incomplete evacuation (tenesmus)
 Sensation of obstruction/blockage
 Manual/physical manipulation to assist evacuation
(digitation)
 Less than three bowel motions per week
pathophysiology
 The pathophysiology of constipation is poorly understood,

one of three major functions of the colon:

1. Mucosal transport (ie, mucosal secretions facilitate the
movement of colon contents),
2. Myoelectric activity (ie, mixing of the rectal mass and
propulsive actions),
3. The processes of defecation (eg, pelvic floor
dysfunction).
 The urge to defecate is stimulated normally by rectal
distention  stimulation of the inhibitory rectoanal
reflex  relaxation of the internal sphincter muscle 
relaxation of the external sphincter muscle 
muscles in the pelvic region increased
intraabdominalpressure.
The diagnosis of constipation
 Patient’s history,
 Physical examination
 A barium enema or sigmoidoscopy,
 And stool testing for occult blood
KOMPLIKASI
 Hypertension
 Fecal impaction,
 Hemorrhoids (dilated portions of anal veins),
 Fissures (tissue folds),
 Megacolon.
TERAPI
Target : Penyebab dan mencegah terjadinya
 Education,
 Bowel habit training,
 Increased fiber and fluid intake,
 Use of laxatives.
 Routine exercise to strengthen abdominal muscles is
encouraged.

 Biofeedback is a technique that can be used to help patients

learn to relax the sphincter mechanism to expel stool
(Bharucha, 2007; Heitkemper & Wolf, 2007).

 Daily dietary intake of 25 to 30 g/day of fiber (soluble and

bulk-forming) is recommended, especially for the treatment
of constipation in the elderly
Diarrhea
Definisi
 Diarrhea is an increased frequency of bowel movements
(more than three per day), an increased amount of stool
(more than 200 g/day), and altered consistency (ie, increased
liquidity) of stool.
Klasifikasi
1. Acute diarrhea is most often associated with infection
and is usually self-limiting, lasting up to 7 to 14 days;

2. Chronic diarrhea persists for more than 2 to 3

weeks and may return sporadically.
Tipe
1. Secretory diarrhea is usually high-volume diarrhea. Often
associated with bacterial toxins and neoplasms, it is caused by
increased production and secretion of water and electrolytes by the
intestinal mucosa into the intestinal lumen.

2. Osmotic diarrhea occurs when water is pulled into the intestines

by the osmotic pressure of unabsorbed particles, slowing the
reabsorption of water. It can be caused by lactase deficiency,
pancreatic dysfunction,or intestinal hemorrhage
3. Malabsorptive diarrhea combines mechanical and
biochemical actions, inhibiting effective absorption of nutrients
manifested by markers of malnutrition that include hypo
albuminemia. Low serum albumin levels lead to intestinal
mucosa swelling and liquid stool

4. Infectious diarrhea results from infectious agents invading

the intestinal mucosa. Clostridium difficile is the most commonly
identified agent in antibiotic-associated diarrhea in the hospital

5. Exudative diarrhea is caused by changes in mucosal integrity,

epithelial loss, or tissue destruction by radiation or
chemotherapy (Sabol & Carlson, 2007).
GEJALA
 Abdominal cramps,
 Distention,
 Intestinal rumbling (ie, borborygmus),
 Anorexia, and thirst.
 Painful spasmodic contractions of the anus and ineffective
straining (ie, tenesmus) may occur with defecation.

 Other symptoms depend on the cause and severity of the

diarrhea but are related to dehydration and to fluid and
electrolyte imbalances.
 Watery stools are characteristic of disorders of the small bowel,
whereas loose, semisolid stools are associated more often with
disorders of the large bowel.
 Voluminous, greasy stools suggest intestinal malabsorption,
 The presence of blood, mucus, and pus in the stools suggests
inflammatory enteritis or colitis.
 Oil droplets on the toilet water are almost always diagnostic of
pancreatic insufficiency.
 Nocturnal diarrhea may be a manifestation of diabetic
neuropathy.
 The possibility of c. Difficile infection should be considered in all
patients with unexplained diarrhea who are taking or have recently taken
antibiotics (sabol & carlson, 2007)
DIAGNOSTIC TESTS
 Complete blood cell count;
 Serum chemistries;
 Urinalysis;
 Routine stool examination; and stool examinations for
infectious or parasitic organisms, bacterial toxins, blood, fat,
electrolytes, and white blood cells.
 Endoscopy or barium enema may assist in identifying the
cause.
Complications
 Potential for cardiac dysrhythmias because of significant fluid and
electrolyte loss (especially loss of potassium).

 Urinary output of less than 30 ml per hour for 2 to 3 consecutive

hours,

 Muscle weakness, paresthesia, hypotension, anorexia, and drowsiness

with a potassium level of less than 3.5 meq/L (3.5 mmol/L)
must be reported.

 Chronic diarrhea can also result in skin care issues related to irritant
dermatitis, which can be prevented by cleansing with a wet wipe,
drying the skin, and then applying barrier cream (metcalf, 2007; sabol &
carlson,2007).
Primary management
 controlling symptoms, preventing complications, and eliminating
or treating the underlying disease.

 Certain medications (eg, antibiotics, anti-inflammatory agents)

and antidiarrheals (eg, loperamide [Imodium], diphenoxylate
[Lomotil]) may be used to reduce the severity of the diarrhea and
treat the underlying disease (Sabol & Carlson, 2007).

 In most cases, loperamide is the medication of choice because it

has fewer side effects than diphenoxylate (Sabol & Carlson, 2007).

Nurse Role
 The nurse’s role includes assessing and monitoring the
characteristics and pattern of diarrhea.

 A health history should address the patient’s medication

therapy, medical and surgical history, and dietary patterns
and intake.

 Reports of recent exposure to an acute illness or recent

travel to another geographic area are important.
 Assessment includes abdominal auscultation and palpation for
tenderness.

 Inspection of the abdomen, mucous membranes, and skin is

important to determine hydration status.

 Stool samples are obtained for testing. It is also necessary to

assessthe perianal area.

 During an episode of acute diarrhea, the nurse encourages bed

rest and intake of liquids and foods low in bulk until the acute
attack subsides.
 When the patient is able to tolerate food intake, the nurse
recommends a bland diet of semisolid and solid foods.

 The patient should avoid caffeine, carbonated beverages, and

very hot and very cold foods, because they stimulate
intestinal motility. It may be necessary to restrict milk
products, fat, whole-grain products, fresh fruits, and
vegetables for several days.
 The nurse administers antidiarrheal medications such as
diphenoxylate or loperamide as prescribed. Intravenous (IV)
fluid therapy may be necessary for rapid rehydration in some
patients, especially in elderly patients and in patients with
preexisting GI conditions (eg, inflammatory bowel disease).

 It is important to monitor serum electrolyte levels closely.

The nurse immediately reports evidence of dysrhythmias or a
change in a patient’s level of consciousness.
 The perianal area may become excoriated because diarrheal
stool contains digestive enzymes that can irritate the skin.
The patient should follow a perianal skin care routine to
decrease irritation and excoriation

 The skin of an older person is very sensitive because of

decreased turgor and reduced subcutaneous fat layers.
Anorexia nervosa
 AN is a condition characterised by a compulsive need to
achieve a low body weight by avoiding certain
foodsmthat are deemed to be fattening (Treasure, 2009).

 AN can be linked to low confidence, perfectionism and

other life stressors; it can also be ascribed to both
cultural and personal factors such as family conflicts,
high pressures to succeed and poor communication
(Costin, 2007; Jade, 2009; Treasure, 2009)
 To avoid weight gain, individuals with AN may use food
restrictions, excessive exercise and self-induced
vomiting (Bendelius, 2005).

 The body is denied essential nutrients that are needed to function

normally, hence the body slows down all its processes to conserve
energy (Lask and Bryant-Waugh, 2007; Treasure, 2009).

 Individuals with AN may undergo specific rituals when eating such

as chewing very slowly and cutting food into very small
pieces (Warbrick, 2008; Gilbert, 2013).
Bulimia nervosa
 BN is an eating disorder distinguished by bouts of overeating
(when someone with the condition feels they have
lost control over their eating) followed by self-
induced vomiting, dietary restrictions or excessive
exercise to avoid weight gain (Bendelius, 2005; Jongsma
and Bruce, 2012).

 BN can be accompanied by self-harming and risk taking

behaviours like cutting, alcohol/drug abuse and
overdosing (Lask and Bryant-Waugh, 2007).
 People with BN may binge on junk foods until the urge to eat
is gone, the tension is reduced or they are interrupted; they
often eat to the point of feeling pain (Lask and Bryant-
Waugh, 2007).

 They may enjoy the food but it is often consumed very

quickly; this will then be followed by attempts to get rid of
the calories ingested through laxative use and
vomiting (Costin, 2007; Mehler et al, 2010).
Faktor Penyebab
 Food addiction
bad habits around food (e.G. Comfort eating)
 Lack of will power
 Body image problem
 Deeper emotional issues/moodiness
 Stress
 Low self-esteem/self-dislike
 Difficulty managing feelings or expressing their needs
 Desire to be liked or loved
 Personality disorder/excessive perfectionism
 Alcohol/drug abuse n history of personal trauma
POTENSIAL EFEK
 STARVATION  otot, saluran cerna, jantung, otak, sistem
imun
 Sensitive terhadap lingkungan panas atau dingin  mudah
sakit
 Menimbulkan perubahan warna pada kulit  luka pada kaki
 Osteoporosis
 Reproduksi  berhenti mensturasi dan fertility
 Laksativ dan muntah iritasi salura gastrointestinal
 Muntah  keseimbangan cairan dan elektrolit
PENGOBATAN
 Identifying the problem early before it becomes severe
 Noticing changes in growth, weight and vital signs
 Sharing problems with other professionals for quick
intervention
 Developing strategies to manage the problems once noticed
 Referring the individual for therapy
 Educating him or her about positive benefits of treatment
 Monitoring medical status and keep him or her stable
 Providing compassion, consistency and care.
Malabsorption
 Malabsorption refers to alterations of the gastrointestinal
tract (GIT) affecting the digestion, absorption and transport
of nutrients across the bowel wall
 Malabsorption is defined as intestinal absorption capacity
falling short of 85%.
 It is regarded as an important clinical indicator of intestinal
failure
GEJALA
 This may include abdominal pain
and bloating (due to bacterial gas
production and bacterial
overgrowth),diarrhoea and
steatorrhoea, fluid and
electrolyte losses, anaemia (iron,
folate and vitamin B12), growth
retardation and osteopenia
(malabsorption of calcium,
vitamin D, phosphate and
magnesium results in secondary
hyperparathyroidism).3–5
 Malabsorption  malnutrition independent risk factor for
morbidity and mortality,

 According to a recent article by Richard et al describing the

consequences of malnutrition, hospitalised malnourished
patients had a significantly greater risk of developing
infectious complications, respiratory failure,
cardiac arrest, cardiac failure, arrhythmias and
wound dehiscence.
TERIMAKASIH