Exam 3: IBD Flashcards
Crohn’s Disease
Periods of remission and exacerbations, occurs in any portion of the GI tract (primarily ileum, secondarily colon)
Cobblestone appearance of affected bowel Fistulas, fissures, abscesses form as inflammation occurs
Manifestations: May be mild and nonspecific, diarrhea (up to 12 times/day) and crampin, RLQ pain, weight loss, low grade fever, flatulence, nausea, altered digestion, pain and bleeding from anal or rectal fissures, fistulas may form
Diagnostic tests for Crohn’s Disease
Barium study of upper GI tract with a small bowel follow through
Barium enema and colonoscopy shows string sign of colon (strictures of segments of intestines)
CT scan and MRI (most accurate) showing bowel wall thickening and mesenteric edema, obstructions, abscesses, and fistulas
Labs: CBC (low H&H), elevated WBCs, elevated ESR, electrolyte imbalances, decreased albumin, decreased protein
Complications of Crohn’s Disease
Intestinal obstruction or stricture
Perianal disease
Fluid and electrolyte imbalances
Malnutrition from malabsorption
Fistula and abscess
Colorectal cancer
Ulcerative Colitis
Affects only the large intestine and sometimes small intestine
Linked to genetic factors
Immune response to a virus or bacteria, autoimmune reactions (allergic reactions to food, milk, or other histamine releasing substances)
Manifestations: Hallmark sign = bloody diarrhea and pus (mild up to 4 liquids per day and severe up to 12 or more liquid stools/day), unpredictable exacerbations and remissions, LLQ pain, pallor, cramping, tenesmus (feeling need to defecate despite emptying bowels), weight loss, malaise, fever, anorexia, vomiting, dehydration
Ulcerative colitis health history assessment
Identify: Onset, duration, characteristics of abd pain, fecal urgency, diarrhea, tenesmus, nausea, weight loss, family history
Dietary patterns (alcohol, caffeine, nicotine-containing products)
Bowel elimination patterns
Allergies and food intolerance
Sleep disturbances (if diarrhea or pain occurs at night)
Diagnostic tests for Ulcerative Colitis
Abd x-ray
Flexible sigmoidoscopy
Colonoscopy
Biposies
Stool examination
Labs: CBC (low H&H), elevated WBCs, elevated ESR, electrolyte imbalances, decreased albumin and protein levels, elevated C reactive protein
Complications of Ulcerative Colitis
Toxic megacolon (fever, abd pain and distention, vomiting, fatigue) - surgery possible if unresponsive to treatment
Perforation
Peritonitis
Bleeding
Osteoporotic fractures (from corticosteroids)
Colon cancer
External associations of IBD
Extra-intestinal manifestations (EIM) occurs in 25-40% of patients with IBD
Kidney, liver, anemia
Management of IBD (both Crohn’s and UC)
Aimed at reducing inflammation
Suppressing inappropriate immune responses
Providing rest for a diseased bowel
Improving quality of life
Preventing or minimizing complications
Nutritional management of IBD
Oral fluids - no pulp
Low-residue, low-fiber
High-protein, high-calorie
Avoid milk in lactose intolerance
Avoid carbonation
Avoid cold foods
Management of IBD
Supplemental vitamins
B12 injections
Iron replacement
I&Os
Avoid smoking
TPN
Sufonamide
Medical management for IBD - sulfasalazine
Reduces recurrences in long-term regimens
NO if Sulfa allergy
Can take up to 4-6 weeks
Monitor: CBC, renal and hepatic function
Urine, skin, contact lenses can have yellow-orange color, avoid the sun
Prednisone
Severe disease exacerbations
Decreasing dosage or stopping medication may cause symptoms to return
Teaching: Watch blood sugars, increased fracture risk, monitor for infections
Immunomodulators
Prevent inflammation of the GI tract, helps with relapses (maintenance)
Immunosuppressants
Methotrexate - takes up to 6 months, monitor for pancreatitis and neutropenia
Antidiarrheals
Control diarrhea but not used with bowel obstruction
Antispasmodics
Minimize peristalsis to rest inflamed bowel
Surgical management of Crohn’s Disease
For recurrent partial or complete obstructions or bowel perforation
Intractable fistulas or abscesses
Surgical management of Ulcerative Colitis
Colonic dysplasia/polyps = colon cancer
Mega colon
Severe, intractable bleeding or perforation
Nursing care for patients with IBD
Attain normal bowel elimination patterns
Relief of abd pain and cramping
Prevention of fluid volume deficit
Maintenance of optimal nutrition and weight - vitamin supplements
Oral hygiene
Absence of skin breakdown - perineal area care and use pressure mattresses
Avoidance of fatigue - bundle care, rest periods
Reduction of anxiety and promotion of effective coping
Increased knowledge of disease process and self-health management
Peritonitis
IBD complication - life threatening inflammation of peritoneum and lining of abd cavity
Cause: Possible bacteria in gut, rupture
Manifestations: Abd distention, board-like abdomen, nausea, vomiting, fever, rebound tenderness, tachycardia, confusion in older adults
Nursing intervention: Fowler’s or Semi-Fowler’s, give oxygen, rest GI tract (NPO, NG tube), hypertonic IV fluids, monitor sodium, antibiotics
