Exam 3: IBD

Question 1

Crohn’s Disease

Answer 1

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

Question 2

Diagnostic tests for Crohn’s Disease

Answer 2

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

Question 3

Complications of Crohn’s Disease

Answer 3

Intestinal obstruction or stricture

Perianal disease

Fluid and electrolyte imbalances

Malnutrition from malabsorption

Fistula and abscess

Colorectal cancer

Question 4

Ulcerative Colitis

Answer 4

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

Question 5

Ulcerative colitis health history assessment

Answer 5

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)

Question 6

Diagnostic tests for Ulcerative Colitis

Answer 6

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

Question 7

Complications of Ulcerative Colitis

Answer 7

Toxic megacolon (fever, abd pain and distention, vomiting, fatigue) - surgery possible if unresponsive to treatment

Perforation

Peritonitis

Bleeding

Osteoporotic fractures (from corticosteroids)

Colon cancer

Question 8

External associations of IBD

Answer 8

Extra-intestinal manifestations (EIM) occurs in 25-40% of patients with IBD

Kidney, liver, anemia

Question 9

Management of IBD (both Crohn’s and UC)

Answer 9

Aimed at reducing inflammation

Suppressing inappropriate immune responses

Providing rest for a diseased bowel

Improving quality of life

Preventing or minimizing complications

Question 10

Nutritional management of IBD

Answer 10

Oral fluids - no pulp
Low-residue, low-fiber
High-protein, high-calorie
Avoid milk in lactose intolerance
Avoid carbonation
Avoid cold foods

Question 11

Management of IBD

Answer 11

Supplemental vitamins
B12 injections
Iron replacement
I&Os
Avoid smoking
TPN

Question 12

Sufonamide

Answer 12

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

Question 13

Prednisone

Answer 13

Severe disease exacerbations

Decreasing dosage or stopping medication may cause symptoms to return

Teaching: Watch blood sugars, increased fracture risk, monitor for infections

Question 14

Immunomodulators

Answer 14

Prevent inflammation of the GI tract, helps with relapses (maintenance)

Question 15

Immunosuppressants

Answer 15

Methotrexate - takes up to 6 months, monitor for pancreatitis and neutropenia

Question 16

Antidiarrheals

Answer 16

Control diarrhea but not used with bowel obstruction

Question 17

Antispasmodics

Answer 17

Minimize peristalsis to rest inflamed bowel

Question 18

Surgical management of Crohn’s Disease

Answer 18

For recurrent partial or complete obstructions or bowel perforation

Intractable fistulas or abscesses

Question 19

Surgical management of Ulcerative Colitis

Answer 19

Colonic dysplasia/polyps = colon cancer

Mega colon

Severe, intractable bleeding or perforation

Question 20

Nursing care for patients with IBD

Answer 20

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

Question 21

Peritonitis

Answer 21

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