Exam 3 Study Guide - Inflammatory Disorders

Question 1

Gastroenteritis - Assessment

Answer 1

-Hx
> recent travel out of country of has eaten at any restaurant in past 24-36hrs
- CMs
> N/V
> abd cramping
> diarrhea
> immunosuppressed or older adult can become dehydrated easily
- Symps of Dehydration
> poor skin turgor
> dry mucous membranes
> orthostatic bBP changes & hypotension
> oliguria
> acute confusion in older adult may be only CM present

Question 2

Gastroenteritis - Treatment

Answer 2

• Oral rehydration or IV fluids
• Monitor VS, I&Os, weight
• Monitor electrolytes
  > potassium may be needed for pts w/ excessive diarrhea
• Drugs tht suppress intestinal motility are usually not admin
  > these can prevent infecting organisms from being eleminated from body
  > if necessary; loperamide (Immodium) is drug of choice
• Antibiotics to treat bacterial gastroenteritis & anti-infective to treat shigellosis may be needed (depends on type & severity)
• Prevent transmission to others
  > hand hygiene
  > sanitize environmental items
  > proper food prep

Question 3

Ulcerative Colitis

location
etiology
peak age
number of stools
comps
surgery

Answer 3

• Location: begins in rectum & proceeds towards cecum
• Etiology: unknown
• Peak Age Incidence: 15-25 & 55-65
• # of Stools per Day: 10-20 liquid, bloody stools
• Complications: hemorrhage, nutritional deficiencies
• Need for Surgery: infrequent

Question 4

Crohn’s Disease

location
etiology
peak age
number of stools
comps
surgery

Answer 4

• Location: most often in terminal ileum, w/ patchy involvement through all layers of bowel
• Etiology: unknown (may be genetic, immune, environmental)
• Peak Age Incidence: 15-40
• # of Stools per Day: 5-6 soft, loose stools; nonbloody
• Complications: fistulas (common), nutritional deficiencies
• Need for Surgery: frequent

Question 5

Crohn’s Disease - Treatment

Answer 5

• Drug Therapy
  > immunomodulators are given to suppress immune syst
  > glucocorticoids are used during exacerbation to dcr inflammation
  > aminosalicylates are used to dcr inflammation
  > antidiarrheals are given cautiously
• Nutrition Therapy
  > NPO
  > TPN
  > nutritional supplements
• Fistulas (abn tracts btwn 2 or more body ares) are common
  > treatment includes nutrition & electrolyte therapy, skin care, & prevention of infection
• Surgery may be needed
  > not as successful bc inflamm occurs along all areas of bowel

Question 6

Crohn’s Disease

lab findings
diagnostic testing

Answer 6

• Lab Findings:
  > anemia
  > dcrd folic acid & vit B12
  > dcrd albumin lvls
  > elevated C-reactive protein & ESR
• Diagnostic Testing:
  > X-ray: shows narrowing, ulcerations & strictures
  > Magnetic resonance enterography (MRE): determine bowel activity/motility
  > Abd ultrasound
  > Abd CT

Question 7

Ulcerative Colitis

lab findings
diagnostic testing

Answer 7

• Lab Findings:
  > anemia
  > incrd WBC
  > elevated C-reactive protein & ESR
  > dcrd electrolytes
• Diagnostic Testing
  > MRE
  > Colonscopy
  > Abd CT
  > Barium enema

Question 8

Ulcerative Colitis - Treatment

drug therapy
nutrition
activity
monitor for
surgery

Answer 8

• Drug Therapy
  > immunomoduators are given to suppress immune syst
  > glucocorticoids are used during exacerbation to dcr inflamm
  > aminosalicylates are used to dcr inflamm
  > antidiarrheals are given cautiously
• Nutrition Therapy
  > NPO
  > TPN
  > avoid caffeine, alcohol, raw veggies, high fiber foods, lactose containing foods
• Restrict Activity
  > can reduce intestinal activity, provide comfort, & promote healing
• Monitor for GI Bleeding
  > H/H
  > electrolyte values
  > VS
• Surgery may be required if medical therapies alone are not effective
  > removal of colon

Question 9

Diverticulosis

define
etiology
CMs
diagnostic

Answer 9

• Presence of many abn pouchlike herniations (diverticula) in wall of intestine
• Etiology: unknown
• CMs
  > usually no symps
  > may go undiagnosed
• Diagnostic Testing
  > abd x-ray
  > abd CT
  > abd ultrasound

Question 10

Diverticulitis

define
etiology
CMs
lab
diagnostic

Answer 10

• Inflammation of diverticula
• Etiology: unknown
• CMs
  > abd pain (LLQ)
  > temp greater than 101F
  > lower GI bleeding
  > may develop peritonitis if ruptures
• Lab Findings
  > elevated WBC
  > drcd H/H
• Diagnostic Testing
  > abd x-ray
  > abd CT
  > abd ultrasound

Question 11

Diverticulitis Treatment

Answer 11

• IV fluids
• Drug Therapy
  > antimicrobial like metronidazole (Flagyl), Bactrium or Septra, & Cipro
  > mild analgesic for pain or opioid analgesic
• Avoid laxatives or enemas; they incr intestinal motility
• Assess electrolyte imbalance
• Avoid incring intra abd pressure
  > lifting, straining, coughing, low fiber diet
• Diet modification
  > NPO, clear liquids, low fiber
  > fiber containing diet is gradually introduced when inflamm has resolved & bowel func returns to normal
• NGT
  > if N/V or abd distention is severe
• Surgery
  > indicated if peritonitis, bowel obstruction or pelvic abcess is present
  > colon resection, w/ or w/out colostomy

Question 12

Celiac Disease

define
causes
CMs
treatment

Answer 12

• Chronic inflamm of small intestinal mucosa tht can cause bowel wall atrophy & malabsorp
• Causes
  > combination of genetic, immunologic, & environmental
• Varying CMs w/ cycles of remission & exacerbation
  > some pts have no symps, some have classic symps: anorexia, diarrhea and/or constipation, steatorrhea, abd pain, abd bloating & distention, weight loss
• Treatment: dietary management of gluten-free diet