GI - Bowel Disorders

Question 1

inflammatory bowel disease: ulcerative colitis

Answer 1

• occurs in colon and rectum
• involves mucosal layer only
• diarrhea, bloody stools*, abdominal pain, fever, fatigue, weight loss (less frequent)
• symptoms increase from mild to severe
• risk for perforation, colorectal cancer
• cure with colectomy

Question 2

IBD: Crohn’s disease

Answer 2

• can occur mouth to anus
• involves all layers of bowel; risk for peritonitis, fistulas (UTI), strictures, abscesses, perforation
• diarrhea, bloody stools (less frequent), abdominal pain, fever, fatigue, weight loss*
• malabsorption (Nutrition)
• risk for small bowel cancer

Question 3

diagnostic studies

Answer 3

• history first to r/o other diseases
• CBC (iron deficiency anemia)
• WBC (Inflammation, perforation or megacolon)
• Na, K, Cl, Bicarb, magnesium (fluid & electrolyte loss)
• hypoalbuminemia (poor nutrition)
• stool cultures (infection), stool for occult blood (bleeding)
• Barium enema, small bowel series
• abdominal ultrasound
• CT scan/MRI
• colonoscopy w/biopsies

Question 4

goals of care

Answer 4

• collaborative: rest the bowel, control the inflammation, combat infection, correct malnutrition, alleviate stress, provide symptomatic relief, improve quality of life
• nursing: decrease occurrence of acute exacerbations, maintain fluid & electrolyte balance, manage pain, teaching to adhere to medical regimens, maintain nutrition, improve quality of life

Question 5

medications

Answer 5

*metronidazole (Flagyl)
Class: Antimicrobial
Action: Prevent or treat infections
Adverse Reactions/Side Effects: Seizures, headache, abd. pain, nausea, Stevens-Johnson Syndrome
Nursing Implications: obtain cultures prior to starting, monitor neurologic status, monitor for rash, I&O, daily weight
*loperamide (Imodium)
Class: Antidiarrheal
Action: Decrease GI motility
Adverse Reactions/Side Effects: drowsiness, constipation, GI discomfort, dry mouth
Nursing Implications: Assess for F&E, monitor dehydration, encourage oral hygiene

Question 6

post-op care

Answer 6

*general care for post-op client
ileostomy: monitor skin around stoma, monitor for hemorrhage, dehydration, I&O, bowel obstruction
*NG-tube care
*monitor perianal skin, incontinence of
mucus may occur

Question 7

nutrition

Answer 7

• Goal: maintain nutrition & prevent exacerbations; correct malnutrition; prevent weight loss; replace F&E
• Promote a balanced, healthy diet; sufficient calories, protein & nutrients; individualize, use “My Plate Guidelines”; address iron deficiency anemia (bloody stools)
• During Exacerbations: enteral feedings vs. PN; advance as tolerated; encourage a food diary to eliminate “problem” foods

Question 8

nursing interventions

Answer 8

*Acute Phase
Monitor hemodynamic stability
Pain management
F&E balance
Nutritional support
Assist with hygiene, sitz baths
Promote rest, sleep
*Chronic Phase
Assist to manage stress & coping; psychotherapy
Encourage independence and autonomy in care

Question 9

diverticular disorders

Answer 9

Diverticula
Diverticulosis
Diverticulitis 
Diagnostic: Routine colonoscopy
*Nursing Implications
Encourage high fiber diet
Weight reduction 
*Acute phase
Rest the colon
NPO, IV fluids & antibiotics
Monitor for abscess, bleeding & peritonitis