IBD

Question 1

Who is at risk of Crohn’s vs Ulcerative colitis?

Answer 1

Crohn’s: Common in adolescents or young adults, but can appear at any time

UC:
Peak incidence between 30 & 50 years old

Question 2

Px assessment findings Crohns vs UC

Answer 2

Crohns:
RLQ pain that occurs with diarrhea but does not decrease with defecation
Generally periumbilical pain
Palpable RLQ tenderness  
hyperactive RLQ bowels sounds 

UC
LLQ pain
Abdominal distention
Rebound tenderness
Rectal bleeding

Question 3

Complications of UC

Answer 3

Toxic megacolon
 Perforation
 Bleeding from ulceration
 Fluid/electrolyte imbalances
 Malnutrition
 Depression
 Pyelonephritis, nephrolithiasis
 Malignant neoplasms

Question 4

Complications of Crohns

Answer 4

Small bowel obstruction
Fluid & electrolyte imbalance
Malnutrition
Fistula & abscess formation
Increased risk for colon cancer
Retinitis, iritis, erythema nodosum
Depression

Question 5

Most common IBD prevention

Answer 5

Chronic diarrhea
Abdominal Pain
Fever
Anorexia

Question 6

Common MNFTS outside GI

Answer 6

Joint disorders (arthritis)
Skin lesions
Ocular disorders

Question 7

Dx of IBD

Answer 7

Proctosigmoidoscopy or colonoscopy with biopsy – Gold Standard
Barium enema
CT
CBC (specifically hgb, wbc, rbc, hct), Albumin, K+, Na+, renal function
Stools for occult blood & steatorrhea, parasites
Upper GI series (Barium study)

Question 8

What is Infliximab and how does it work

Answer 8

Monoclonal Antibodies

Form of immunotherapy

mAb bind to specific target cells or proteins and (possibly) stimulate the patient’s immune system to attack those cells

Question 9

What are the common side effects of Corticosteroids

Answer 9

↑ blood glucose
↓ immune response (↑ risk of infection)
↓ inflammatory response
↓ wound healing
Na+ retention 
Osteoporosis
↑ risk of ulcers
↑ risk of mood disorders
Electrolyte disorders
Muscle wasting/fat shifting

Question 10

how might you minimize side effects of prednisone

Answer 10

Give steroids for short periods of time
Give large doses initially then ↓doses gradually
↑ risk of side effects after continually use for 7-10 days
Give steroids with food
Alternate day dosing
Give steroids locally instead of systemically

Question 11

What are the nursing consideration for steroid use?

Answer 11

Monitor for potential hypergylcemia
Give oral steroids with food if possible
Monitor for & of infection
Monitor for & of skin breakdown
Monitor electrolytes (↑Na, ↓K)
Monitor mood/behaviour for changes