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Maria > IBD - TEXT > Flashcards

IBD - TEXT Flashcards

1
Q

What country has highest IBD rates in the world

A

Canada

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2
Q

When is IBD most common?

What other trends/risks are seen?

A
  • Most common in 15-30yrs, then 50-70yrs
  • High risk r/t family hx (largest independent risk factor for IBD)
  • Equal in men and women; prevalent in Jewish individuals
  • Cause unknown – triggered by environmental factors such as pesticides, food additives, tobacco, and radiation; allergies and immune disorders suggested as causes as well
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3
Q

What classification of drugs exacerbate IBD?

A

NSAIDs

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4
Q

When is crohns often diagnosed?

A

in adolescents and young adults

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5
Q

According to Day et al, what layers of the GI tract are affected by Crohn’s?

A

extends through all layers

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6
Q

Crohn’s area of GI most affected?

A

o Changes most common in distal ileum and ascending colon

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7
Q

Do you see exacerbations and remissions characteristically in Crohns?

A

Yes

this is also said to be true of UC…thought it was more a thing in UC?

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8
Q

How does the bowel change with Crohn’s initially?

How/why does lumen size change overall?

A

o Begins with edema and thickening of mucosa, ulcer begins to appear in inflamed mucosa

o Intestinal lumen narrows as bowel wall thickens

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9
Q

How are the lesions described in Crohn’s?

A

Lesions not continuous, occur in “cobblestone” clusters

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10
Q

What complication is common in Crohns?

A

o Fistulas, fissures, and abscesses form as inflm extends into peritoneum

50% have granulomas

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11
Q

What type of onset is seen in Crohns?

A

Insidious

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12
Q

Where is pain seen in Crohns?

Characteristic of diarrhea in this condition?

A

lower right quadrant abdominal pain

diarrhea unrelieved by defecation

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13
Q

Why are crampy pains seen in Crohns?

A

Scar tissue and granulomas obsruct lumen so contents can’t pass properly, resulting in crampy abdominal pains

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14
Q

Why does anemia result form Crohns?

A

Not eating

and probably some minimal blood loss?

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15
Q

In which kind of IBD do you seen intestinal weeping?

A

Crohn’s

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16
Q

What occurs with perforation of lesions in Crohns?

A

intrabdominal and anal abscesses → Fever and leukocytosis

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17
Q

Manifestations of Crohn’s in other systems?

A

joint disorders, skin lesions, ocular disorders, oral ulcers

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18
Q

What characteristic of stool is seen in Crohns?

A

Steatorrhea

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19
Q

What does a barium show in Crohns?

A

study of upper GI tract shows “string sign” of terminal ileum (constriction of segment)

Barium enema shows ulcerations, fissures, etc

20
Q

Diagnostic procedures used in Crohns?

A

o Proctosigmoidoscopy performed to see if rectosigmoid area inflamed
- Stool sample - blood & steatorrhea
- Endoscopy, colonoscopy, and intestinal biopsies to confirm dx
o Ct shows bowel thickening

21
Q

How would labs be seen to be impacted in Crohns?

A

Hct and Hb down, WBC may be elevated, albumin and protein dec (d/t malnutrition)

22
Q

What layers are most effected in UC?

Characteristics of the lesions?

A
  • Affects superficial mucosa of colon
  • Characterized by multiple ulcerations, diffuse inflammation, and shedding of colonic epithelium
  • Bleeding d/t ulcerations
  • Mucosa = edematous and inflamed
  • Lesions are continuous, occuring one after the other
23
Q

Are abscesses common in UC?

What about fistulas and fissures?

A

Abscesses yes

• Fistulas, fissures not common because inflm process affects inner lining only

24
Q

How do the lesions in UC typically spread?

How does the lumen change?

A
  • Begins in rectum, spreads proximally to entire colon

* Lumen narrows and shortens with fat deposits and muscular hypertrophy

25
Q

Clinical presentations in UC?

A
  • Typically seen as exacerbations and remissions
  • Predominant signs = diarrhea, passage of mucus and pus, LLQ pain, rectal bleeding

Bleeding can result in pallor, anemia, and fatigue
• Anorexia, weight loss, fever, vomiting, dehydration, cramping, feeling urgent need to defecate
• 10-20 liquid stools passed/day

• Skin lesions, joint abnormalities, liver disease

26
Q

Assessments and diagnostic findings in UC?

A
  • Assessed for tachycardia, hypotension, tachypnea, fever and pallor
  • Assess hydration and nutritional status
  • Bowel for sounds, distension, tenderness – show severity of disease
  • Stool for occult blood
  • Labs show dec HCt, Hb, elevated WBC, low albumin, electrolyte imbalance
  • Endoscopy, colonoscopy, barium enema, CT scan, MRI,
  • Stool exam to differentiate form dysentery
27
Q

What is toxic megacolon? (a complication of UC)

A

inflm spreads into muscularis, inhibiting ability to contract with resulting colonic distension, vomiting, and fatigue (if no tx w/in 24-72 hours may require total colonectomy)

28
Q

What kind of nutritional treatment is given to those with IBD?

A

oral fluids with low-residue, high-protein, high-calorie diet & vitamin supplements and iron replacement ordered
o IV fluids for dehydration
o Foods causing diarrhea avoided (milk etc)
o Possible parenteral nutrition

29
Q

What kinds of food/activity inc gut motility?

A

cold foods and smoking

*Avoided in IBD

30
Q

What meds are given to reduce peristalsis in IBD?

A

Sedatives, antidarrheals and antiperistaltic meds

31
Q

When are corticosteroids used in IBD?

Why is duration of these drugs tricky?

A

for severe disease

– when stop, symptoms may return, if continue too long, risk for complications

32
Q

What is the newer drug used for IBD?

A

Infiximab (Remicade) one of newer biologic therapies using monoclonal antibodies – useful but side effects may not be worth it

33
Q

Is noncompliance a big issue for tx in IBD?

A

Yes

34
Q

What kinds of surgical procedures are used in IBD?

Can surgery cure the disease?

A

• Surgical procedures = total colectomy with ileostomy, continent ileostomy, and Restorative Proctocolectomy with Ileal Pouch Anal Anastromosis
o May require total colonectomy and ileostomy
o Intestinal transplants now available for some – mortality rates continue to be high

o No sx is cure for the disease – medical treatment necessary for this

35
Q

What is Anastromosis

A

An anastomosis is a surgical connection between two structures. It usually means a connection that is created between tubular structures, such as blood vessels or loops of intestine. For example, when part of an intestine is surgically removed, the two remaining ends are sewn or stapled together (anastomosed).

36
Q

Nursing assessments or IBD?

A

o Health hx re: onset, duration and characteristics of abdominal pain, diarrhea, straining at stool (tenesmus), nausea, anorexia, or weight loss; fam hx of IBD
o Diet patterns incl alcohol, caffeine, smoking
o Alleriges and intolerances (dairy?)
o Sleep disturbances d/t diarrhea at night?

37
Q

How to maintains normal elimination patterns (a goal of nursing care with IBD)?

A

provide ready access to bathroom, admin antidiarrheals as prescribed
+ Opioids will help

38
Q

Nursing interventions for relieving pain with IBD patients?

A
  • Admin Anticholinergics prior to meals (dec motility) and analgesics;
  • position changes
  • local application of heat
  • diversional activities
39
Q

Why are small frequent meals preferable in IBD?

A

to avoid overdistending stomach and stimulating peristalsis

40
Q

Pt should gain ____kg daily during parenteral nutrition tx

A

0.5kg

41
Q

Diet suitable for diarrhea?

A

Want bland, low-residue, high-protein, high-calorie, high-vitamin diet to relief diarrhea

42
Q

What is an important consideration for use of TPN?

A

• TPN high in glucose – BGM q6hrs

43
Q

If prescribed bed rest, what kind of activity still needs to be carried out?

A

still having activities to prevent DVT, maintain muscle tone, etc

44
Q

Measures for preventing skin breakdown as nurse for pt with IBD?

A

frequent skin exams, esp perianal area; consult with wound-ostomy-continence (WOC) nurse

45
Q

Signs of perforation to look for in IBD pt?

A

• Signs of perforation: acute inc in abdominal pain, rigid abdomen, vomiting, hypotension

46
Q

Signs of obstruction and toxic megacolon

A

abdominal distension, dec or absent bowel sounds, change in mental status, tachycardia, hypotension, dehydration, electrolyte imbalance

47
Q

What kind of teaching r/t self-care should the nurse provide with IBD?

A
  • Need to know why taking anti-inflm, corticosteroids, anti-bacterial, anti and danger of abruptly discontinuing them
  • Review ileostomy care with pt
  • Explain that can lead healthy lives between exacerbations
  • Follow-up to ensure nutritional requirements being met
  • Sleep in room close to BR to dec fear of “accidents”
  • Encourage to rest and adapt activities as per energy levels during exacerbations
  • May eat in isolation, etc for fear of loss of control

Maria (14 decks)

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