Inflammatory Bowel Disease Flashcards
1
Q
Define Inflammatory Bowel Disease (IBD)
A
- Crohn’s
- Ulcerative Colitis
- Characterized by chronic, recurrent inflammation of the intestinal tract
- Periods of remission interspersed with periods of exacerbation
- Exact cause unknown
- No cure
- Treatment relies on medications to treat inflammation and maintain remission
- Flare ups then okay
- Often caused by some kind of trauma or stressful event
- Management but not curable
- May occur at any age
- Peaks between ages 15-25 years
- 2nd peak in 6th decade
- Equally affects both sexes
- Autoimmune disease
- Antigen initiates the inflammation: actual tissue damage results from inappropriate sustained immune responses
- Environment factors play a role (i.e. exposed to chemicals or foods that irritated the bowel)
2
Q
Define Ulcerative Colitis
A
- Diffuse inflammation beginning in the rectum and spreading up the colon in a continuous pattern
- Inflammation and ulcerations occur in mucosa and submucosal layers
- Top 2 layers of bowel
- Ulcerations destroy the mucosal epithelium
- Bleeding and diarrhea
- Fluid and electrolyte losses
- Protein loss
- Think of canker sores in the inside of the bowel
- Lots of diarrhea stools so they lose a lot of fluid and electrolytes
- Protein loss since they are not absorbing it
3
Q
Define Crohn’s Disease
A
- Inflammation involves all layers of the bowel wall
- Can occur anywhere in the GI tract
-Skip lesions: segments of normal bowel occurring between diseased portions
- Can occur anywhere in the GI tract
- Can go up the small intestine to the whole GI tract while UC often does not do that, can pretty much go through all layers of GI tract
- A chronic, nonspecific inflammatory bowel disorder of unknown origin
- Can affect any part of the GI tract from the mouth to the anus
- Most often seen in the terminal ileum and colon
- Ulcerations are deep and longitudinal
- Ulcerations penetrate between islands of inflamed edematous mucosa, causing the classic cobblestone appearance
- Narrowing of the lumen with stricture development
- May cause bowel obstruction
- Microscopic leaks can allow bowel contents into peritoneal cavity which can form abscesses or produce peritonitis
- Abscesses or fistulous tracts that communicate with other loops of bowel, skin, bladder, rectum, or vagina may occur
- Can cause lesions through the whole bowel causing for leakage
4
Q
Clinical Manifestations of Ulcerative Colitis
A
- Bloody diarrhea—moderate and severe cases
- Abdominal pain
- Tenesmus –feeling like you continually need to pass stool
- Pseudopolyps develop – masses of scar tissue that develops after healing from repeated ulcerations
- Rectal bleeding: constantly going to the bathroom, rectum is sore and raw from watery diarrhea
- Weight loss
- Fever
- Fatigue: if you cannot absorb nutrients then you are going to feel bad
5
Q
Complications of Ulcerative Colitis
A
GI complications:
- Hemorrhage
- Strictures: narrowing of the lumen of the bowel
- Perforation (with possible peritonitis): tear, contents of bowel will spill into the peritoneum
- Toxic megacolon: dilates really big and becomes paralyzed, everything builds up
- Dilation and paralysis of the colon
- Associated with perforation
- May need emergency colectomy
6
Q
Clinical Manifestations of Crohn’s Disease
A
- Diarrhea
- Colicky abdominal pain: discomfort in the abdominal area
- Weight loss may occur if small intestine is involved
- Bleeding more common in UC
- Fever
- Can mimic appendicitis:
- Mass felt in the right iliac fossa
7
Q
Complications of Crohn’s Disease
A
- Bowel obstruction
- Peritonitis
- Fistulas
- Fluid/electrolyte imbalances
8
Q
Diagnostic Studies
A
- History and physical examination
- Blood studies:
- CBC
- Serum electrolyte levels
- Serum protein levels
- Stool cultures
- Sigmoidoscopy and colonoscopy
- Biopsy specimens - Double-contrast barium enema-contrast and air
- Small bowel series-contrast of small bowel
- Transabdominal Ultrasound
- CT
- MRI
- Capsule endoscopy
9
Q
Nursing Assessment
A
History and Physical Assessment:
- Autoimmune disorders
- Infection
- Use of prescribed and OTC medicines
- Family history
- Diarrhea (presence of blood)
- Weight loss
- Anxiety, depression
10
Q
Nursing Diagnosis
A
- Pain
- Fluid and Electrolyte imbalance
- Impaired skin integrity
- Anxiety
- Ineffective coping
- Imbalanced nutrition: Less than body requirements
- Hemorrhage = bleeding
- Blood in stool
- Intake and output
- Weight
11
Q
Goals for the patient
A
- Rest the bowel
- Control inflammation
- Combat infection
- Correct malnutrition
- Relieve symptoms/free from pain or discomfort
- Maintain normal fluid/electrolyte balance
- Experience a decrease in number and severity of acute exacerbations
- Improve quality of life
12
Q
Nursing Management - Acute phases
A
- Hemodynamic stability
- Pain control
- Fluid and electrolyte imbalance
- Nutritional support
13
Q
Nursing Interventions
A
- Manage hygiene until diarrhea is controlled: tend to odor control, prevent skin breakdown
- Monitor I&Os
- Weigh daily
- Assess bowel sounds
- Consult with dietician
14
Q
Client Education
A
- How to manage this chronic illness
- Importance of rest and
- Diet management
- Perianal care-witch hazel, sitz baths, compresses or ointments
- Drug action and side effects
- Symptoms of recurrence of disease
- When to seek medical care
- Encourage discussion of self-care strategies
- Fully explain all procedures and treatments
15
Q
Nursing Interventions - Nutritional Therapy
A
- Dietary consult
- Provide adequate nutrition without exacerbating symptoms
- Correct and prevent malnutrition
- Replace fluid and electrolyte losses
- Prevent weight loss
- High-calorie
- High-protein
- Low-residue (low-fiber)
- Vitamin and iron supplements
- Lactose free (if lactase deficiency)
- Elemental diet: a medical protocol prescribed for certain gastrointestinal conditions. The diet consists of a liquid formula of complete nutrition broken down into its most elemental form. This “predigested” nutrition is easily absorbed in the upper digestive tract, allowing the lower digestive tract to rest and recover from illness or injury.
