Inflammatory Bowel Disease

Question 1

What is IBD?

Answer 1

Autoimmune disease. Cause unknown. Tissue is damaged in the intestines due to an overactive, inappropriate and sustained inflammatory response of the body. The disease is characterized by intermittent periods of inflammation with periods of remission.

Question 2

Types of IBD

Answer 2

1. Crohn’s Disease
2. Ulcerative Colitis (UC)

Question 3

Crohn’s Disease

Answer 3

Can occur anywhere in the GI tract but is most common in the terminal ileum and colon. It involves all the layers of the bowel wall.

Question 4

Ulcerative Colitits

Answer 4

Starts in the rectum and moves in a continual fashion towards the cecum. Affects the innermost layer of the bowel wall.

Question 5

Causes of Ulcerative Colitis

Answer 5

Autoimmune disease

Question 6

Assessment of UC

Answer 6

1. Abdominal Cramping pain
2. Diarrhea
3. Rectal Bleeding
4. Tenesmus (feeling of constantly needing to pass stool)

Question 7

Pattern of Inflammation UC

Answer 7

1. Starts in the rectum and moves toward the cecum
2. Disease of the colon and rectum
3. Inflammation occurs in mucosal layer of bowel

Question 8

Diagnostic Testing UC

Answer 8

• Colonoscopy
• Barium Enema

Question 9

Nursing Diagnoses UC

Answer 9

• Diarrhea r/t bowel inflammation
• Imbalanced nutrition, less than body requirements r/t decreased intake, decreased absorption

Question 10

Nursing Interventions for UC

Answer 10

Assess:

1. VS
2. Pain
3. Stool Pattern

Nutriiton:

1. Low residue, high calorie, high protein
2. May be NPO to rest bowel if severe case

Medications:

1. Corticosteriods (decrease inflammation)
2. Salicylates (decrease prostaglandins)
3. Immunomodulators (alter immune response)
4. Antidiarrheals (symptom management)

Teaching:

1. Take meds as ordered
2. Avoid foods that exacerbate symptoms
3. Call MD if blood in stool
4. Perianal skin care
5. Post op stoma care if indicated

Question 11

Surgical Management of UC

Answer 11

1. Can be cured with total colectomy. Indicated when medical and nutritional therapies fail.
2. Colectomy with ileoanal reservoir
3. Colectomy with Koch pouch (continent ileostomy)
4. Colectomy with permanent ostomy

Question 12

Common Complications UC

Answer 12

1. Hemorrhage
2. Perforation d/t toxic megacolon
3. Infection

Question 13

Causes of CD

Answer 13

Autoimmune disease

Question 14

Assessment of CD

Answer 14

1. Abdominal cramping pain
2. Diarrhea
3. Weight loss
4. Malabsorption and nutritional deficiencies

Question 15

Pattern of Inflammation CD

Answer 15

• Involves all layers of bowel wall
• Can occur anywhere in the GI tract

Question 16

Diagnostic Test CD

Answer 16

1. Colonoscopy
2. Barium Enema

Question 17

Nursing Diagnoses CD

Answer 17

1. Diarrhea r/t bowel inflammation
2. Imbalanced nutrition, less than body requirements r/t decreased intake, decreased absorption

Question 18

Nursing Interventions CD

Answer 18

Assess:

1. VS
2. Weight
3. I&O
4. Pain

Medication Teaching:

1. Goal of medical management is to reduce inflammation and tissue damage
2. Aminosalcylates (inflammation)
3. Antidiarrheal (control amount of fluid loss)
4. Immune supressants (control autoimmune response)
5. Remicade (works against tumor necrosis factor TNF)

Nutrition Teaching:

1. Vitamin and Iron supplements
2. High protein, high caloric, low residue diet
3. Low fiber foods will result in a reduced amount of fecal material in the lower intestinal tract
4. Enteral supplements and parenteral nutrition (TPN) necessary
5. Eliminate indigestible or stimulating foods to intestinal tract to reduce the amount of residue in the colon

Question 19

Surgical Management of CD

Answer 19

1. Done when medical management fails
2. General nursing postoperative care, and ostomy care if indicated
3. Conservative intestinal resection with anastomosis of healthy bowel is procedure of choice