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NUR 200: Exam 2 > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

Etiology of Inflammatory Bowel Disease

A

Starts with canker sore- like lesion that penetrates deep into intestinal wall that progresses into ulcerations, lesions and fissures. This leads to a cobblestone like appearance of the intestines. This leads to obstruction, edema and inflammation of bowel which causes the abcess that decrease the flexibility and absorption of the intestines

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2
Q

What are two Chronic Inflammatory Bowel Diseases?

A

Crohn’s and ulcerative colitis

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3
Q

What are manifestations of Crohn’s?

A 
Persistent diarrhea (May or may not have blood)
RLQ pain relieved by defecation
palpable RLQ mass
fever, fatigue, malaise, ,weight loss, anemia
signs of shock
n/v epigastric pain
fissures, ulcers, fistulas, abscesses 
ABD distention, hypoactive bowel sounds
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4
Q

Manifestations of Ulcerative Colitis

A

Bloody, Mucousy Diarrhea
LLQ pain, cramping relieved by defecation
Fatigue, malaise, weakness, arthritis, uveitis (inflammation of the eye, sclera)
hypokalemia
elevated BUN, CRT
absent bowel sounds

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5
Q

Assessment for Inflammatory Bowel Disease

A 
Pain? Where? Start? What makes it better/worse? Quality? Intensity? Constant?
Rebound Tenderness?
ABD assessment?
Bowel Sounds?
Bowel Changes?
N/V?
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6
Q

Diagnostic Tests for IBD

A

Colonoscopy, sigmoidoscopy, X-ray, CBC (malnutrition) , ESR (inflammation), LFT (elevated) , Bilirubin (elevated) , stool examination

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7
Q

What are some complications of UC

A 
Hemorrhage
Toxic Megacolon
Perforation
Peritonitis
Colorectal cancer
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8
Q

What are some signs of hemorrhage and how do treat it?

A

Signs of shock

TX: transfusions, IV fluids, surgery, vasoconstrictors

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9
Q

Toxic Megacolon
Cause?
S/S?
tx?

A

Paralysis and dilation of the colon
S/S: fever, shock, cramping, tenderness, change in stools
Causes: laxative, narcotics, anticholenergics, hypokalemia
TX: fecal disimpaction, enema, suppository, colectomy

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10
Q

Perforation

A

Can lead to peritonitis (emptying of stomach contents in to ABD cavity)

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11
Q

Colorectal Cancer

A

Having UC greatly increases risk of colorectal cancer

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12
Q

Complications of Crohns Disease

A

Obstruction, Abscess, Fistulas, Toxic Megacolon

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13
Q

Obstruction r/t Crohns
Cause?
S/S?

A

Cause: repeated inflammation and scarring leads to fibrosis and strictures
s/s: ABD distention, cramping, hyperactive bowel sounds, n/v

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14
Q

Manifestations of Abscess r/t Crohns

A

Chills, fever, abd mass, leukocytosis

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15
Q

Manifestations of fistulas

A

Asymptomatic, exacerabated by diarrhea, weight loss, malnutrition, and frequent UTI’s

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16
Q

Goals of Tx for IBD

A

Nutritional Therapy, Drug Therapy, Surgery

17
Q

Nutritional Therapy for IBD

A

NPO –> TPN –> elemental formulas –> low residue diet

18
Q

Nursing Care for TPN

A 
Check bag for accuracy
Monitor pump for appropriate rate
If TPN available use 10% dextrose or 20% DW
Daily weights
Daily labs
Strict I and O
Central Line Care
Change tubing every 24 hrs
Accuchecks and Insulin
Watch for fluid shifts
19
Q

Drug Therapy for IBD

A

Long-acting/ systemic inflammatory drugs, biologics and immunosuppressants like:
Aminosalicylates
Corticosteriods
ABX

20
Q

Aminosalicylates

Nursing implications?

A

Ex: sulfasalazine, mesosalazine, olsalazine
Nursing implications: hypersensitivity to aspirin, take with food or glass of water, do not take if pregnant, monitor for anaphylaxis, easily bruising, leukopenia, thrombocytopenia, agranulocytosis and hemolytic anemia

21
Q

Corticosteriods

A

Ex: methylpredisolone, predinisolone
Nursing Implications: take with food, monitor GI bleeds, increased susceptibility for infections, monitor for hyperglycemia and hypokalemia, monitor weight gain/ HTN, monitor for Cushing’s Syndrome

22
Q

Biologics and Immunomodulators and Immunosuppressants

A

infliximab: suppress tumor necrosis factor
flagyl and cipro: anti-inflammtory meds
Nursing Implications: complete all therapy even asymptomatic

23
Q

Pre op Care

A 
Bowel Prep (cathartics, enemas, abx)
consult enterostomal therapist
consult united ostomy association
Educate. Educate. 
Routine pre op care
24
Q

Surgery

A 
Treat complications
Clear obstruction, perforation 
Stricureplasty- clear fistulas
total proctocoletomy with ileostomy
kock procedure
restorative proctocolectomy with ileal pouch-anal anastomosis
25
Q

Total Protocolectomy with ileostomy

Patient Teaching

A

Removal of colon, rectum, anus, and permanent closure of anus. create ileostomy in RLQ. cures UC.
Patient Teaching: Iniital stool green liquid with blood then yellow-green/ brown stool. Will present odor, must be worn at all times, stool will be irritating, must maintain good skin care

26
Q

Kock Procedure

A 
Total colectomy, with contient ileostomy
Nipple like valve for ileostomy
Indwelling cathether with intermittent suction
Internal pouch that increases with time
Patient Teaching:
How to drain pouch
Dressing worn around incision
Surgical revision might be needed if there is a leak
27
Q

Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis

A

Eliminates the need for a permanent ileostomy
Stage 1: removal of colon and most of rectum but anal and sphincter is intact, internal pouch attached to anus and temporary ileostomy created
Stage 2: Ileostomy closed, regain continence maybe nighttime leaking,
Patient Teaching:
meticulous peri-anal care, regular proctoscopy exams

28
Q

Post Op Nursing Care

A

Routine post op care
Apply ostomy pouch
Assess stoma (red moist, 2cm protrusion)
1st drainage is greenish, odorless, record ouput
Assess skin (monitor rash for yeast infection)
Hernias

29
Q

Patient Teaching

A 
Must empty pouch when 1/3- 1/2 full
Less irritation as stool thickens
ostomy care
use electric razor for peristomal hair
teach proper intake (low residue diet)
teach proper appearance of stoma
how to prevent wart like nodules and infection
30
Q

Low Residue Diet

A

avoid alcohol, prune juice, whole grains, nuts, bran, coconut, rich pastries, potato skins, chips, fried or spicy meats, brown rice, jams, raw veggies and fruits

31
Q

Ileostomy complications

A 
Skin Irritation
Retraction 
Prolapse
Bleeding
Diarrhea
Stenosis
32
Q

Nursing Care for Crohsn

A 
NG tube
consults WOC nurse
admin meds
VS
CBC
33
Q

Nursing Care for UC

A

Wound Care
ABD assessment
fluid replacement and electrolyte balance ( D5 1/2W with K)

NUR 200: Exam 2 (12 decks)

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