Inflammatory Bowel Disease Flashcards
Etiology of Inflammatory Bowel Disease
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
What are two Chronic Inflammatory Bowel Diseases?
Crohn’s and ulcerative colitis
What are manifestations of Crohn’s?
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
Manifestations of Ulcerative Colitis
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
Assessment for Inflammatory Bowel Disease
Pain? Where? Start? What makes it better/worse? Quality? Intensity? Constant? Rebound Tenderness? ABD assessment? Bowel Sounds? Bowel Changes? N/V?
Diagnostic Tests for IBD
Colonoscopy, sigmoidoscopy, X-ray, CBC (malnutrition) , ESR (inflammation), LFT (elevated) , Bilirubin (elevated) , stool examination
What are some complications of UC
Hemorrhage Toxic Megacolon Perforation Peritonitis Colorectal cancer
What are some signs of hemorrhage and how do treat it?
Signs of shock
TX: transfusions, IV fluids, surgery, vasoconstrictors
Toxic Megacolon
Cause?
S/S?
tx?
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
Perforation
Can lead to peritonitis (emptying of stomach contents in to ABD cavity)
Colorectal Cancer
Having UC greatly increases risk of colorectal cancer
Complications of Crohns Disease
Obstruction, Abscess, Fistulas, Toxic Megacolon
Obstruction r/t Crohns
Cause?
S/S?
Cause: repeated inflammation and scarring leads to fibrosis and strictures
s/s: ABD distention, cramping, hyperactive bowel sounds, n/v
Manifestations of Abscess r/t Crohns
Chills, fever, abd mass, leukocytosis
Manifestations of fistulas
Asymptomatic, exacerabated by diarrhea, weight loss, malnutrition, and frequent UTI’s
Goals of Tx for IBD
Nutritional Therapy, Drug Therapy, Surgery
Nutritional Therapy for IBD
NPO –> TPN –> elemental formulas –> low residue diet
Nursing Care for TPN
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
Drug Therapy for IBD
Long-acting/ systemic inflammatory drugs, biologics and immunosuppressants like:
Aminosalicylates
Corticosteriods
ABX
Aminosalicylates
Nursing implications?
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
Corticosteriods
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
Biologics and Immunomodulators and Immunosuppressants
infliximab: suppress tumor necrosis factor
flagyl and cipro: anti-inflammtory meds
Nursing Implications: complete all therapy even asymptomatic
Pre op Care
Bowel Prep (cathartics, enemas, abx) consult enterostomal therapist consult united ostomy association Educate. Educate. Routine pre op care
Surgery
Treat complications Clear obstruction, perforation Stricureplasty- clear fistulas total proctocoletomy with ileostomy kock procedure restorative proctocolectomy with ileal pouch-anal anastomosis
