Inflammatory Bowel Disease Flashcards
1
Q
Appendicitis
A
- inflammation of the appendix
- Caused by obstruction of the lumen or opening of the appendix
- Fecaliths (hard pieces of stool) can be initial cause of obstruction
- Adolescents or young adults at inc risk
2
Q
Peritonitis
A
- inflammation of peritoneum
- Results from infection of peritoneum due to puncture (surgery or trauma), septicemia, or rupture of part of GI tract
- Can lead to septicemia
- Life threatening event
3
Q
Gastroenteritis
A
- inflammation of stomach and small intestine
- Triggered by infection: either bacterial or viral
- Vomiting and frequent, watery stools–>place the client at inc risk of fluid and electrolyte imbalance and impaired nutrition
4
Q
what characterizes UC and Crohn’s?
A
- Frequent stools
- Crampy abdominal pain
- Exacerbations
- Remissions
5
Q
ulcerative colitis (UC)
A
- edema and inflammation primarily in the rectum and rectosigmoid colon
- In severe cases, it can involve the entire length of the colon
- Mucosa and submucosa become hyperemic (inc in blood flow)
- Colon will become edematous and reddened
- Can lead to abscess formation
- Edema and thickened bowel mucosa can cause partial bowel obstruction
- Intestinal mucosal cell changes can lead to colon cancer or insufficient absorption of vitamin B12
- Classified as either mild, moderate, severe, and fulminant
6
Q
Crohn’s Dz
A
- inflammation and ulceration of the GI tract
- Often at distal ileum
- All bowel layers can be involved and lesions are sporadic
- Fistulas are common
- Can involve the entire GI tract from the mouth to the anus
- Malabsorption and malnutrition: develop when the jejunum and ileum become involved
- Requires supplemental vitamins and minerals
- Possibly includes vitamin B12 injections
- Requires supplemental vitamins and minerals
7
Q
diverticulitis
A
- inflammation and infection of the bowel mucosa caused by bacteria, food, or fecal matter trapped in one or more diverticula (pouch like herniations in the intestinal wall)
- Not the same as diverticulosis: presence of many small diverticula in colon W/O inflammation
- Not all clients with diverticulosis develop diverticulitis
- Diverticula can perforate and cause peritonitis, and or severe bleeding
8
Q
UC: risk factors
A
- genetics
- caucasians
- Jewish heritage
- gender and age:
- adolescence to young adulthood–>More often in females
- Older adulthood–>more often in males
9
Q
Crohn’s dz: risk factors
A
- genetics
- Jewish heritage
- develops in adolescents and young adults, but can occur at any age
- tobacco use
10
Q
Diverticulitis: risk factors
A
- African Americans
- occurs more often in older adults and more frequently in men
11
Q
UC: expected findings
A
- Abdominal pain/cramping: often left lower quadrant pain
- Anorexia and weight loss
- Fever
- Diarrhea: up to 15-20 liquid stools/day
- Stools can contain mucus, blood, or pus
- Abdominal distention, tenderness, and/or firmness on palpation
- High pitched bowel sounds
- Rectal bleeding
12
Q
Crohn’s dz: expected findings
A
- Abdominal pain/cramping: often right lower quadrant pain
- Anorexia and weight loss
- Fever
- Diarrhea: 5 loose stools/day w/ mucus or pus
- Abdominal distention, tenderness, and/or firmness upon palpation
- High pitched bowel sounds
- Steatorrhea
13
Q
Diverticulitis: expected findings
A
- Acute onset of abdominal pain in left lower quadrant
- n/v
- Fever
- Chills
- Tachycardia
14
Q
UC: lab tests
A
- H&H: dec
- ESR: inc
- WBC: inc
- CRP: inc
- Serum albumin: dec
- Stool for occult blood: can be positive
- K+, Mg, Ca: dec
15
Q
Crohn’s dz: lab tests
A
- H&H: dec
- ESR: inc
- WBC: inc
- CRP: inc
- Serum albumin: dec
- Folic acid & B12: dec
- Anti glycan antibodies: inc
- Stool for occult blood: can be positive
- Urinalysis: WBC
- K+, Mg, Ca: dec
16
Q
diverticulitis: lab tests
A
- H&H: dec
- ESR: inc
- WBC: inc
- Stool for occult blood: can be positive
17
Q
chronic inflammatory bowel dz: diagnostic procedure
A
- Magnetic resonance enterography: can be used w/ all IBD
- Client edu:
- remain NPO for 4-6 hr prior
- Will have to drink contrast medium
- Client edu:
18
Q
UC: diagnostic procedures
A
- sigmoidoscopy/colonoscopy: can diagnose UC
- Barium enema: can help distinguish UC from other dz processes
- CT scan or MRI: can identify presence of abscesses
- Stool exam: for the presence of parasites or microbes
19
Q
Crohn’s dz: diagnostic procedures
A
- Endoscopy:
- Can use pill cam
- Proctosigmoidoscopy: performed to identify inflamed tissue
- colonoscopy/sigmoidoscopy: can visualize large intestine and rectum
- Abdominal U/S, x-ray, CT scan:
- CT scan shows bowel thickening
- Barium enema
20
Q
Crohn’s dz: barium enema
A
- barium inserted into rectum as contrast media for x-ray
- Allows for visualization of rectum and large intestine
- Used to diagnose UC
- Can also show presence of diverticulosis but is contraindicated in diverticulitis due to risk of perforation
- Nursing Actions:
- Monitor postprocedure for manifestations of bowel perforation: rectal bleeding, firm abdomen, tachycardia, hypoTN
- Findings:
- Small intestine ulcerations and narrowing consistent with Crohn’s
- Ulcerations and inflammation of sigmoid colon and rectum significant for UC
- Client Edu:
- NPO and bowel prep
- May have possible abdominal discomfort and cramping during barium enema
21
Q
UC & Crohn’s dz: nursing care
A
- Seek care for bowel obstruction or perforation: fever, severe abdominal pain, vomiting
- Instruct on med therapy and vitamin supplements
- Monitor by colonoscopy for inc risk of colon cancer
- If long exacerbations, NPO status and administer TPN to promote bowel rest
- Eat high protein, high calorie, low fiber foods
- Identify trigger foods
- Avoid caffeine and alcohol
- Take a multivitamin with iron
- Small frequent meals
- Monitor for electrolyte imbalance, esp K, b/c of diarrhea
- Monitor I&O–>assess for dehydration
- Educate regarding use of B12 injections
22
Q
diverticulitis: nursing care
A
- If severe manifestations (pain, high fever), client is hospitalized, NPO, and receives NG suctioning, IV fluids, IV abx, and opioids for pain
- Mild diverticulitis: home care–>abx, analgesics, antispasmodics, rest
- Clear liquid diet until manifestations subside, then progress to low fiber diet
- Add fiber to diet once solid foods are tolerated w/o problems
- Advance slowly to high fiber diet
- Avoid seeds or indigestible material which can block diverticulum (nuts, popcorn, seeds)
- Avoid foods or drinks that irritate the bowel: alcohol, limit fat
- Bulk forming laxatives, fluids, avoid enemas
23
Q
chronic inflammatory bowel dz: med classes
A
- 5 amino salicylic acid (anti-inflammatory): sulfonamides, non-sulfonamides
- corticosteroids
- immunosuppressants
- immunomodulators
- antidiarrheals
24
Q
chronic inflamm bowel dz: 5 aminosalicylic acid: anti-inflammatory
A
Reduces inflammation of intestinal mucosa and inhibits PGs
25
chronic inflamm bowel dz: sulfonamides
* Nursing considerations:
* Contraindicated in sulfa allergy
* Monitor CBC, kidney and hepatic fcn
* Given orally
* ADRs: nausea, fever, rash, agranulocytosis, hemolytic anemia, macrocytic anemia
* 2-4 for therapeutic effects
* Client Edu:
* Take w/ full glass of water after meals
* Avoid sun exposure
* Inc fluids to 2 L/day
* Can cause urine, skin, contact lenses to have yellow orange color
* Report if n/v, anorexia, sore throat, rash, bruising, fever occur
* Maintenance dose: 2-4 g/day
26
chronic inflamm bowel dz: nonsulfonamides
* mesalamine, balsalazide, olsalazine
* Nursing considerations:
* ADRs not as serious as sulfonamides
* Contraindicated if salicylate or sulfa allergy
* Monitor for kidney toxicity
* Report HA or GI discomfort or diarrhea
27
chronic inflamm bowel dz: corticosteroids
* Reduces inflammation and pain
* Nursing considerations:
* If rectal inflammation: topical steroids administered by retention enema
* Used to induce remission
* Don’t use long term
* Can cause adrenal suppression, osteoporosis, infection, cushingoid syndrome
* Use low doses
* Monitor BP, electrolyte, glucose
* Can slow healing
* Client Edu:
* Take w/ food
* Don’t d/c suddenly
* Report unexpected inc in weight
* Avoid crowds
* Report evidence of infection
28
chronic inflamm bowel dz: immunosuppressants
* cyclosporine, methotrexate, azathioprine, mercaptopurine
* Nursing Considerations:
* Monitor for pancreatitis and neutropenia
* 6 mos to see therapeutic effects
* Not used as monotherapy
* Reserved for refractory dz due to toxicity
* Client Edu:
* Avoid crowds
* Report evidence of infection
* Monitor for bleeding, bruising, infection
29
chronic inflamm bowel dz: immunomodulators
* infliximab, adalimumab, natalizumab, certolizumab
* Suppress immune response and inhibits TNF
* Nursing Considerations:
* Follow directions for IV use
* ADRs: chills, fevers, HTN/hypoTN, dysrhythmias, blood dyscrasias
* Monitor liver enzymes, coagulation studies, CBC
* Client Edu:
* Avoid crowds and report evidence of infection
* Report bleeding, bruising, infection
30
chronic inflamm bowel dz: antidiarrheals
* diphenoxylate and atropine, loperamide
* Suppress number of stools
* Nursing Considerations:
* Dec risk of fluid vol deficit and electrolyte imbalance
* Reduce discomfort
* Can lead to toxic megacolon: massive dilation of colon with risk of development of gangrene and peritonitis
* Observe for: hypoTN, fever, abdominal distention, dec/absence of bowel sounds
* Watch for respiratory depression
* Client Edu:
* Avoid hazardous activities
31
diverticulitis: antimicrobials
* cipro, metronidazole, SMX
* Treat infection (dec inflammation in Crohn’s)
* Nursing considerations:
* Can cause superinfection
* Watch for thrush or yeast infection
* d/c cipro for tendon pain b/c can lead to tendon rupture
* Dec dose used if client has impaired kidney
* Monitor kidney and hepatic studies
* Client edu:
* Use may darken and is harmless
* Monitor for manifestations of CNS effects: numbness of extremities, ataxia, seizures
32
UC: therapeutic procedures
colectomy w/ or w/o ileostomy
33
Crohn's dz: therapeutic procedures
* Laparoscopic stricturoplasty to inc diameter of bowel for bowel strictures
* Surgical repair of fistulas or in response to other complications related to dz (perforation)
34
diverticulitis: therapeutic procedures
* (dependent on problem)
* Required for rupture that results in peritonitis, bowel obstruction, uncontrolled bleeding, abscess
* Colon resection w/ or w/o colostomy
35
chronic inflamm bowel dz: therapeutic procedures pre/post op
* Pre Op:
* Creation of stoma planned--\>collaborate w/ enterostomal therapy
* Administer abx bowel prep
* Administer cleansing enema or laxative
* Post Op:
* Remain NPO and have NG tube to suction
* An ileostomy can drain as much as 1000 mL/day
* Prevent fluid vol deficit
* Replace fluid loss with IV fluids if client is NPO
* Oral hydration is slowly introduced in 1-2 days
36
chronic inflamm bowel dz: complications
* peritonitis
* bleeding due to deterioration of the bowel
* F&E imbalance
* abscess and fistula
* toxic megacolon
37
peritonitis:: what is it? assessment?
* Life threatening inflammation of peritoneum and lining of abdominal cavity
* Often caused by bacteria in peritoneal cavity
* Assessment:
* Rigid, board like abdomen
* Abdominal distention
* n/v
* Rebound tenderness
* Tachycardia
* Fever
38
peritonitis: nursing actions
* Client in Fowler’s or semi Fowler’s to promote drainage of peritoneal fluid and improve lung expansion
* Monitor respiratory status: turn, cough, deep breathe, O2
* Monitor NG suction
* Keep NPO
* Monitor F&E and monitor for hypovolemia
* Administer IV abx
* If surgery performed:
* Closely monitor V/S post op
* Monitor I&O every hour
* Monitor surgical dressing for bleeding
* If wound irrigation post op: use sterile technique
39
peritonitis: client edu
* Maintain adequate rest and resume home activity slowly
* No heavy lifting for 6 weeks
* Monitor for infection
40
chronic inflamm bowel dz: bleeding due to deterioration of bowel as a complication
* Bleeding due to deterioration of bowel
* Nursing actions:
* Watch for rectal bleeding
* Monitor V/S
* Check labs: H&H, coag factors
* Client Edu:
* Report rectal bleed
* Explain importance of bed rest
41
chronic inflamm bowel dz: F&E imbalance as a complication
* occurs due to loss of fluid thru diarrhea, vomiting, NG suctioning
* Nursing actions:
* Monitor lab values, provide replacement therapy
* Monitor weight
* Assess for fluid vol deficit
* Client edu:
* Record number of loose stools
* Maintain fluid intake
* Follow prescribed diet
42
chronic inflamm bowel dz: abscess and fistula as a complication
* occurs due to destruction of bowel wall, leading to infection
* Nursing actions:
* Monitor F&E
* Watch for dehydration
* High protein and calorie (at least 3000) diet with low fiber
* Vitamin supplement
* Talk to enterostomal therapist to prevent skin breakdown and promote wound healing
* Monitor for infection
43
chronic inflamm bowel dz: toxic megacolon
* occurs due to inactivity of colon
* Massive dilation of colon occurs and client at risk for perforation
* Nursing actions:
* Maintain NG suction
* Administer IV F&E
* Administer meds: abx, corticosteroids
* Prep for surgery (usually an ileostomy) if client does not begin to show improvement w/in 72 hours
