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Adult Health I Test IV > Inflammatory Bowel Disease > Flashcards

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
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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
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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
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4
Q

what characterizes UC and Crohn’s?

A
  • Frequent stools
  • Crampy abdominal pain
  • Exacerbations
  • Remissions
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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
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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
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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
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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
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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
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10
Q

Diverticulitis: risk factors

A
  • African Americans
  • occurs more often in older adults and more frequently in men
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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
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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
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13
Q

Diverticulitis: expected findings

A
  • Acute onset of abdominal pain in left lower quadrant
  • n/v
  • Fever
  • Chills
  • Tachycardia
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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
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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
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16
Q

diverticulitis: lab tests

A
  • H&H: dec
  • ESR: inc
  • WBC: inc
  • Stool for occult blood: can be positive
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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
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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
Q

chronic inflamm bowel dz: sulfonamides

A
  • 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
Q

chronic inflamm bowel dz: nonsulfonamides

A
  • 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
Q

chronic inflamm bowel dz: corticosteroids

A
  • 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
Q

chronic inflamm bowel dz: immunosuppressants

A
  • 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
Q

chronic inflamm bowel dz: immunomodulators

A
  • 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
Q

chronic inflamm bowel dz: antidiarrheals

A
  • 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
Q

diverticulitis: antimicrobials

A
  • 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
Q

UC: therapeutic procedures

A

colectomy w/ or w/o ileostomy

33
Q

Crohn’s dz: therapeutic procedures

A
  • 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
Q

diverticulitis: therapeutic procedures

A
  • (dependent on problem)
  • Required for rupture that results in peritonitis, bowel obstruction, uncontrolled bleeding, abscess
  • Colon resection w/ or w/o colostomy
35
Q

chronic inflamm bowel dz: therapeutic procedures pre/post op

A
  • 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
Q

chronic inflamm bowel dz: complications

A
  • peritonitis
  • bleeding due to deterioration of the bowel
  • F&E imbalance
  • abscess and fistula
  • toxic megacolon
37
Q

peritonitis:: what is it? assessment?

A
  • 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
Q

peritonitis: nursing actions

A
  • 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
Q

peritonitis: client edu

A
  • Maintain adequate rest and resume home activity slowly
    • No heavy lifting for 6 weeks
  • Monitor for infection
40
Q

chronic inflamm bowel dz: bleeding due to deterioration of bowel as a complication

A
  • 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
Q

chronic inflamm bowel dz: F&E imbalance as a complication

A
  • 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
Q

chronic inflamm bowel dz: abscess and fistula as a complication

A
  • 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
Q

chronic inflamm bowel dz: toxic megacolon

A
  • 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

Adult Health I Test IV (10 decks)

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