Module 2: Part 3 Flashcards
Describe Crohn’s:
Be able to recognize the differences from ulcerative colitis
- Granulomatous
- Skip lesions, cobblestone
- Mostly in the terminal end of the ilium but can be in both large and small intestine
- Submucosa
- Mnfts w diarrhea, wt loss, colicky abdm pain
- Complications: Fistulas, abscesses, stricture
Describe ulcerative colitis:
- Continuous, proximal from rectum
- Mucosa
- Ulcers (duh)
- Crypt abscesses
- Pseudopolyps
- Mnfts w bloody diarrhea, cramping, wt loss (less than crohn’s though)
For someone experiencing multiple repeating episodes of IBD exacerbations, what nursing diagnosis could you make? what are some interventions to help with this?
Diagnosis:
Risk for ineffective therapeutic regimen management related to insufficient knowledge concerning the process and management of the disease
Interventions:
Provide pt with information regarding preventative measures eg nutritional management; a bland, low-residue, high-protein, high-calorie, and high-vitamin diet relieves symptoms and decreases diarrhea. Also providing info about the importance of the prescribed drugs.
Why are corticosteroids used to treat IBD?
These are used because they suppress the immune response, thus limiting the damage caused to the bowel by the immune system reacting to the normal flora and reducing inflm.
Side effects of steroids:
- Decreased immune fx and wound healing
- Increased blood glucose
- Osteoporosis
- Wt gain, moon face
- Increased risk of ulcers and mood disorders
- ‘lyte imbalances
How can you reduce the risks associated with steroids?
- Short periods of time
- Decrease dose over time
- Give w food
- Alt day doses
- Give locally instead of systemic
Why is important to slowly decrease steroid doses?
To allow time for recovery of adrenal Fx and minimize withdrawal side effects.
What are symptoms of steroid withdrawal?
- Hypotension
- Hypoglycemia
- Myalgia
- Arthralgia
- Fatigue
T or F:
Crohn’s can be transmural.
T, this can cause the complications: fistulas, abscesses, stricture, possible perforation = peritonitis
Steatorrhea may be seen in pts with Crohn’s, what is this?
Abnormal quantities of fat in stool, may be whitish in color.
Erythema nodosum may be seen in pts with Crohn’s, what is this?
Bruises in the adipose tissue layer, usually seen on the front of the legs below the knees
Ulcerative colitis causes increased risk of developing what 4 conditions?
- Toxic Megacolon
- Perforation
- Colon Cancer
- Nephrolithiasis
What is the gold standard for Dx IBD?
Proctosigmoidoscopy or Colonoscopy with biopsy
5 Dx for IBD (not including scoping):
- Barium enema
- Upper GI series (Barium study)
- CT scan
- CBC, Alb, K+, Na+, RFTs
- Stool culture
4 surgical interventions for IBD:
- Total Colectomy (ileostomy)
- Continent ileostomy (K- pouch)
- Temporary loop ileostomy
- Ileoanal anastomosis with J-pouch
