Ulcerative Colitis and Crohn's disease: IBD

Question 1

What is ulcerative colitis?

Answer 1

Ulcerative inflammatory bowel disease just in the large intestine

Question 2

What is crohn’s disease also called?

Answer 2

Regional enteritis

Question 3

What is Crohn’s disease?

Answer 3

Inflammation and erosion of the ileum (small intestines), but it can be found anywhere in the small or large intestines.

Question 4

What are S/S of IBD?

Answer 4

• Diarrhea
• Rectal bleeding
• Vomiting
• Weight loss
• Cramping
• Dehydration
• Blood in stools
• Anemia
• Rebound tenderness
• Fever

Question 5

What is rebound tenderness?

Answer 5

push in, let go and it hurts the client

Question 6

What does rebound tenderness indicate?

Answer 6

Peritoneal inflammation

Question 7

How do you diagnose IBD?

Answer 7

• CT or MRI
• Colonoscopy (most common test for diagnosing)
• Barium enema

Question 8

What should you watch for post colonoscopy?

Answer 8

Perforation

Question 9

What are the signs of perforation?

Answer 9

Pain or unusual discomfort

Question 10

How do you treat IBD?

Answer 10

• Diet
• Meds
• Surgery

Question 11

What kind of diet should people with IBD have?

Answer 11

• Low residue (limit GI motility)

- Avoid cold foods and smoking (increase motility)

Question 12

What meds are given for the treatment of IBD?

Answer 12

• Antibiotics
• Steroids (to decrease inflammation)
• Biologics and immunomodulators
• Aminosalicylates (decrease inflammation)

Question 13

What surgeries are done for ulcerative colitis?

Answer 13

• Total colectomy (proctocolectomy) - ileostomy is formed

- Kock’s ileostomy or an Ideal Pouch Anal Anastamosis (IPAA) - with these two procedures, there is no external bag.

Question 14

What is formed with a total colectomy?

Answer 14

an ileostomy

Question 15

With a Kock’s ileostomy or a IPAA, is there an external bag?

Answer 15

No

Question 16

What type of pouch has a nipple valve that opens and closes to empty the intestines?

Answer 16

Kock’s pouch

Question 17

What procedure removes the colon and attaches the ileum to the rectum? (most popular)

Answer 17

IPAA procedure

Question 18

Do they try not to do surgery with Crohn’s?

Answer 18

Yes

Question 19

With surgery for Crohn’s, what is removed?

Answer 19

Only affected area

Question 20

With surgery for Crohn’s the client may end up with what?

Answer 20

Ileostomy or colostomy (depends on area affected)

Question 21

What is an ostomy in the ileum called?

Answer 21

Ileostomy

Question 22

What is a ostomy in the colon called?

Answer 22

Colostomy

Question 23

Do we irrigate ileostomies?

Answer 23

No, it’s going to drain liquid all the time.

Question 24

Ileostomy care

Answer 24

• Don’t have to irrigate.
• Avoid foods hard to digest and rough foods (they increase motility).
• Gatorade or similar electrolyte replacement drink in the summer.
• At risk for kidney stones (d/t being always a little dehydrated)

Question 25

What happens as waste moves through the colon?

Answer 25

Water and nutrients are being absorbed and the stool is formed

Question 26

What types of stool will a colostomy in the ascending and transverse colon produce?

Answer 26

Semi-liquid stools

Question 27

What type of stools will a colostomy in the descending or sigmoid colon produce?

Answer 27

Semi-formed or formed

Question 28

Which colostomies do you irrigate?

Answer 28

Descending and sigmoid

Question 29

Why do we irrigate descending and sigmoid colostomies?

Answer 29

For regularity

Question 30

When is the best time to irrigate a colostomy?

Answer 30

Same time everyday and after a meal (increased peristalsis)

Question 31

The further down the colon the stoma is, the more formed the stool will be, why?

Answer 31

Because water is being drawn out, the stool is more normal.

Question 32

When irrigating an ostomy, should you use the same principles as if administrating an enema?

Answer 32

Yes

Question 33

Anytime you give an enema, if the client starts to cramp, what should you do?

Answer 33

Stop the fluid, lower the bag and/or check the temperature of the fluid

Question 34

Pre and post-procedure nursing care for colonoscopy

Answer 34

- Clear liquid diet for 12-24 hrs pre-procedure. - NPO 6-8 hours pre-procedure. - Avoid NSAIDs to reduce bleeding risk. - Laxatives or enemas until clear. - Polyethylene glycol (Go-Lytely) - To help client drink a colon prep more easily, get it icy cold. - Sedated for procedure. Post-colonoscopy - Watch for perforation.

Question 35

What should we watch for post-colonoscopy?

Answer 35

Perforation *watch for signs of perforation - pain and unusual discomfort.