Ulcerative Colitis, Crohn's Disease, Diverticulitis

Question 1

Inflammatory Bowel Disease (IBD)

Answer 1

includes:

• ulcerative colitis
• Crohn’s disease
• diverticulitis

IBD is characterized by diarrhea, crampy abdominal pain, and exacerbations (“flare-ups”) and remissions

Question 2

IBD Risk Factors

Answer 2

1) genetics
- both ulcerative colitis and Crohn’s disease are familial diseases.
- incidence of ulcerative colitis is higher in Caucasians and people with a Jewish heritage
2) gender & age
- incidence of ulcerative colitis peaks at 2 point in life:
a. adolescent to young adult (more often in females)
b. with older adults (more often in males)
- crohn’s disease may be diagnosed at any age
- diverticulitis occurs more often in older adults and affects men more frequently than women.
3) diet
- low-fiber diet may predispose a client to ulcerative colitis and the development of diverticula
4) other factor:
- stress, autoimmunity, and infection may be causative agents for both ulcerative colitis and crohn’s disease

Question 3

Ulcerative Colitis

Answer 3

1) edema and inflammation of the rectum may progress to the sigmoid colon and may expand the length of the colon.
- usually begins in the rectum and distal colon, involving the mucosa and submucosa
2) bowel obstruction may occur, and instestinal mucosal cell changes may cause colon cancer or insufficient production of intrinsic factor, which is necessary for absorption of vitamin B12
3) insufficient amounts of vitamin B12 may lead to pernicious anemia

Question 4

Manifestations of Ulcerative Colitis

Answer 4

1) abdominal pain/cramping, often RLQ pain
2) anorexia and weight loss
3) fever
4) diarrhea: may have up to 15-20 liquid stools/day (mucus, blood or pus may be present)
5) abdominal distension, tenderness, and/or firmness upon palpation
6) high-pitched bowel sounds
7) rectal bleeding

Question 5

Crohn’s Disease

Answer 5

1) an inflammation and ulceration of the GI tract, often at distal ileum
2) all bowel layers may become involved, and lesions are not continuous but sporadic
3) fistulas are common
4) can involve entire GI tract from mouth to anus
5) malabsorption and malnutrition may develop when jejunum and ileum become involved
6) supplemental vitamins and minerals (including vitamin B12 injections) may be necessary

Question 6

Manifestations of Crohn’s Disease

Answer 6

1) abdominal pain/cramping, often RLQ pain
2) anorexia and weight loss
3) fever
4) diarrhea: 5 loose stools/day with mucous or pus
5) abdominal distension, tenderness, and/or firmness upon palpation
6) high-pitched bowel sounds
7) steatorrhea

Question 7

Diverticulitis

Answer 7

1) inflammation of the diverticula (hernia in intestinal wall)–frequently occurs in colon
2) only about 10% of clients who have diverticula develop diverticulitis
3) frequent episodes of inflammation from trapped feces or bacteria may lead to bleeding and infection
4) diverticula may bleed, and loss of blood may be minimal or severe

Question 8

Manifestations of Diverticulitis

Answer 8

1) abdominal pain LLQ
2) nausea and vomiting
3) fever
4) chills
5) tachycardia

Question 9

Diagnostic Procedures

Answer 9

1) abdominal x-ray
2) CT scan
3) barium enema
4) colonoscopy
5) sigmoidoscopy

Question 10

Nursing Care of Client with Ulcerative Colitis or Crohn’s Disease

Answer 10

1) reinforce education about eating foods that are high in protein and calories and low in fiber
2) instruct client to avoid caffeine and alcohol and take a multivitamin that contains iron
3) advise client that small, frequent meals may reduce the occurrence of symptoms
4) inform client that dietary supplements high in protein and low in fiber may be used
5) monitor for an electrolyte imbalance, especially potassium. (Diarrhea can cause a loss of fluids and electrolytes)
6) monitor for fluids and assess for dehydration
7) educate client regarding use of vitamin supplements and B12 injections, if needed
8) assist client in identifying foods that trigger symptoms
9) instruct client to seek emergency care for signs of bowel obstruction or perforation (fever, severe abdominal pain, vomiting)

Question 11

Nursing Care of Client with Diverticulitis

Answer 11

1) mild diverticulitis can be treated at home
2) provider may prescribe antibiotics, analgesics, antispasmodics, and rest
3) oral intake is limited to clear liquids initially but may progress to a high-fiber, low-fat diet
4) client is hospitalized when symptoms are more severe (sever pain, high fever)
- may be NPO w/ nasogastric suctioning, receive IV fluids, IV antibiotics, TPN, and opioid analgesics for pain

Question 12

Medications used in treatment of Ulcerative Colitis and Crohn’s Disease

Answer 12

1) anti-inflammatories
2) corticosteroids
3) immunosuppressants
4) immunomodulators
5) antidiarrheals
6) antibiotics

Question 13

Surgical Interventions

Answer 13

1) clients who do not have success with medical treatment or who have complications (bowel perforation, colon cancer) will require surgery
2) surgical procedure for ulcerative colitis
- colectomy w/ or w/o ileostomy
3) surgical procedures for Crohn’s disease
- stricturoplasty
- surgical repair of fistulas
4) surgical procedures for diverticulitis
- double-barrel colostomy, but may be temporary

Question 14

Preoperative Care

Answer 14

• similar to care for clients with other abdominal surgeries
• if stoma is planned, collaborate with an enterostomal therapy nurse regarding care related to stoma
• administer antibiotic bowel prep (neomycin sulfate) if prescribed
• administer cleaning enema or laxative if prescribed

Question 15

Postoperative Care

Answer 15

• similar to care for clients w/ other types of abdominal surgery
• NPO and have a nasogastric tube to suction, unless surgery was laparoscopic
• ileostomy may drain as much as 1,000 mL/day
• prevent fluid volume deficit
• administer IV fluids as prescribed if client is NPO

Question 16

Complications

Answer 16

1) bleeding
2) fluid and electrolyte imbalance
3) peritonitis
4) abscess formation