Unit 3: Inflammatory Bowel Disease (IBD) Flashcards
Inflammatory Bowel Disease (IBD)
umbrella term for Crohn’s Disease and Ulcerative Colitis
- chronic in nature
- cannot be cured w/ medications; but there are medications that help control the disease and treat or prevent exacerbations
Pathophysiology of Inflammatory Bowel Disease (IBD)
-exact cause of IBD unknown
-linked to genetics, environmental conditions, and defects in immune regulation
>genetic predisposition may manifests as an overactive immune response to bacteria located in the GI tract
>may be then triggered by an environmental response such as infection, medication, or smoking
>the immune system usually attacks foreign invaders, but in IBD, the immune response has an inappropriate response in the GI tract causing inflammation; affects the ability to absorb nutrients resulting in diarrhea and weight loss
Clinical Manifestations of IBD
- mild to severe
- periods of remission and exacerbations
Similarities between Crohn’s Disease and Ulcerative Colitis
- persistent diarrhea
- abdominal pain or cramps
- fever
- weight loss
- fluid imbalances
- malnutrition
- mouth ulcers
- anemia
- blood from rectum
- joint, skin, or eye irritations
- delayed growth
Extraintestinal Manifestations in IBD
- uveitis (intraocular inflammatory disorder)
- sclerosing cholangitis (inflammation of hepatic ducts)
- nephrolithiasis (renal stones)
- cholelithiasis (gallstones)
- joint disorders
- skin disorders
- oral ulcerations
Crohn’s Disease
can affect any portion of the GI tract from mouth to anus
- transmural, affecting all layers of the bowel
- not uniform in appearance
- noted for having skip lesions w/ normal-appearing bowel between lesions
- lesions cause deep ulcerations between layers of edematous tissue, creating cobblestone appearance
- w/ exacerbation, the intestines become more scarred = less ability to absorb nutrients; nutritional deficits
- complications: fistulas, abscesses, and peritonitis
- diarrhea
- stool typically soft or semiliquid; do not usually contain blood unless there has been a perforation
- abdominal pain in RLQ
Fistula
abnormal tracts between two or more body areas
Ulcerative Colitis
affects the large intestine and involves only the mucosa and submucosa
- dpreads uniformly beginning at the rectum and spreading upward toward the cecum
- diarrhea; often w/ more than 20 stools; losses of several liters of fluid per day
- blood, mucus, and pus in stool
- abdominal pain and tenderness in LLQ
- tenesmus (spasms of anal sphincter and persistent desire to empty bowel)
- crypt abscess
- abscesses may form in ulcerated areas
- scar tissue; interfering w/ absorption of nutrients
Tenesmus
spasms of the anal sphincter and persistent desire to empty the bowel
-seen in ulcerative colitis
Crypt Abscess
- seen in ulcerative colitis
- releases secretions that result in purulent discharge from the bowel mucosa
Primary Goal of IBD
- rest the bowel
- control the inflammation
Goals of IBD
- rest the bowel
- control the inflammation
- combat infection
- correct malnutrition
- alleviate stress
- provide symptomatic relief
- improve quality of life
Treatments for IBD
- medications
- surgery
- correction of nutritional deficits
- involve psychosocial needs
- IBD cannot be cured w/ medications, but there are medications that can help with controlling the disease and treat or prevent exacerbations
Diagnostics for IBD
-Colonoscopy
-Sigmoidoscopy
-Barium Enemas
>Others: Complete blood count (CBC), serum electrolytes, serum albumin, and stool samples for pathogens
Colonoscopy
- may assist in differentiating Crohn’s disease and ulcerative colitis
- In Crohn’s Disease: detects early mucosal changes including inflammation, stricture, and fistulae
- In Ulcerative colitis: swollen, friable bowel mucosa w/ multiple ulcerations
Barium Enema
provide data regarding the depth of the disease involvement
Medical Management For IBD: Fluid and Electrolyte management
fluid and electrolyte management is crucial for the patient with ulcerative colitis
- when bowel is inflamed, and the patient is exhibiting severe diarrhea, absorption of fluids and nutrients is compromised
- patient encouraged to rest frequently to decrease bowel motility
IBD: Malnutrition
malnutriton is common w/ IBD
- leads to poor wound healing, decreased muscle mass, and dcreased immune system
- may need to be hospitalized for bowel rest and receive total parenteral nutrition (TPN)
- In Crohn’s disease: monthly vitamin B12 injections may be necessary b/c of the inability of the ileum to absorb this nutrient
- liquid vitamin preparations b/c tablets or capsules may be excreted intact b/c of frequency of diarrhea
- albumin levels to determine nutritional status
- foods to avoid: milk, gluten, caffeine, coca, chocolate, citrus juices, cold or carbonated drinks, nuts, seeds, popcorn, and alcohol
Foods to avoid w/ Inflammatory Bowel Disease
- milk
- gluten
- caffeine
- cocoa
- chocolate
- citrus juices
- cold or carbonated drinks
- nuts
- seeds
- popcorn
- alcohol
Complementary and Alternative Medicines (CAM)
- marijuana, turmeric and curcumin, fish oil, probiotics, aloe vera, Androphigus paniculata, Boswellia, Tripterygium wilfordii Hook F, wheat grass, and wormwood
- acupuncture and moxibustion, mind-body therapies, and exercise
Why is Psychosocial Management included?
exacerbations may occur during times of emotional or physical stress
-inability to control manifestations can disrupt lives
-fear of being away from home b/c of frequency of diarrhea
-eating is associated w/ onset of abdominal pain; causing mealtimes to be unpleasant
-depression and anxiety are common in IBD
-patients may be concerned w/ how others view them; impacts self-esteem
-may be a perceived, or actual, loss of independence, sense of control, privacy, body image, healthy self, peer relationships, self-confidence, productivity, and ways pf expressing sexuality; causes depression
-embarrassment of public bathrooms
-shame with the individuals with ostomies
>thorough assessment of support systems, stress-producing factors, and coping mechanisms
Surgical Management for Crohn’s Disease
reserved for patients for whom medical management has failed, an/or who experience complications from the disease
- when a diseased portion of the bowel is removed, it frequently recurs in another section of the bowel
- surgery does not cure Crohn’s disease
Surgical Management for Ulcerative Colitis
for whom medical management has failed or who have experienced complications may undergo colectomy and be cured of the disease
- standard procedure: Ileal pouch anal anastomosis (IPAA)
- may undergo proctocolectomy w/ permanent ileostomy
Ileal pouch anal anastomosis (IPAA)
- surgical procedure (ulcerative colitis)
- entire colon and rectum are removed, a pouch is created to collect waste, and the patient is able to defecate normally
Proctocolectomy
- surgical procedure (ulcerative colitis)
- the removal of the colon and rectum and permanent closure of the anus
- ileostomy is permanent
- another option: continent ileostomy (kock or Koch pouch) after proctocolectomy
Continent Ileostomy (Kock or Koch Pouch)
can be placed after a proctocolectomy
-a portion of the ileum is used to create a reservoir that can be catheterized to remove stool
Complications that come from IBD
- perineal abscesses, fistulas, and structures found in Crohn’s disease
- joint swelling and pain, ankylosing spondylitis, osteoporosis, kidney stones, eye inflammation, mouth sores, and skin lesions
- during inflammation; fever, anorexia, and malaise
- anal fissures; d/t severe bouts of diarrhea
- intestinal obstruction secondary to inflammation and edema
- fibrosis and scarring over time may also cause narrowing of the bowel, leading to obstruction
- malnutrition b/c of malabsorption of nutrients, severe diarrhea, and anorexia d/t fear that eating may cause exacerbation of symptoms
- anemia from hemorrhage and malnutrition may lead to patients needing blood transfusions and iron supplements
- narcotic bowel syndrome from chronic narcotic use
Surgical Complications
- anal canal strictures
- pelvic sepsis
- pouch failure
- fecal incontinence
- female infertility
- chronic pouchitis associated with IPAA procedure
Complications from Fistula Formation
- common w/ Crohn’s disease
- sepsis
- skin irritations
- malnutrition
- dehydration
- fluid and electrolyte imbalance
Nursing Management: Assessment and Analysis
- assessment of intake and output and daily weights helps determine nutritional status
- frequent diarrhea leads to extreme losses of fluids and potassium (hypokalemia)
- often victims of social isolation b/c of the fear of incontinence in public or having the need to be close to a bathroom at all times
- report exacerbations r/t a stressful event
- clinical manifestations: persistent diarrhea, abdominal pain or cramps, fever, weight loss, fluid imbalances, mouth ulcers, anemia, melena
- extraintestinal manifestations: uveitis, sclerosing cholangitis, nephrolithiasis, cholelithiasis, joint disorders, and skin disorders
Nursing Diagnoses
- deficient fluid volume associated w/ diarrhea
- diarrhea associated w/ intestinal inflammation and malabsorption of nutrients
- imbalanced nutrition less than body requirements r/t inability to absorb nutrients secondary to inflammation
- ineffective coping associated w/ chronic disease
Nursing Assessments
- Vital signs
- Nutritional Intake
- Frequency and characteristics of stools; note blood
- Intake and Output
- Daily weight
- Fluid and Electrolyte status
- Psychosocial Assessment and support systems
Nursing Actions
> Encourage smaller frequent meals
-decreases gastric motility
Engage in mealtimes w/ family
Encourage periods of rest
Establish therapeutic relationship
Make appropriate referral to interprofessional team
Pain management
-positioning and maintaining a quiet environment may promote comfort; pain medications ordered; monitor for side effects
Provide meticulous skin care (especially rectal area)
Patient Teaching
- Adequate nutrition: reducing fiber and fat intake during exacerbation, drink plenty of fluids, avoid milk and milk products
- Indications, actions, and side effects of prescribed medications
- Regular follow-ups and annual colonoscopy
Evaluating Care Outcomes
- should have a good understanding of the importance of maintaining a healthy weight b/c malnutrition is a common problem
- important outcomes: stable vital signs, fluid and electrolyte imbalances, and stable weight
- patient who has failed medical management may undergo surgery to control clinical manifestations
