Week 5 - IBD Flashcards
what is inflammatory bowel disease
- autoimmune disease that commonly refers to 2 disorders of the GI tract
- characterized by inflammation and ulceration
what 2 disorders are included in IBD
- Ulcerative colitis (UC)
- crohn’s
what is UC
- chronic IBD characterized by inflammation and ulceration of the rectum and colon
describe the progression of UC
- begins in the rectum and spreads proximally along the colon
what does inflammation in UC involve
- mucosa
- submucosa
describe the trajectory of UC
- involves periods of remissions and exacerbations
list symptoms of UC (5)
- bloody diarrhea
- abdominal pain
- urgent frequent need to defecate
- loss of weight, fluid, and electrolytes (d/t diarrhea and decreased mucosal SA for absorption)
- if mod or severe, systemic manifestations (ex. fever, malaise)
complications of UC are classified into which categories
- intestinal
2. extraintestinal
what are intestinal complications of UC (5)
- hemorrhage
- perforation –> peritonitis
- toxic megacolon
- colonic dilation
- colorectal Ca
what is toxic megacolon
- when the large intestine dilates due to the overwhelming inflammation
- the large intestine is unable to function properly and becomes paralyzed
- and can eventually can rupture.
- extensive dilation and paralysis of the colon
what is perforation in UC often associated with (2)
- toxic megacolon
- may also occur alone
what increases the risk of colorectal Ca in UC
- if they have had it for more than 10 years
what implication does the risk of colorectal ca have in a pt with UC
- pt should be regularly screened w colonoscopy
what is crohn’s disease
- chronic IBD of unknown origina
what part of the GI system does crohn’s impact
- can affect any part of the GI tract, from mouth to anus
crohn’s disease is characterized by.. (2)
- inflammation of segments of the GI tract = skip lesions
- inflammation of all layers of bowel wall
what are symptoms of crohn’s disease (7)
- non-bloody diarrhea**
- fatigue
- abdominal pain **
- weight loss
- fever
- abdominal cramping/tenderness
- abdominal distension
describe the onset of crohns
- pt experiences periods of remission & exacerbation
as crohn’s progresses, what does the pt experience (6)
- weight loss
- malnutrition
- dehydration
- electrolyte imbalances
- anemia
- pain around right lower quad and umbilicus
what are complications of crohn’s (5)
- stricture & obstruction
- fistulas
- perforation –> peritonitis
- intra-abdominal abcess
- malabsorption
what causes stricture and obstruction in crohn’s
- scar tissue
what do fistulas in crohn’s cause
- may communicate w lops of bowel, vagina, or urinary tract = feces in urine = UTi
how does crohn’s lead to malabsorption
- due to damage of intestinal mucosa
= fat malabsorption = deficiency of fat soluble vitamins (ADEK)
what is the peak age for UC vs crohn’s?
- UC = ages 15-25
- crohn’s = 15-30
what diagnostics are used for IBD (8)
- Hx
- physical exam
- endoscopy
- barium studies
- fecal occult blood test
- CBC
- ESR, CRP (for inflammation)
- electrolytes (diarrhea = loss)
what are some extra intestinal complications of IBD (6)
- skin
- ocular
- arthropathy
- osteopenia/osteoporosis
- arthritis
- thromboembolic event
what is the most important thing to monitor in the acute care phase of IBD? why?
- frequency, amount, and color of stools
- severity of diarrhea determines how much fluid replacement is necessary
what should be included in the acute phase of care of IBD (11)
- nutrition, fluid, and electrolyte balance
- daily weights
- meticulous perianal care (bc increased BM is irritating)
- symptomatic relief
- treat/manage anxiety & stress
- monitoring
- pain control
- I&O
- psychosocial support
- facilitate mgmt of BM (close to bathroom door, bedside comode)
- rest imp –> may be tired due to frequent BM and abdominal pain
what is given to manage nutrition, fluid, and electrolyte balance in the acute phase of IBD (4)
- NPO (for bowel rest)
- IV D5W 1/2NS with K+ (short term)
- TPN (short term)
- elemental enteral nutrition
what should you monitor for during the acute phase of IBD (6)
- dehydration
- fatigue
- skin breakdown
- ineffective coping strategies
- intra/extraintestinal complications
- number & characteristics of stool (blood?)
what is included in nursing care of IBD during the maintenance phase
- maintenance drugs
- diet
what meds are given for the maintenance phase of IBD (6)
- 5-ASA - sulphasalazine (long term) **
- corticosteroids
- immunosuppressants
- immunomodulators
- vitamins
- antidiarrheal
what is the action of 5-ASA - sulphasalazine
- works best in lrg intestine to decrease inflammation
what is an example of a corticosteroid used for IBD
- prednisone
what is an example of an immunosuppressants used for IBD
- cyclosporine (neoral)
when are immunosuppressive drugs used for treatment of IBD (3)
- in severe cases
- if pt has failed to respond to any of the usual drugs
- before surgery is considered
what is a type of immunomodulator used for mngmt of IBD
- infliximab (remicade)
what type of vitamins are used in mngmt of IBD (2)
- oral iron (ferrous gluconate)
- IV iron (iron dextran)
what is an example of an antidiarrheal for IBD
- diphenoxylate (lomotil)
describe nutritional therapy during maintenance phase of IBD (7)
- avoid triggers
- use food diary
- avoid high quanities of dairy
- high cal, high protein, low fat
- nutritional supplements
- low residue diet
- avoid things that increase GI motility –> smoking, cold foods
what foods should be avoided in a low residue diet
- high fibre foods
ex. whole wheat bread, cereal w bran, nuts, raw fruit
what nutritional supplements may be needed for IBD (4)
- iron
- vitamin
- potassium (if on corticosteroids)
- zinc
when is surgery indicated with UC (4)
- if pt fails to respond to treatment
- if exacerbations are frequent and debilitating
- if massive bleeding, perforation, strictures, or obstructure occur
- if carcinoma develops
what 2 types of surgeries can be done for UC
- total proctocolectomy w permanent ileostomy
- total proctocolectomy with ileoanal reservoir
what is a total proctocolectomy w permanent ileostomy
- 1-stage operation
- involves removal of the colon, rectum, and the anus, with closure of the anus
- the end of the terminal ileum is brought out through the abdominal wall to form a stoma (usually in RLQ)
what is required after a total proctocolectomy w permanent ileostomy
- colostomy bag at all times to collect stool
what is a total proctocolectomy with ileoanal reservoir
- total colectomy with formation of an ileal reservoir and anal anastomosis
- staged approach, encompassing a combo of 1 to 3 procedures, generally done 12 weeks apart
describe how a total proctocolectomy with ileoanal reservoir is done (3)
1) colectomy with temporary ileostomy
2) takedown of ileostomy, resection of anal stump to just above anal sphincters, and formation of ileal reservoir w subsequent anastomosis to anus, with a diverting temp loop ileostomy
3) take down of loop ileostomy, which functionalizes the reservoir
what does a total proctocolectomy with ileoanal reservoir result in
- 6-8 pasty stools/day
- good daytime continence
describe postop care after a UC surgery (10)
- stoma and peristomal skin care
- NG tube until bowel function returns
- dressings/packing
- observe for signs of hemorrhage, abdominal abscesses, small bowel obstruction, dehyration
- use of abdominal drain
- use of catheter
- anal sphincter control exercises (if have reservoir)
- perianal care w first BM
- monitor stool amt, frequency, type
how long is an abdominal drain in place postop
- removed within 3-4 days of surgery
what exercises can be done to help w anal sphincter control? when should they be done
- kegel exercises
- not recommended in immediate postop period
describe surgery in crohn’s disease
- not curative
- used in pts with symptoms that are unresponsive to therapy and w life-threatening complications
- high recurrence rate –> just keep taking out pieces
a nursing diagnosis r/t IBD is diarrhea. describe nursing interventions for diarrhea mngmt. (6)
- record color, vol, freq, and consistency of stool
- rest bowel –> NPO, liquid diet
- stress-reduction techniques to reduce exac.
- encourage freq, small feedings, add bulk gradually
- eliminate gas forming & spicy foods from diet to decrease inflam
- low fiber, high protein, high cal diet
a nursing diagnosis r/t IBD is imbalanced nutrition. what are some nursing interventions for this (8)
- weight pt to eval nutritional status & response to treatment
- lab testing & monitor results (albumin, hgb, hct)
- identify changes in appetite
- monitor food/fluid ingested
- calc daily caloric intake
- select nutritonal supp (cal, iron, protein, fluid)
- instruct pt & caregiver abt diet
- refer for diet teaching & planning as needed
a nursing diagnosis r/t IBD is chronic pain. what nursing interventions can be done for this (5)
- pain assessment
- determine impact of pain on QOL
- select & use variety of measures for pain relief
- notify HCP is measures are unsuccessful
- consider referal to support groups & resources
