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NURS 3512 - Class 1-6 > Week 5 - IBD > Flashcards

Week 5 - IBD Flashcards

1
Q

what is inflammatory bowel disease

A
  • autoimmune disease that commonly refers to 2 disorders of the GI tract
  • characterized by inflammation and ulceration
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2
Q

what 2 disorders are included in IBD

A
  • Ulcerative colitis (UC)

- crohn’s

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3
Q

what is UC

A
  • chronic IBD characterized by inflammation and ulceration of the rectum and colon
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4
Q

describe the progression of UC

A
  • begins in the rectum and spreads proximally along the colon
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5
Q

what does inflammation in UC involve

A
  • mucosa

- submucosa

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6
Q

describe the trajectory of UC

A
  • involves periods of remissions and exacerbations
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7
Q

list symptoms of UC (5)

A
  • 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)
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8
Q

complications of UC are classified into which categories

A
  1. intestinal

2. extraintestinal

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9
Q

what are intestinal complications of UC (5)

A
  • hemorrhage
  • perforation –> peritonitis
  • toxic megacolon
  • colonic dilation
  • colorectal Ca
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10
Q

what is toxic megacolon

A
  • 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
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11
Q

what is perforation in UC often associated with (2)

A
  • toxic megacolon

- may also occur alone

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12
Q

what increases the risk of colorectal Ca in UC

A
  • if they have had it for more than 10 years
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13
Q

what implication does the risk of colorectal ca have in a pt with UC

A
  • pt should be regularly screened w colonoscopy
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14
Q

what is crohn’s disease

A
  • chronic IBD of unknown origina
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15
Q

what part of the GI system does crohn’s impact

A
  • can affect any part of the GI tract, from mouth to anus
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16
Q

crohn’s disease is characterized by.. (2)

A
  • inflammation of segments of the GI tract = skip lesions

- inflammation of all layers of bowel wall

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17
Q

what are symptoms of crohn’s disease (7)

A
  • non-bloody diarrhea**
  • fatigue
  • abdominal pain **
  • weight loss
  • fever
  • abdominal cramping/tenderness
  • abdominal distension
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18
Q

describe the onset of crohns

A
  • pt experiences periods of remission & exacerbation
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19
Q

as crohn’s progresses, what does the pt experience (6)

A
  • weight loss
  • malnutrition
  • dehydration
  • electrolyte imbalances
  • anemia
  • pain around right lower quad and umbilicus
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20
Q

what are complications of crohn’s (5)

A
  • stricture & obstruction
  • fistulas
  • perforation –> peritonitis
  • intra-abdominal abcess
  • malabsorption
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21
Q

what causes stricture and obstruction in crohn’s

A
  • scar tissue
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22
Q

what do fistulas in crohn’s cause

A
  • may communicate w lops of bowel, vagina, or urinary tract = feces in urine = UTi
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23
Q

how does crohn’s lead to malabsorption

A
  • due to damage of intestinal mucosa

= fat malabsorption = deficiency of fat soluble vitamins (ADEK)

24
Q

what is the peak age for UC vs crohn’s?

A
  • UC = ages 15-25

- crohn’s = 15-30

25
Q

what diagnostics are used for IBD (8)

A
  • Hx
  • physical exam
  • endoscopy
  • barium studies
  • fecal occult blood test
  • CBC
  • ESR, CRP (for inflammation)
  • electrolytes (diarrhea = loss)
26
Q

what are some extra intestinal complications of IBD (6)

A
  • skin
  • ocular
  • arthropathy
  • osteopenia/osteoporosis
  • arthritis
  • thromboembolic event
27
Q

what is the most important thing to monitor in the acute care phase of IBD? why?

A
  • frequency, amount, and color of stools

- severity of diarrhea determines how much fluid replacement is necessary

28
Q

what should be included in the acute phase of care of IBD (11)

A
  • 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
29
Q

what is given to manage nutrition, fluid, and electrolyte balance in the acute phase of IBD (4)

A
  • NPO (for bowel rest)
  • IV D5W 1/2NS with K+ (short term)
  • TPN (short term)
  • elemental enteral nutrition
30
Q

what should you monitor for during the acute phase of IBD (6)

A
  • dehydration
  • fatigue
  • skin breakdown
  • ineffective coping strategies
  • intra/extraintestinal complications
  • number & characteristics of stool (blood?)
31
Q

what is included in nursing care of IBD during the maintenance phase

A
  • maintenance drugs

- diet

32
Q

what meds are given for the maintenance phase of IBD (6)

A
  • 5-ASA - sulphasalazine (long term) **
  • corticosteroids
  • immunosuppressants
  • immunomodulators
  • vitamins
  • antidiarrheal
33
Q

what is the action of 5-ASA - sulphasalazine

A
  • works best in lrg intestine to decrease inflammation
34
Q

what is an example of a corticosteroid used for IBD

A
  • prednisone
35
Q

what is an example of an immunosuppressants used for IBD

A
  • cyclosporine (neoral)
36
Q

when are immunosuppressive drugs used for treatment of IBD (3)

A
  • in severe cases
  • if pt has failed to respond to any of the usual drugs
  • before surgery is considered
37
Q

what is a type of immunomodulator used for mngmt of IBD

A
  • infliximab (remicade)
38
Q

what type of vitamins are used in mngmt of IBD (2)

A
  • oral iron (ferrous gluconate)

- IV iron (iron dextran)

39
Q

what is an example of an antidiarrheal for IBD

A
  • diphenoxylate (lomotil)
40
Q

describe nutritional therapy during maintenance phase of IBD (7)

A
  • 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
41
Q

what foods should be avoided in a low residue diet

A
  • high fibre foods

ex. whole wheat bread, cereal w bran, nuts, raw fruit

42
Q

what nutritional supplements may be needed for IBD (4)

A
  • iron
  • vitamin
  • potassium (if on corticosteroids)
  • zinc
43
Q

when is surgery indicated with UC (4)

A
  • if pt fails to respond to treatment
  • if exacerbations are frequent and debilitating
  • if massive bleeding, perforation, strictures, or obstructure occur
  • if carcinoma develops
44
Q

what 2 types of surgeries can be done for UC

A
  • total proctocolectomy w permanent ileostomy

- total proctocolectomy with ileoanal reservoir

45
Q

what is a total proctocolectomy w permanent ileostomy

A
  • 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)
46
Q

what is required after a total proctocolectomy w permanent ileostomy

A
  • colostomy bag at all times to collect stool
47
Q

what is a total proctocolectomy with ileoanal reservoir

A
  • 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
48
Q

describe how a total proctocolectomy with ileoanal reservoir is done (3)

A

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

49
Q

what does a total proctocolectomy with ileoanal reservoir result in

A
  • 6-8 pasty stools/day

- good daytime continence

50
Q

describe postop care after a UC surgery (10)

A
  • 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
51
Q

how long is an abdominal drain in place postop

A
  • removed within 3-4 days of surgery
52
Q

what exercises can be done to help w anal sphincter control? when should they be done

A
  • kegel exercises

- not recommended in immediate postop period

53
Q

describe surgery in crohn’s disease

A
  • 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
54
Q

a nursing diagnosis r/t IBD is diarrhea. describe nursing interventions for diarrhea mngmt. (6)

A
  • 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
55
Q

a nursing diagnosis r/t IBD is imbalanced nutrition. what are some nursing interventions for this (8)

A
  • 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
56
Q

a nursing diagnosis r/t IBD is chronic pain. what nursing interventions can be done for this (5)

A
  • 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

NURS 3512 - Class 1-6 (47 decks)

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