IBD in Children & Adolescents
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Questions and Answers

What percentage of IBD cases start before the age of 20?

  • 10–15%
  • 30–40%
  • 20–30% (correct)
  • 50–60%

    • Crohn disease affects boys and girls equally.

    False

    What is the primary objective in managing pediatric UC and Crohn disease?

    Induction and maintenance of disease remission

    The majority of pediatric patients with Crohn disease present with ______ disease.

    <p>ileocolonic or colonic</p> Signup and view all the answers

    Which type of complications are children with IBD at risk for?

    <p>Nutritional deficiencies</p> Signup and view all the answers

    What is the most likely nutritional status outcome for children with Crohn disease?

    <p>Protein-energy malnutrition</p> Signup and view all the answers

    Match the following disease presentations to their common characteristics in pediatric IBD:

    <p>Crohn disease = Nonstricturing, nonpenetrating disease Ulcerative colitis = Equal gender affection</p> Signup and view all the answers

    Children with IBD may have lower ______ density compared to those without the disease.

    <p>bone</p> Signup and view all the answers

    What is an important focus when providing care for pediatric patients with IBD?

    <p>Providing emotional support and counseling</p> Signup and view all the answers

    Women with IBD face a lower risk of infertility compared to the general population.

    <p>False</p> Signup and view all the answers

    What percentage of individuals with IBD are over the age of 60?

    <p>25–35%</p> Signup and view all the answers

    In pregnant women with IBD, it is recommended to have at least _____ months of remission before attempting to conceive.

    <p>6</p> Signup and view all the answers

    Match the following aspects of IBD management with their corresponding challenges:

    <p>Emotional support = Pediatric patients Nutritional status = Pregnant women Medication adherence = Older adults Surveillance for cancer = Family members</p> Signup and view all the answers

    How does IBD typically affect older adults compared to younger patients?

    <p>Stable disease location</p> Signup and view all the answers

    Individuals diagnosed with Crohn disease after age 60 report more systemic symptoms compared to younger patients.

    <p>False</p> Signup and view all the answers

    What interprofessional team is required for the care of pregnant women with IBD?

    <p>Maternal–fetal medicine and gastroenterology</p> Signup and view all the answers

    What is a critical component of managing patients with IBD?

    <p>Adhering to the prescribed treatment regimen</p> Signup and view all the answers

    Stress can impact an adolescent's willingness to discuss their IBD treatment openly.

    <p>True</p> Signup and view all the answers

    What should a nurse allow to maintain trust with an adolescent patient during consultations?

    <p>Privacy and control over the conversation.</p> Signup and view all the answers

    A thorough assessment for patients with IBD includes a __________ assessment.

    <p>psychosocial</p> Signup and view all the answers

    Match the following manifestations of IBD with their corresponding descriptions:

    <p>Number of stools per day = Frequency of bowel movements Presence of blood in stool = Indicates potential inflammation or ulceration Abdominal pain = Common symptom experienced by patients Fatigue = Associated manifestation due to chronic illness</p> Signup and view all the answers

    Which vital sign assessment is particularly important for patients with IBD?

    <p>Temperature and orthostatic vitals</p> Signup and view all the answers

    It is unnecessary for a nurse to document the patient's general appearance during assessment.

    <p>False</p> Signup and view all the answers

    What type of nature of the disorder must be considered in nursing care planning for IBD patients?

    <p>Chronic and recurrent nature.</p> Signup and view all the answers

    What type of diet is recommended for patients with Crohn disease to help manage their nutritional status?

    <p>High-calorie, high-protein, low-fat diet</p> Signup and view all the answers

    Encouraging patients with IBD to discuss their physical changes does not impact their self-concept.

    <p>False</p> Signup and view all the answers

    What should be monitored to assist in the accurate assessment of nutritional status in IBD patients?

    <p>Laboratory results</p> Signup and view all the answers

    Patients with IBD may experience ______ losses in their stools.

    <p>nutrient</p> Signup and view all the answers

    Match the following strategies with their benefits:

    <p>Dietary modifications = Increases protein and calorie intake Elemental enteral nutrition = Supports healing and bowel rest Parenteral nutrition = Reverses nutritional deficits Supportive family involvement = Reinforces teaching and dietary restrictions</p> Signup and view all the answers

    Which of the following is an important strategy when caring for a patient with a colostomy or ileostomy?

    <p>Encouraging the patient to make choices about their care</p> Signup and view all the answers

    Lactose intolerance is relevant in suggesting dietary modifications for patients with Crohn disease.

    <p>True</p> Signup and view all the answers

    What is one coping strategy that can be taught to patients with IBD to help them adapt to their condition?

    <p>Odor control strategies</p> Signup and view all the answers

    What is a primary concern for patients with IBD during an acute exacerbation?

    <p>Fluid volume deficit</p> Signup and view all the answers

    Patients with IBD should be encouraged to limit their fluid intake during exacerbations.

    <p>False</p> Signup and view all the answers

    What should be recorded in a stool chart during an acute exacerbation of IBD?

    <p>Frequency, amount, and color of stools.</p> Signup and view all the answers

    Diarrhea and __________ are significant problems for patients with IBD.

    <p>disturbed body image</p> Signup and view all the answers

    Match the following symptoms with their corresponding indications of IBD.

    <p>Tachycardia = Hypovolemia Dry skin = Fluid deficit Lethargy = Fluid volume deficit Abdominal pain = Severity of disease</p> Signup and view all the answers

    Which of the following is NOT a potential problem for patients with IBD?

    <p>Enhanced appetite</p> Signup and view all the answers

    Corticosteroid therapy can lead to growth retardation in children with IBD.

    <p>True</p> Signup and view all the answers

    What are two nonpharmacologic interventions to relieve constipation in IBD patients?

    <p>Mild exercise and abdominal massage.</p> Signup and view all the answers

    Monitoring vital signs every ___ hours is essential for patients hospitalized with IBD.

    <p>4</p> Signup and view all the answers

    Match the IBD-related issue with its appropriate management strategy.

    <p>Fluid replacement = Diarrhea Bowel rest = Acute exacerbation Skin care = Protect against breakdown Coping strategies = Anxiety management</p> Signup and view all the answers

    What is a key goal of care for patients with IBD?

    <p>Optimize nutritional status</p> Signup and view all the answers

    Constipation can be a symptom of impaction or bowel obstruction in IBD patients.

    <p>True</p> Signup and view all the answers

    What should patients be taught to observe for in their stools?

    <p>Blood and signs of hemorrhage.</p> Signup and view all the answers

    Diarrhea may interfere with the patient's ability to meet basic needs, such as eating and __________.

    <p>sleeping</p> Signup and view all the answers

    Study Notes

    IBD in Children & Adolescents

    • 20-30% of all IBD cases start before age 20
    • Childhood onset IBD tends to be more extensive, severe, and have greater complications
    • Crohn's disease affects more boys than girls, while UC affects both genders equally
    • Location of disease differs in children and adults
      • Adults with Crohn's usually have terminal ileal disease without colonic involvement
      • Children with Crohn's often have ileocolonic or colonic disease, increasing hematochezia
      • Children with Crohn's often present with inflammatory or non-stricturing, non-penetrating disease
      • Adults with Crohn's often present with fistulizing or stricturing disease
      • Children with UC usually present with pancolitis
      • Adults with UC often present with left-sided colitis
    • Pediatric pancolitis is often more aggressive, and first surgery is earlier in children than adults
    • Treatment goals are induction and maintenance of remission
    • Treatment considers severity, location, phenotype, age, and psychosocial status and family support
    • Medications are the same as adults but dosage adjustments are necessary for children
    • Nutritional monitoring is essential due to disease and treatment complications
      • 34% of children with UC and 70% of children with Crohn's experience weight loss
      • Children are vulnerable to macro and micronutrient deficiencies
    • Dietary supplements are frequently used alongside medications
    • IBD in children can lead to surgery for bowel removal
    • Children with IBD might have lower bone density compared to children without the disease
    • Emotional support and counseling is key to help children adjust to their condition
    • Support for parents is vital for their child's care
    • Patient teaching is critical for the child and family to manage the disease appropriately
    • Surveillance for colorectal cancer and monitoring for primary sclerosing cholangitis are necessary

    IBD in Pregnant Women

    • Peak incidence of IBD is during childbearing years
    • Interprofessional care involving maternal-fetal medicine and gastroenterology is essential
    • 6 months of remission (3 months steroid-free) is recommended before conception
    • Maximizing nutritional status is vital before, during, and after pregnancy
    • Women with IBD may worry about fertility
    • Infertility risk is the same as the general population for women without surgeries
    • Surgery increases risk of fallopian tube and ovary inflammation and scarring
    • Artificial reproductive technology is less effective for women with Crohn's or UC

    IBD in Older Adults

    • 25-35% of individuals with IBD are over 60 years old
    • Up to 15% of IBD diagnoses occur after age 60
    • IBD tends to be less aggressive in older adults with stable disease location
    • Older adults with Crohn's report less abdominal pain, systemic symptoms, and diarrhea
    • Older adults with UC report less abdominal pain and rectal bleeding
    • Treatment is tailored to disease severity and existing comorbidities
    • Poor adherence can be a concern due to multiple medication regimens
    • Drug-to-drug interactions should be carefully considered before administering medications

    IBD Management

    • IBD cannot be predicted or prevented, but effective management can help avoid complications
    • Adhering to prescribed treatment regimens and promptly reporting exacerbations is crucial
    • Psychosocial assessments are important, especially for adolescents who may struggle with treatment adherence due to social pressures

    Assessment

    • Assess current manifestations: onset, duration, severity of symptoms (stool frequency, blood/mucus, pain, tenesmus), diet, weight, nutrition, food intolerances, associated symptoms (arthralgias, fatigue), medication history, previous treatments and tests
    • Document general appearance, weight, vital signs, abdominal assessment (shape, contour, bowel sounds, tenderness, masses, stoma/scars)

    Potential Problems

    • Risk for fluid volume deficit
    • Weight loss and macro/micronutrient deficiencies
    • Constipation
    • Diarrhea
    • Acute pain
    • Chronic pain
    • Anxiety
    • Disturbed body image

    Planning

    • Care is collaborative between the healthcare team and the patient
    • Goals include: optimizing nutritional status, developing healthy coping strategies, self-care related to the disease, managing exacerbations

    Implementation - Monitoring Fluid Volume

    • Use a stool chart to record frequency, amount, and color of stools
    • Monitor vital signs every 4 hours for tachycardia, tachypnea, and fever which might indicate hypovolemia
    • Weigh daily and record; significant weight loss may indicate fluid loss or malnutrition
    • Assess for signs of hypovolemia such as: dry skin, poor skin turgor, dry mucous membranes, weakness, lethargy, thirst
    • Maintain bowel rest with NPO or limited oral intake
    • Administer prescribed anti-inflammatory and antidiarrheal medications
    • Maintain fluid intake orally or intravenously as indicated

    Implementation - Skin Care

    • Provide good skin care to prevent excoriations due to diarrhea
    • Assess the perianal area for irritation or denuded skin
    • Use gentle cleansing agents
    • Apply protective creams

    Implementation - Constipation

    • Explain that intestinal swelling associated with IBD may cause constipation
    • Instruct the patient to take only laxatives recommended by the HCP and avoid laxatives during flares
    • Explain non-pharmacologic interventions such as exercise, abdominal massage, and warm baths
    • Inform the patient to contact the HCP if constipation continues
    • Teach patients to observe stools for blood and report grossly bloody stools which might necessitate surgery

    Implementation - Healthy Body Image

    • Encourage discussion of feelings about physical changes and their consequences
    • Accept the patient's feelings and self-perception
    • Encourage the patient to make choices and decisions regarding care
    • Discuss treatment options and their effects openly and honestly
    • Teach coping strategies (odor control, dietary modifications)

    Implementation - Adequate Nutritional Intake

    • Ensure adequate intake, especially at home
    • Crohn's disease can significantly alter nutrient absorption
    • Malabsorption and nutrient losses can cause deficiencies affecting growth, development, wound healing, muscle mass, bone density, and electrolytes
    • Provide prescribed diet: high calorie, high protein, low fat, restricted milk products if lactose intolerance is present
    • Provide parenteral nutrition if enteral nutrients cannot be absorbed
    • Arrange dietary consultation and consider food preferences
    • Provide elemental enteral nutrition and supplements as ordered
    • Include family members in teaching and dietary discussions

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    Description

    This quiz examines the unique characteristics of Inflammatory Bowel Disease (IBD) in children and adolescents. It covers differences in disease presentation, severity, and treatment strategies compared to adults. Test your knowledge on the impact of IBD on younger populations and how it influences clinical management.

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