Inflammatory Bowel Disease Overview

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Questions and Answers

A patient presenting with ileus exhibits abdominal distention, abdominal fullness, and inability to pass gas. Which of the following is a late finding associated with ileus that indicates a more serious complication?

  • Diarrhea
  • Constipation
  • Nausea
  • Fever (correct)

A patient with ileus is experiencing metabolic alkalosis. What can you infer about the location of the obstruction based on this information?

  • The obstruction is most likely in the small intestine. (correct)
  • The obstruction is most likely in the large intestine.
  • The obstruction is most likely in the stomach.
  • The location of the obstruction cannot be determined based on metabolic alkalosis alone.

A patient with a history of multiple surgeries is suspected of having ileus. What imaging study would be most appropriate to diagnose this condition?

  • Ultrasound
  • Barium enema
  • Magnetic Resonance Imaging (MRI)
  • Computed Tomography (CT) scan (correct)

In the context of ileus management, what is the primary purpose of placing a nasogastric (NG) tube to suction?

<p>To reduce abdominal distention and pressure (D)</p> Signup and view all the answers

Which of the following is NOT a potential complication of ileus?

<p>Stroke (C)</p> Signup and view all the answers

A patient with ileus is experiencing a potassium level of 2.1. What can you infer about the location and severity of the obstruction?

<p>The obstruction is most likely in the small intestine, and it is severe. (C)</p> Signup and view all the answers

What is the main goal of fluid resuscitation with potassium in a patient with ileus?

<p>To prevent dehydration and electrolyte imbalances (C)</p> Signup and view all the answers

A patient with ileus is having a bowel obstruction. What is the most likely cause of this obstruction?

<p>All of the above (D)</p> Signup and view all the answers

What is the purpose of placing an ostomy in a patient with ileus?

<p>To provide a temporary route for bowel drainage (A)</p> Signup and view all the answers

Which of the following nursing assessments would be MOST helpful in identifying a potential complication of ileus?

<p>Observing for changes in bowel sounds and urine output (B)</p> Signup and view all the answers

Flashcards

Inflammatory Bowel Disease

Chronic inflammation causing damage primarily in the intestines, notably Crohn’s disease and ulcerative colitis.

Ileus

A non-mechanical obstruction in the intestine often due to paralysis post-surgery.

Clinical Manifestations

Signs and symptoms that indicate a medical condition, including abdominal pain and distention.

Electrolyte Imbalances

Disruptions in the levels of minerals in the body, critical for nerve and muscle function.

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Metabolic Acidosis

A condition where the body produces excess acid or cannot remove it, often due to diarrhea.

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Septic Shock

A severe infection leading to dangerously low blood pressure and organ failure.

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NGT Suction

Nasogastric tube suctioning helps to remove stomach contents to prevent aspiration.

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Fluid Resuscitation

The process of replenishing bodily fluids lost due to dehydration or medical conditions.

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Ostomy

A surgical procedure creating an opening for waste removal from the body.

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Nursing Assessment

The process of evaluating a patient's health status through observation and questioning.

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Study Notes

Inflammatory Bowel Disease (IBD)

  • IBD (Crohn's disease and ulcerative colitis) causes constant inflammation in the body.
  • Results in damage to the small intestines and can leave scar tissue.
  • Ileus, a non-mechanical obstruction, can occur due to intestinal paralysis after surgery.

Clinical Manifestations

  • GI Symptoms: Distention (swelling), abdominal fullness (due to inability to pass gas), pain, cramping, breath odor, nausea, vomiting, diarrhea (early), constipation (late).
  • Other Symptoms: Fever, tachycardia (late - associated with strangulation).
  • Severe Cases: Septic shock.

Complications

  • Prevent Complications: Electrolyte imbalances, dehydration, intestinal perforation, infection, jaundice, obstructed blood supply to the intestine (leading to infection, tissue death, and sepsis), peritonitis.
  • Severe complications can lead to bowel death.

Patient Management and History

  • Patient History: Multiple surgeries are a significant factor.
  • Diagnostic Imaging: CT scan to evaluate potential complications.
  • Sign of Perforation: Absence of contrast on the CT scan.

Treatment

  • Initial Management: NPO (nothing by mouth), nasogastric tube (NGT) for suction, fluid resuscitation (with potassium replacement), surgery, ostomies, and parental nutrition.
  • IV Fluids: D5W, Normal Saline, Potassium (20%).

Post-Surgical Care and Healing

  • Ostomy placement: Required after some surgeries.

Assessing Tissue Perfusion

Metabolic Imbalances

  • Metabolic Acidosis: Associated with large volume diarrhea.
  • Metabolic Alkalosis: Often caused by prolonged vomiting.

Nursing Assessment and Management

  • Comprehensive Assessments: Pain, surgery history, vomit characteristics, medications, diet, bowel patterns.
  • Vital Signs monitoring: Tachycardia, fever.
  • Lab Values: Assessment of WBC count to evaluate for infection (elevated WBC suggests infection, potentially peritonitis).
  • Physical Exam: Tenderness, fever, peritonitis-related signs (infection symptoms).
  • Absent Bowel Sounds: A sign of possible obstruction.
  • Other Assessments: Changes in VS, elevated WBC, possible need for antibiotics.
  • Monitoring pt in hospital: Urine output, Creatinine (to assess kidney function). NG tube output monitoring.

Nursing Interventions

  • Post-Op: Maintain proper nasogastric tube placement and functions.
  • Small Bowel Obstruction: Leads to vomiting, metabolic alkalosis.
  • Small Bowel Obstruction (more subtle): Metabolic acidosis can occur.
  • Hypokalemia: Low potassium levels (2.1 mEq/L) can be a sign of a small bowel obstruction.

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