Interprofessional Care for IBD Management

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Questions and Answers

What is a primary role of the nurse in interprofessional care for IBD?

Conducting diagnostic tests

Performing surgical interventions

Providing patient education about disease management (correct)

Assessing the efficacy of medications

Which of the following tests is NOT typically used in the diagnosis of IBD?

Sigmoidoscopy

Colonoscopy

CT scan (correct)

Barium upper x-ray series

What is the leading indication for surgical intervention in Crohn disease?

Bowel obstruction (correct)

Hemorrhage

Abscess formation

Chronic inflammation

Which laboratory test result is typically elevated during periods of acute inflammation in IBD?

Sedimentation rate Signup and view all the answers

Which of the following complications may require surgical intervention in Crohn disease?

Internal fistula Signup and view all the answers

What is the typical treatment approach when surgery is required for IBD?

Resection of the affected bowel segment Signup and view all the answers

Which laboratory finding can indicate chronic inflammation in IBD?

Elevated liver enzymes Signup and view all the answers

Which dietary approach is NOT indicated for managing IBD?

High-fiber diet Signup and view all the answers

What is the primary purpose of a nutritionist collaborating with a patient's medical provider in the context of Crohn disease?

To maintain micronutrient, calorie, and protein needs Signup and view all the answers

What is a common method to maintain nutritional status during an acute exacerbation of Crohn disease?

Enteral or total parenteral nutrition (TPN) Signup and view all the answers

Which dietary approach may be prescribed to provide essential nutrients for patients with Crohn disease?

An elemental diet such as Ensure Signup and view all the answers

What risk is associated with total parenteral nutrition compared to enteral nutrition?

Higher risk of complications Signup and view all the answers

What should patients with IBD do regarding alternative therapies?

Discuss all potential therapies with their healthcare provider Signup and view all the answers

Which of the following self-care measures has been noted to help patients manage discomfort associated with IBD?

Mindfulness training and cognitive-behavioral therapy Signup and view all the answers

Why might the effectiveness and safety of most alternative therapies be limited in treating IBD?

Many alternatives interact with prescribed medications Signup and view all the answers

What is a common outcome for patients with IBD related to their quality of life?

Low quality of life due to stress and fatigue Signup and view all the answers

What is the surgical procedure of choice for extensive ulcerative colitis?

Total colectomy with ileal pouch–anal anastomosis (IPAA) Signup and view all the answers

What is the purpose of creating a temporary loop ileostomy after an IPAA procedure?

To facilitate healing of the anal anastomosis Signup and view all the answers

Which of the following is a key goal of pharmacologic therapy for inflammatory bowel disease (IBD)?

To control chronic intestinal inflammation and reduce relapses Signup and view all the answers

What might be a consequence of long-term corticosteroid therapy for IBD?

Increased risk of infection due to immune suppression Signup and view all the answers

What is a common treatment for bowel strictures?

Strictureplasty Signup and view all the answers

What is the main reason for considering a prophylactic total colectomy in patients with extensive ulcerative colitis?

To reduce risk of colon cancer Signup and view all the answers

In a continent ileostomy, how is stool managed?

It is drained through a nipple valve Signup and view all the answers

Which drug category is primarily used to induce remission during acute exacerbations of IBD?

Corticosteroids Signup and view all the answers

How is drug therapy for IBD typically administered?

Orally, subcutaneously, or intravenously Signup and view all the answers

What dietary management may help in reducing diarrhea for patients with IBD?

Eliminating milk and milk products Signup and view all the answers

In the event of having a temporary ileostomy, how long is it generally maintained before closure?

2 to 3 months Signup and view all the answers

What is a potential effect of antidiarrheal agents like loperamide in IBD patients?

They may slow GI motility and reduce diarrhea Signup and view all the answers

Why might some patients require a permanent ileostomy instead of IPAA?

Because of advanced age or obesity Signup and view all the answers

What is a common characteristic of ostomies?

They create an opening for fecal matter to exit the body Signup and view all the answers

What role does immunization play for pediatric IBD patients undergoing treatment with immunosuppressants?

Immunization schedules may need to be altered Signup and view all the answers

Study Notes

Interprofessional Care for Inflammatory Bowel Disease (IBD)

Diagnosis and extent of disease are established first
Supportive treatment with medications and dietary changes to reduce inflammation, promote healing, and reduce intestinal motility.
Surgical interventions are common to manage the disease and complications.
Nurses play a crucial role in patient education regarding disease management, diagnostic tests, and treatments.

Diagnostic Tests for IBD

Sigmoidoscopy, colonoscopy, and barium x-ray series used to assess bowel mucosa for IBD.
Stool examination for blood and mucus as well as stool cultures are used to rule out infections.
Complete Blood Count (CBC) with hemoglobin and hematocrit reveals anemia and leukocytosis.
Elevated sedimentation rate indicates acute inflammation.
Low serum albumin levels are caused by malabsorption, malnutrition, and protein loss.
Malabsorption leads to decreased folic acid and vitamin levels.
Elevated liver enzymes (ALT, alkaline phosphatase, AST, GGTP, LDH) and bilirubin levels suggest sclerosing cholangitis.

Surgical Intervention for IBD

Surgical procedures vary depending on the specific type of IBD and location of the bowel.
Procedures are performed when complications arise or conservative treatments prove ineffective.

Crohn Disease

Bowel obstruction is the most common indication for surgery.
Other complications requiring surgery include perforation, fistulas, abscesses, and perianal complications.
Resection of affected bowel with end-to-end anastomosis is the usual treatment.
Recurrence of disease is likely in other areas after bowel segment removal.
Risk of fistula formation is increased following surgery.
Stricturoplasty can be performed to relieve bowel strictures while preserving bowel length.

Ulcerative Colitis

Total colectomy may be necessary for extensive chronic UC to treat the disease, manage complications, and prevent colon cancer risk.
Ileal pouch-anal anastomosis (IPAA) is the preferred surgical procedure for extensive UC.
The procedure involves removal of the colon and rectum, creating a pouch from the ileum, and connecting it to the anal canal.
Temporary ileostomy is typically performed concurrently and maintained for 2-3 months to promote anal anastomosis healing.
Following ileostomy closure, patients experience 6-8 daily bowel movements through the anus.
Permanent ileostomy or continent ileostomy may be necessary in patients with limitations.

Ostomy Procedures

Surgically created connection between the intestine and abdominal wall for fecal passage.
The opening is called a stoma.

Types of Ostomy Procedures

Ileostomy: Created in the ileum and typically involves complete removal of the colon, rectum, and anus.
Temporary/Loop Ileostomy: Created for temporary fecal diversion for healing.
Continent Ileostomy: Internal reservoir with nipple valve for stool collection and drainage via catheter.

Pharmacologic Treatment

The goal of drug therapy is to rapidly treat acute inflammation, reduce relapse frequency, and control chronic inflammation.
Medications are administered orally, subcutaneously, or intravenously for systemic inflammation.
Time-release drugs can be administered orally for local treatment.
Rectal enemas are used for local inflammation reduction.

Drug Categories Used to Treat IBD

5-aminosalicylic acid derivatives
Corticosteroids
Biologic therapies
Janus-associated kinase inhibitors

Drug Therapy Management

Corticosteroids are used to reduce inflammation and induce remission during acute exacerbations.
Long-term low-dose corticosteroid therapy may be required to prevent relapse.
Antibiotic or antiprotozoal therapy may be used to treat intestinal abscesses or fistulas.
Antidiarrheal agents such as loperamide and diphenoxylate can help manage chronic diarrhea.
It is important to continue drug therapy even during asymptomatic periods.
Patients on immunosuppressive medications should avoid exposure to infectious diseases and report any symptoms or fevers to healthcare providers.
Immunization schedules for pediatric patients may need to be adjusted.

Nonpharmacologic Therapy

Dietary management is individualized to minimize antigen-induced immune activation.
Milk elimination may benefit some individuals.
Increased fiber intake can reduce diarrhea and alleviate rectal symptoms but should not be considered for patients with strictures.
Collaboration with a nutritionist is crucial for optimal micronutrient intake and calorie and protein sufficiency.
Bowel rest can be achieved by withholding all food during acute Crohn disease exacerbations.
Nutritional needs during this time are met via enteral or total parenteral nutrition (TPN).

Complementary Health Approaches

Limited evidence suggests that some probiotics may improve IBS symptoms, but further research is required.
Lack of research on the effectiveness and safety of alternative therapies, especially herbal supplements, limits their use by conventional practitioners.
Patients should inform healthcare providers about any integrative therapies considered.

Quality of Life Considerations

Poor quality of life is associated with increased stress levels, depression, and fatigue in patients with IBD.
Mindfulness training, cognitive-behavioral therapy, and stress management can improve quality of life.
Exercise, abdominal massage, and warm baths can help manage discomfort.

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Description

This quiz focuses on the interprofessional care strategies for managing Inflammatory Bowel Disease (IBD). It covers diagnostic tests, supportive treatments, and the crucial role of healthcare professionals, particularly nurses, in educating patients about IBD. Test your knowledge on the diagnosis, treatment modalities, and the roles of various healthcare providers in managing this condition.