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Questions and Answers
What is a primary role of the nurse in interprofessional care for IBD?
Which of the following tests is NOT typically used in the diagnosis of IBD?
What is the leading indication for surgical intervention in Crohn disease?
Which laboratory test result is typically elevated during periods of acute inflammation in IBD?
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Which of the following complications may require surgical intervention in Crohn disease?
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What is the typical treatment approach when surgery is required for IBD?
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Which laboratory finding can indicate chronic inflammation in IBD?
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Which dietary approach is NOT indicated for managing IBD?
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What is the primary purpose of a nutritionist collaborating with a patient's medical provider in the context of Crohn disease?
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What is a common method to maintain nutritional status during an acute exacerbation of Crohn disease?
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Which dietary approach may be prescribed to provide essential nutrients for patients with Crohn disease?
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What risk is associated with total parenteral nutrition compared to enteral nutrition?
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What should patients with IBD do regarding alternative therapies?
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Which of the following self-care measures has been noted to help patients manage discomfort associated with IBD?
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Why might the effectiveness and safety of most alternative therapies be limited in treating IBD?
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What is a common outcome for patients with IBD related to their quality of life?
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What is the surgical procedure of choice for extensive ulcerative colitis?
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What is the purpose of creating a temporary loop ileostomy after an IPAA procedure?
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Which of the following is a key goal of pharmacologic therapy for inflammatory bowel disease (IBD)?
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What might be a consequence of long-term corticosteroid therapy for IBD?
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What is a common treatment for bowel strictures?
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What is the main reason for considering a prophylactic total colectomy in patients with extensive ulcerative colitis?
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In a continent ileostomy, how is stool managed?
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Which drug category is primarily used to induce remission during acute exacerbations of IBD?
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How is drug therapy for IBD typically administered?
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What dietary management may help in reducing diarrhea for patients with IBD?
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In the event of having a temporary ileostomy, how long is it generally maintained before closure?
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What is a potential effect of antidiarrheal agents like loperamide in IBD patients?
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Why might some patients require a permanent ileostomy instead of IPAA?
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What is a common characteristic of ostomies?
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What role does immunization play for pediatric IBD patients undergoing treatment with immunosuppressants?
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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.
