Nutrition Therapy for IBD Patients
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Questions and Answers

What is the primary reason why individualized diets are important for patients with IBD?

  • To ensure adequate nutrition without worsening symptoms. (correct)
  • To improve appetite and increase food intake.
  • To eliminate the need for medical interventions.
  • To prevent exposure to common allergens.

    • Which of the following nutrients is frequently deficient in patients with IBD due to impaired absorption in the terminal ileum?

  • Calcium
  • Vitamin D
  • Cobalamin (correct)
  • Vitamin A

    • What is a key factor that may lead to iron deficiency anemia in patients with IBD?

  • Blood loss and malabsorption (correct)
  • Overconsumption of fatty foods
  • Increased appetite due to medications
  • Excessive vitamin C intake

    • Which intervention is preferred for supporting nutrition during an acute exacerbation of IBD?

    <p>Liquid enteral feedings (C)</p> Signup and view all the answers

    What effect do inflammatory mediators have on appetite in IBD patients?

    <p>They reduce appetite. (C)</p> Signup and view all the answers

    Which supplement is recommended for patients taking sulfasalazine or methotrexate to prevent nutrient deficiency?

    <p>Folate (folic acid) (A)</p> Signup and view all the answers

    What role do bile salts play in the body that is specifically affected in patients with IBD?

    <p>They aid in fat absorption. (B)</p> Signup and view all the answers

    What should patients with IBD do to help identify which foods may exacerbate their symptoms?

    <p>Maintain a food diary. (A)</p> Signup and view all the answers

    What is the potential consequence of corticosteroid use in patients with IBD regarding bone health?

    <p>Bone fractures due to osteoporosis (C)</p> Signup and view all the answers

    Which nutrient might be required as a supplement due to the gastrointestinal losses from diarrhea in IBD patients?

    <p>Zinc (D)</p> Signup and view all the answers

    Which of the following statements accurately describes nutritional concerns for patients with inflammatory bowel disease (IBD)?

    <p>Nutrient deficiencies may occur due to chronic diarrhea. (B)</p> Signup and view all the answers

    In planning care for an IBD patient, which goal is most crucial during the acute phase?

    <p>Focus on maintaining hemodynamic stability and hydration. (C)</p> Signup and view all the answers

    Which of the following factors could complicate the diagnosis of IBD in older adults?

    <p>Confusion with infections like CDI or diverticulitis. (B)</p> Signup and view all the answers

    Which symptom is most commonly associated with the cognitive-perceptual pattern in IBD patients?

    <p>Lower abdominal pain, especially before defecation. (D)</p> Signup and view all the answers

    What is the primary focus of ambulatory care for a patient with IBD?

    <p>Helping the patient cope with the chronicity of the condition. (A)</p> Signup and view all the answers

    Which of the following practices is essential in managing skin care for IBD patients?

    <p>Maintaining meticulous perianal skincare with plain water. (C)</p> Signup and view all the answers

    What should be monitored to assess the hydration state of an IBD patient?

    <p>Serum electrolytes and vital signs. (C)</p> Signup and view all the answers

    Which symptom might indicate an acute exacerbation of IBD?

    <p>Onset of severe abdominal cramps. (A)</p> Signup and view all the answers

    Which intervention is critical for supporting an IBD patient’s mental health?

    <p>Helping patients establish realistic goals. (C)</p> Signup and view all the answers

    What is a common diagnostic finding in IBD patients?

    <p>Anemia and electrolyte imbalance. (B)</p> Signup and view all the answers

    Flashcards

    Goals of diet management

    To provide nutrition without worsening symptoms, correct malnutrition, replace losses, and prevent weight loss.

    Malnutrition in IBD

    Many patients with IBD are malnourished due to decreased intake, blood loss, or impaired absorption.

    Individualized diet

    A personalized diet plan is crucial for managing IBD adequately.

    Iron deficiency anemia

    A common problem in IBD, often needing oral or IV iron supplements.

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    Zinc deficiency causes

    Can result from ostomies or diarrhea, potentially requiring supplementation.

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    Cobalamin absorption

    Reduced absorption can occur in IBD, leading to anemia; injections may be necessary.

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    Role of bile salts

    Important for fat absorption; insufficient bile salts may cause osmotic diarrhea.

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    Liquid enteral feedings

    Preferred during acute exacerbation of IBD to provide nutrition without causing gut atrophy.

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    Food diaries for IBD

    Helps patients identify food triggers that worsen symptoms or cause diarrhea.

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    Folic acid for IBD patients

    Patients on sulfasalazine or methotrexate should take folate daily to prevent deficiency.

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    Clinical Problems of IBD

    Common issues faced by patients with IBD include bowel elimination issues, nutritional deficiencies, coping difficulties, and pain.

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    Subjective Data in IBD

    Patient-reported symptoms include fatigue, nausea, diarrhea, and abdominal pain.

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    Objective Data in IBD

    Clinically observed signs include fever, weight loss, and abnormal bowel sounds.

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    Goals for IBD Management

    Goals include fewer flare-ups, normal fluid balance, pain relief, and improved nutrition.

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    Acute Care for IBD

    Focus during acute phase on hemodynamic stability, pain control, and nutrition.

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    IV Fluids in IBD Treatment

    Administering IV fluids is crucial for hydration and electrolyte balance in IBD patients.

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    Perianal Care in IBD

    Meticulous skin care around the anus is essential to prevent breakdown and irritation.

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    Chronicity of IBD

    IBD is a lifelong condition requiring ongoing management and support.

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    Coping Strategies for IBD

    Patients need to develop ways to manage stress and cope with illness fluctuations.

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    Gerontologic Considerations in IBD

    Older patients face unique challenges, such as higher risks of complications and difficulty in diagnosis.

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    Study Notes

    IBD Nutrition Therapy Goals

    • Diet management aims to provide adequate nutrition without worsening symptoms, correct and prevent malnutrition, replace fluid and electrolyte losses, and prevent weight loss.
    • Individualized diets are crucial for IBD patients, many of whom are malnourished.
    • A balanced diet with sufficient calories, protein, and nutrients is essential. Consult a dietitian for personalized dietary recommendations.

    Nutrition Problems in IBD

    • Decreased oral intake, blood loss, and impaired absorption (depending on inflammation location) contribute to nutrition problems.
    • Patients may reduce food intake to manage diarrhea, due to inflammatory mediators reducing appetite.
    • Blood loss and malabsorption lead to Iron Deficiency Anemia (IDA), requiring oral or IV iron supplements.
    • Ostomies or diarrhea can cause zinc deficiency, potentially necessitating zinc supplementation.

    Specific Nutrient Deficiencies and Management

    • Terminal ileum disease reduces cobalamin and bile acid absorption, contributing to anemia.
    • Cobalamin injections are needed for those with cobalamin deficiency-related anemia.
    • Bile salts are vital for fat absorption and can contribute to osmotic diarrhea.
    • Cholestyramine (an ion-exchange resin) can bind to unabsorbed bile salts, managing diarrhea.
    • Patients taking sulfasalazine or methotrexate need daily folate supplementation.
    • Corticosteroid use increases osteoporosis risk, requiring calcium supplementation and sometimes potassium.

    Nutritional Support During Acute Exacerbation

    • Liquid enteral feedings (EN) are preferred over parenteral nutrition (PN) due to potential GI tract atrophy or bacterial overgrowth during acute exacerbation.
    • EN provides high calories and nutrients, is lactose-free, easily absorbed, and enhances achieving remission and improving nutritional status.

    Food Triggers and Dietary Management in IBD

    • No universal food triggers exist for IBD, but some individuals may be sensitive to certain foods causing diarrhea.
    • A food diary helps identify problematic foods to avoid or limit.
    • Limiting or avoiding foods causing GI distress or worsening symptoms is typical.

    Nursing Management of IBD

    • Assessment: Comprehensive assessment includes subjective (medical history, medications, family history, symptoms) and objective (physical examination, lab values, diagnostic imaging) data. Clinical problems include impaired bowel elimination, nutritional compromise, difficulty coping, and pain.
    • Planning: Main goals focus on fewer/less severe exacerbations, normal fluid/electrolyte balance, pain/discomfort freedom, adherence to regimens, nutrition balance, improved quality of life.
    • Implementation: Acute Care: Hemodynamic stability, pain control, fluid/electrolyte balance, and nutritional support are crucial; intake/output monitoring, stool assessment, IV fluids/electrolytes/analgesics, anti-inflammatories, and monitoring vitals/labs critical. Perianal care is needed; focus on maintaining cleanliness, dryness, and odor control; use a humidifier or deodorizer, apply plain water and a moisturizing cream; consider Dibucaine, witch hazel, sitz baths.
    • Implementation: Postoperative Care: Follow guidelines similar to those for bowel resection and ostomy surgeries in Chapter 20.
    • Implementation: Ambulatory Care: Support patient understanding chronic nature for IBD; teaching on rest, diet management, perianal care, med side effects, recurrence symptoms, seeking care, and stress management; establish rapport and encourage self-care; talk with smokers about cessation and explain procedures and treatments.

    Importance of Coping and Support

    • Teach effective coping strategies for dealing with chronic, unpredictable nature of the illness, including rest, diet management, and stress reduction. Recommend support groups like the Crohn's and Colitis Foundation of America.

    Evaluation Criteria

    • Expected outcomes include reduced diarrhea frequency, maintenance of healthy body weight, absence of pain/discomfort, and use of effective coping mechanisms.

    Geriatric Considerations

    • IBD incidence spikes in the 6th decade.
    • Proctitis and left-sided ulcerative colitis are more common in older patients.
    • IBD diagnosis can be challenging in older adults, easily confused with other conditions like CDI, diverticulitis, or colitis.
    • Treatment is similar but adverse drug events, hospitalization, and mortality risk are higher in older adults.
    • Immunomodulators and biologics have a higher risk for infection and cancer in older adults. Anemia and malnutrition are more prevalent. Volume depletion risk from diarrhea is an important concern. Physical limitations may hinder fecal urgency management.

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    Description

    This quiz focuses on the nutrition therapy goals for individuals with Inflammatory Bowel Disease (IBD). It explores the importance of individualized diets, common nutritional problems, and specific nutrient deficiencies faced by these patients. Understanding these aspects is crucial for managing IBD effectively and ensuring proper nutrition.

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