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Questions and Answers
What is a common characteristic of Crohn disease in children compared to adults?
What is a common characteristic of Crohn disease in children compared to adults?
- Children typically experience stricturing disease more frequently.
- Children usually present with inflammatory or nonstricturing, nonpenetrating disease. (correct)
- Children are more likely to present with fistulizing disease.
- Children often have terminal ileal disease without colonic involvement.
What is the primary objective in managing pediatric ulcerative colitis (UC) and Crohn disease?
What is the primary objective in managing pediatric ulcerative colitis (UC) and Crohn disease?
- To increase the frequency of infections for better immunity.
- To perform early surgical interventions.
- To induce and maintain disease remission. (correct)
- To reduce the need for hospitalization.
How does the presentation of pancolitis in children typically differ from that in adults?
How does the presentation of pancolitis in children typically differ from that in adults?
- Pediatric pancolitis presents with more frequent colonic polyps.
- Pediatric pancolitis is usually more aggressive. (correct)
- Pediatric pancolitis is generally less aggressive.
- Pediatric pancolitis often requires surgery much later.
What factor is NOT considered when determining the treatment plan for pediatric IBD?
What factor is NOT considered when determining the treatment plan for pediatric IBD?
In which area do children with IBD typically show greater complication rates?
In which area do children with IBD typically show greater complication rates?
What is the primary route of administration for integrin antagonists?
What is the primary route of administration for integrin antagonists?
Which side effect is NOT typically associated with integrin antagonists?
Which side effect is NOT typically associated with integrin antagonists?
What specific type of vaccines should patients on ustekinumab avoid?
What specific type of vaccines should patients on ustekinumab avoid?
What is one of the primary monitoring concerns for patients taking Janus-associated kinase inhibitors?
What is one of the primary monitoring concerns for patients taking Janus-associated kinase inhibitors?
Which of the following is a common side effect for ustekinumab administration?
Which of the following is a common side effect for ustekinumab administration?
Which of the following statements about 5-ASA derivatives is true?
Which of the following statements about 5-ASA derivatives is true?
What is a primary nursing consideration when administering sulfasalazine?
What is a primary nursing consideration when administering sulfasalazine?
What side effect should be closely monitored when administering corticosteroids?
What side effect should be closely monitored when administering corticosteroids?
Which administration method is used for biologic therapies such as TNF inhibitors?
Which administration method is used for biologic therapies such as TNF inhibitors?
What should be evaluated to determine the therapeutic response of 5-ASA derivatives?
What should be evaluated to determine the therapeutic response of 5-ASA derivatives?
What is a possible effect of biologic therapies that requires monitoring?
What is a possible effect of biologic therapies that requires monitoring?
Which assessment is critical before administering oral forms of 5-ASA derivatives?
Which assessment is critical before administering oral forms of 5-ASA derivatives?
Which form of administration is recommended for retention enemas of 5-ASA derivatives?
Which form of administration is recommended for retention enemas of 5-ASA derivatives?
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Study Notes
IBD in Children
- 20–30% of IBD cases start before age 20.
- Childhood IBD is often more severe, extensive, and has more complications.
- Crohn's disease affects more boys than girls, while ulcerative colitis affects both genders equally.
Location of Disease
- Adults with Crohn's disease usually present with terminal ileal disease, while children are more likely to have ileocolonic or colonic disease.
- This increased involvement in children leads to a higher incidence of hematochezia (blood in stool).
- Children with Crohn's disease often present with inflammatory or non-stricturing, non-penetrating disease, while adults typically present with fistulizing or stricturing disease.
- Children with ulcerative colitis often present with pancolitis, while adults are more likely to have left-sided colitis.
- Pediatric pancolitis is generally more aggressive, and surgery is often required earlier for children than adults.
Management of Pediatric IBD
- The goal of management in pediatric IBD is to induce and maintain disease remission.
- Treatment approaches are tailored to disease severity, location, phenotype, child's age (considering growth effects), psychosocial status, and family support.
- Medications used are the same as those used in adults, but dosages are adjusted for children.
5-Aminosalicylic Acid (5-ASA) Derivatives
- Reduce inflammation in the intestine by inhibiting leukotrienes and tumor necrosis factor
- Available in oral, enema, and suppository forms.
- Metabolized by bacteria in the intestines to an active drug form that acts locally
- Contraindications: History of sulfonamide or salicylate hypersensitivity, intestinal or urinary tract obstruction.
- Potential Adverse Effects: Headache, diarrhea, dizziness, rhinitis, sinusitis, skin rash, and pruritus.
- Nursing Considerations: Assess for contraindications, monitor renal and liver function, and CBC. Administer oral forms with water, suppositories or enemas should be administered at bedtime.
Corticosteroids
- Suppress immune system activity and leukocyte migration.
- Available in oral and enema formulations.
- Nursing Considerations: Monitor for signs of headache, acne, infections, and Cushing disease. Follow tapering dose as prescribed.
Biologic Therapies - Tumor Necrosis Factor (TNF) Inhibitors
- Interrupt TNFα to suppress inflammation in the intestine.
- Monoclonal antibodies administered subcutaneously.
- Nursing Considerations: Monitor for signs of infection or cancer, as these are immunosuppressant drugs. Potential side effects include headache, skin rash, positive ANA titer, and increased creatine phosphokinase.
Integrin Antagonists (Alpha-4 Integrin Inhibitors)
- Prevent leukocyte migration to the intestine by binding to the adhesion molecule Alpha-4 integrin.
- Monoclonal antibodies administered intravenously.
- Nursing Considerations: Monitor for signs of infection, due to immunosuppressive effects. Potential side effects include headache, nausea, fatigue, depression, and skin rash.
Interleukin-12/23 Inhibitors
- Block the activation of natural killer cells and TNF by inhibiting the inflammatory substances interleukin-12 and interleukin-23.
- Administered subcutaneously.
- Nursing Considerations: Monitor for infections, especially TB and fungal infections. Potential side effects include headache, nausea, fatigue, depression, and skin itching. Educate patients about vaccines; they should not receive any live vaccines while on ustekinumab and nonlive vaccines may not be effective.
Janus-Associated Kinase Inhibitors
- Inhibit intracellular JAK enzymes, which regulate immune cells, natural killer cells, immunoglobulins, and B cells.
- Administered orally.
- Nursing Considerations: Monitor for side effects of infection.
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