Podcast
Questions and Answers
Which statement best differentiates Crohn’s Disease from Ulcerative Colitis?
Which statement best differentiates Crohn’s Disease from Ulcerative Colitis?
- Crohn’s disease involves patchy inflammation that affects all bowel layers. (correct)
- Ulcerative colitis typically spares the colon.
- Ulcerative colitis affects the entire gastrointestinal tract.
- Crohn’s disease only affects the rectum.
Select all common triggers or contributing factors for IBD:
Select all common triggers or contributing factors for IBD:
- Vitamin K deficiency
- Psychological stress (correct)
- Autoimmune dysfunction (correct)
- Bacterial infection (correct)
- Genetic predisposition (correct)
A patient recently diagnosed with IBD asks, 'Why did this happen to me?' Which is the nurse’s best response?
A patient recently diagnosed with IBD asks, 'Why did this happen to me?' Which is the nurse’s best response?
- You must have been eating an unhealthy diet.
- The cause is unknown, but genetics and immunity play a role. (correct)
- You probably caught it from someone with the disease.
- This condition usually happens due to bacterial food poisoning.
Which patient history should alert the nurse to a possible diagnosis of IBD?
Which patient history should alert the nurse to a possible diagnosis of IBD?
Which best describes the pathophysiology of ulcerative colitis?
Which best describes the pathophysiology of ulcerative colitis?
A patient with UC has blood in their stool. What explains this symptom?
A patient with UC has blood in their stool. What explains this symptom?
Which feature of Crohn’s disease leads to malnutrition?
Which feature of Crohn’s disease leads to malnutrition?
Which signs and symptoms are characteristic of Crohn’s disease?
Which signs and symptoms are characteristic of Crohn’s disease?
What structural change is unique to Crohn’s disease compared to UC?
What structural change is unique to Crohn’s disease compared to UC?
The nurse is assessing a client with IBD. Which finding indicates Crohn’s over UC?
The nurse is assessing a client with IBD. Which finding indicates Crohn’s over UC?
A provider orders a colonoscopy for a client suspected of having IBD. What priority action must the nurse take before the procedure?
A provider orders a colonoscopy for a client suspected of having IBD. What priority action must the nurse take before the procedure?
Which lab test is most indicative of active inflammation in a client with IBD?
Which lab test is most indicative of active inflammation in a client with IBD?
Which findings from diagnostic studies support a diagnosis of Crohn’s disease?
Which findings from diagnostic studies support a diagnosis of Crohn’s disease?
The nurse is reviewing stool studies for a client with chronic diarrhea. Which result would most support a diagnosis of IBD?
The nurse is reviewing stool studies for a client with chronic diarrhea. Which result would most support a diagnosis of IBD?
Which imaging study is most useful in identifying strictures or fistulas in Crohn’s disease?
Which imaging study is most useful in identifying strictures or fistulas in Crohn’s disease?
A client with IBD is prescribed mesalamine. What should the nurse teach the client about this medication?
A client with IBD is prescribed mesalamine. What should the nurse teach the client about this medication?
Which medications are commonly used in the management of IBD?
Which medications are commonly used in the management of IBD?
A patient on long-term corticosteroids for UC presents with weight gain and facial swelling. What is the nurse's best action?
A patient on long-term corticosteroids for UC presents with weight gain and facial swelling. What is the nurse's best action?
How do biologic therapies like infliximab work in IBD management?
How do biologic therapies like infliximab work in IBD management?
A patient with Crohn’s disease develops fever and malaise after starting infliximab. What complication is the nurse most concerned about?
A patient with Crohn’s disease develops fever and malaise after starting infliximab. What complication is the nurse most concerned about?
A client with Crohn’s disease is losing weight. What dietary recommendation should the nurse provide?
A client with Crohn’s disease is losing weight. What dietary recommendation should the nurse provide?
Which foods should be avoided by clients experiencing an IBD flare?
Which foods should be avoided by clients experiencing an IBD flare?
A patient with UC reports frequent diarrhea and weakness. What should the nurse monitor for?
A patient with UC reports frequent diarrhea and weakness. What should the nurse monitor for?
Which nonpharmacologic approach is most helpful in reducing IBD flare-ups related to stress?
Which nonpharmacologic approach is most helpful in reducing IBD flare-ups related to stress?
A nurse is counseling a client with newly diagnosed IBD. Which statement by the client requires follow-up?
A nurse is counseling a client with newly diagnosed IBD. Which statement by the client requires follow-up?
Which surgical procedure is most commonly performed for ulcerative colitis?
Which surgical procedure is most commonly performed for ulcerative colitis?
Which are potential complications of intestinal resection surgery for Crohn’s disease?
Which are potential complications of intestinal resection surgery for Crohn’s disease?
A patient is scheduled for a proctocolectomy with IPAA. Which information provided by the nurse demonstrates understanding of this procedure?
A patient is scheduled for a proctocolectomy with IPAA. Which information provided by the nurse demonstrates understanding of this procedure?
Which nursing interventions are appropriate for a client with a new ileostomy?
Which nursing interventions are appropriate for a client with a new ileostomy?
The nurse assesses a pale, dusky stoma 6 hours post-op. What should the nurse do first?
The nurse assesses a pale, dusky stoma 6 hours post-op. What should the nurse do first?
A client with Crohn’s disease develops a bowel obstruction. Which surgical intervention is most likely?
A client with Crohn’s disease develops a bowel obstruction. Which surgical intervention is most likely?
What is the main purpose of a temporary ileostomy after intestinal resection?
What is the main purpose of a temporary ileostomy after intestinal resection?
A client asks, 'Will I be able to control bowel movements after IPAA surgery?' What’s the best response?
A client asks, 'Will I be able to control bowel movements after IPAA surgery?' What’s the best response?
Postoperative nursing priorities for a client after bowel surgery include:
Postoperative nursing priorities for a client after bowel surgery include:
A client is recovering from bowel resection and reports increasing abdominal pain, fever, and guarding. What should the nurse suspect?
A client is recovering from bowel resection and reports increasing abdominal pain, fever, and guarding. What should the nurse suspect?
Preoperative teaching for IBD surgery should include which priority content?
Preoperative teaching for IBD surgery should include which priority content?
Which are key post-op nursing actions after bowel surgery?
Which are key post-op nursing actions after bowel surgery?
Which outcome indicates effective nursing care for a client with active IBD?
Which outcome indicates effective nursing care for a client with active IBD?
Which nursing assessments are important in a client hospitalized with an IBD flare?
Which nursing assessments are important in a client hospitalized with an IBD flare?
A client receiving immunosuppressants asks about infection risk. What teaching should the nurse provide?
A client receiving immunosuppressants asks about infection risk. What teaching should the nurse provide?
A nurse notices a client with UC is increasingly fatigued and pale. Which lab value should be assessed first?
A nurse notices a client with UC is increasingly fatigued and pale. Which lab value should be assessed first?
Which are appropriate teaching points for a client being discharged with IBD?
Which are appropriate teaching points for a client being discharged with IBD?
What is the best indicator that the client's nutritional status is improving?
What is the best indicator that the client's nutritional status is improving?
A client with Crohn’s is admitted with fatigue and numbness in the hands. Which deficiency is most likely?
A client with Crohn’s is admitted with fatigue and numbness in the hands. Which deficiency is most likely?
Which nursing diagnosis is most appropriate for a client with frequent diarrhea due to IBD?
Which nursing diagnosis is most appropriate for a client with frequent diarrhea due to IBD?
Flashcards
Crohn's Disease vs. Ulcerative Colitis
Crohn's Disease vs. Ulcerative Colitis
Crohn's affects the entire GI tract wall with patchy inflammation.
IBD Triggers/Contributing Factors
IBD Triggers/Contributing Factors
Autoimmune dysfunction, genetic predisposition, psychological stress, and bacterial infections.
Cause of IBD
Cause of IBD
Autoimmune dysfunction in genetically susceptible individuals, triggered by environmental or infectious factors.
Signs of IBD
Signs of IBD
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Ulcerative Colitis Pathophysiology
Ulcerative Colitis Pathophysiology
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Blood in Stool with Ulcerative Colitis
Blood in Stool with Ulcerative Colitis
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Crohn's Disease and Malnutrition
Crohn's Disease and Malnutrition
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Characteristics of Crohn's Disease
Characteristics of Crohn's Disease
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Unique Structural Change in Crohn's
Unique Structural Change in Crohn's
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Crohn's vs. Ulcerative Colitis (Location)
Crohn's vs. Ulcerative Colitis (Location)
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Colonoscopy Prep for IBD
Colonoscopy Prep for IBD
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Lab Test for Inflammation in IBD
Lab Test for Inflammation in IBD
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Diagnostic Findings for Crohn's
Diagnostic Findings for Crohn's
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Stool Study Finding in IBD
Stool Study Finding in IBD
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Imaging for Strictures/Fistulas in Crohn's
Imaging for Strictures/Fistulas in Crohn's
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Mesalamine Action
Mesalamine Action
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Common Medications in IBD Management
Common Medications in IBD Management
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Long-Term Corticosteroids and UC
Long-Term Corticosteroids and UC
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Biologic Therapies (Infliximab) in IBD
Biologic Therapies (Infliximab) in IBD
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Infliximab Complication
Infliximab Complication
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Study Notes
Introduction to IBD & Etiology
- Crohn's disease involves patchy inflammation affecting all bowel layers
- Ulcerative Colitis (UC) is continuous and affects the mucosal layer of the colon and rectum
- IBD triggers include autoimmune dysfunction, genetic predisposition, psychological stress, and bacterial infection
- Vitamin K deficiency is not a direct trigger
IBD & Symptoms
- IBD is linked to autoimmune dysfunction in genetically susceptible individuals
- Environmental or infectious factors often trigger IBD
- Chronic diarrhea, fatigue, abdominal pain, and unintentional weight loss can indicate IBD
- Ulcerative colitis involves continuous inflammation of the mucosal layer of the colon, typically starting in the rectum
- Blood in the stool of a UC patient is caused by erosion of the mucosal lining in the colon
- Crohn’s disease can lead to malnutrition due to small intestine involvement and impaired nutrient absorption
Crohn's Disease: Signs, Symptoms & Diagnosis
- RLQ abdominal pain, steatorrhea, and cobblestone appearance of bowel mucosa are common signs
- Constipation and bloody diarrhea alone are less typical symptoms
- Cobblestoning of the intestinal mucosa is a structural change unique to Crohn’s
- Crohn’s disease is characterized by segmental inflammation throughout the GI tract
- A colonoscopy requires proper bowel preparation for visualizing the intestinal mucosa
- Elevated ESR (erythrocyte sedimentation rate) is indicative of active inflammation in IBD
Diagnostic Findings of Crohn's Disease
- Skip lesions on colonoscopy
- Elevated C-reactive protein
- Cobblestone appearance on imaging are all important indicators
- Positive occult blood in stool can occur in both UC and Crohn's due to mucosal ulceration
- CT enterography is useful for identifying strictures or fistulas in Crohn’s disease
Pharmacologic and Nonpharmacologic IBD Therapy
- Mesalamine reduces intestinal inflammation
- Corticosteroids, immunosuppressants and biologics are commonly used medications for IBD management
- Long-term use of corticosteroids can cause Cushingoid features and requires education
- Biologic therapies like infliximab block tumor necrosis factor-alpha (TNF-α) to reduce inflammation
- Biologic therapies suppress the immune system, increasing the risk of reactivating latent infections like tuberculosis or hepatitis
- IBD clients need a high-protein, high-calorie diet because of malabsorption and increased metabolic demands
- Dairy, spicy foods, and high-fiber vegetables should be avoided during IBD flares
- Lean meats and white rice are generally tolerated.
IBD & Nursing Management
- Frequent diarrhea can cause significant potassium losses and hypokalemia that leads to muscle weakness and arrhythmias
- Deep breathing exercises are helpful for reducing IBD flare-ups related to stress
- Raw vegetables may exacerbate symptoms during flares
- Cooking vegetables or following a low-residue diet is often better tolerated
Surgical Interventions for IBD
- Proctocolectomy with IPAA is the most common surgery for UC by removing the colon and rectum and replacing them with a J-pouch from the ileum to allow for natural defecation
- Intestinal resection postoperative complications for Crohn’s include strictures, fistulas, bowel obstruction, and short bowel syndrome
- The J-pouch in proctocolectomy is formed from the ileum and attached to the anus, allowing stool passage without a permanent stoma
Ileostomy & Postoperative Care
- Ileostomies require close monitoring for dehydration and stoma function
- High-fiber foods and fluid restriction are inappropriate early post-op
- A dusky or pale stoma may indicate compromised blood flow and requires immediate notification of a surgeon
- Intestinal resection with anastomosis removes obstructed or diseased bowel segments in Crohn’s
- Temporary ileostomies divert fecal content to allow surgical sites to heal without contamination
- IPAA allows for relatively normal bowel function and control
- Frequency may be increased
- Postoperative nursing priorities involve monitoring for peritonitis
- Encouraging early ambulation
- Assessing bowel sounds and output
- Monitoring for infection and leakage at the anastomosis site
- Increasing abdominal pain, fever, and guarding can indicate peritonitis
Nursing Actions for IBD
- Preoperative teaching includes post-op mobility and stoma expectations in order to reduce anxiety
- Pulmonary hygiene, pain control, and mobility are key post-op care elements
- Bedrest increases the risk for complications, so should be avoided if possible
- Effective nursing care results in a decrease in symptoms and stable nutritional status
- Important assessments include bowel sounds, stool characteristics, skin integrity, mood and coping
- Bone density testing is not acute
- Immunosuppressed clients should avoid crowded places and sick contacts to prevent infection
IBD & Related Conditions
- Fatigue and pallor suggest anemia commonly caused by chronic blood loss
- Crohn’s may affect the terminal ileum where B12 is absorbed, which causes neurologic symptoms
- Monitoring and recording bowel movements, stress reduction and adherence to prescribed medications
- Nutritional improvement is reflected by weight stabilization and energy return
- Fluid losses from diarrhea lead to deficient fluid volume
- This is a critical nursing concern
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