Inflammatory Bowel Disease PDF

Inflammatory Bowel Disease Chapter 38 (4th ed.) NRSG 3013 Adapted by J. Black RN, BScN, MN Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Inflammatory Bowel Disease (IBD) vRegional enteritis (Crohn’s disease) vUlcerative colitis o See Table 3...

Inflammatory Bowel Disease Chapter 38 (4th ed.) NRSG 3013 Adapted by J. Black RN, BScN, MN Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Inflammatory Bowel Disease (IBD) vRegional enteritis (Crohn’s disease) vUlcerative colitis o See Table 38-5 for comparison Copyright © 2020 Wolters Kluwer All Rights Reserved Crohn’s Disease vA chronic, non-specific inflammatory bowel disorder of unknown origin that can affect any part of the GI tract from the mouth to the anus (gum to bum). Copyright © 2020 Wolters Kluwer All Rights Reserved Crohn’s Disease v Prolonged, variable course v Transmural thickening v Deep, penetrating granulomas v Affects primarily the ileum, ascending colon v Bleeding unusual, mild v Skip lesions - cobblestone v Fistulas common Copyright © 2020 Wolters Kluwer All Rights Reserved Copyright © 2020 Wolters Kluwer All Rights Reserved Ulcerative Colitis vCharacterized by inflammation and ulceration of the colon and rectum vMay occur at any age; peaks between 15 & 25 years. vAffects both genders; however, increased in females. vCommon in Jewish and upper/middle class urbanites. Copyright © 2020 Wolters Kluwer All Rights Reserved Ulcerative Colitis vExacerbations/remissions vMucosal ulcerations vAffects rectum, descending colon vBleeding may be severe vContinuous ulcerations/lesions Copyright © 2020 Wolters Kluwer All Rights Reserved Copyright © 2020 Wolters Kluwer All Rights Reserved Secondary Characteristics of IC v May be directly related to the colitis v May be non-specific complications mediated by a disturbance in the immune system v Joint o Arthritis; “Juvenile Arthritis” v Skin o Erythema nodosum; pyoderma gangrenosum; stomatitis v Malabsorption o Gallstones/kidney stone Copyright © 2020 Wolters Kluwer All Rights Reserved http://ibmi3.mf.uni-lj.si/mmd/derma/eng/sz-00/sldr00113.html http://hardinmd.lib.uiowa.edu/oa/pyoderma1.html Copyright © 2020 Wolters Kluwer All Rights Reserved Secondary Characteristics of IC vBlood o Anemia vEye o Conjunctivitis o Uveitis Copyright © 2020 Wolters Kluwer All Rights Reserved Characteristics of IBD vCharacterized by chronic, recurrent inflammation of the intestinal tract. vClinical manifestations are varied for both conditions. vLong periods of remission interspersed with episodes of acute inflammation. vBoth diseases can be debilitating. Copyright © 2020 Wolters Kluwer All Rights Reserved Causes vUnknown etiology, possible causes: o Infectious agent – viral/bacterial resulting from mucosal changes to the bowel o Autoimmune reactions – secondary response r/t other immune related disorders o Food allergies o Heredity or familial o No evidence of psychosomatic cause o Smoking Copyright © 2020 Wolters Kluwer All Rights Reserved Indications of IBD vFrequency, urgency of bowel movements vAbdominal discomfort vFatigue vWeight loss vMalnutrition vDehydration vElectrolyte imbalance Copyright © 2020 Wolters Kluwer All Rights Reserved Diagnostic Studies vLabs o CBC, LFTs, Lytes, BUN, creatinine o Inflammatory markers – ESR & C-reactive protein o Nutritional markers - albumin o Stool C&S, O&P Copyright © 2020 Wolters Kluwer All Rights Reserved Diagnostic Studies (cont.) vRadiology o Abdominal x-ray o Barium Contrast Studies o CT o MRI vEndoscopy vColonoscopy vProctoscopy Copyright © 2020 Wolters Kluwer All Rights Reserved Collaborative Goals vControl inflammation vPain & symptom management vOptimize nutrition vDecrease bowel movements to tolerable frequency vMaintain skin integrity vCombat infection vPromote healing - psychosocial Copyright © 2020 Wolters Kluwer All Rights Reserved Collaborative Interventions vRest the bowel vCorticosteroids vAntidiarrheals vImmunomodulators vAntispasmodics vBiologic therapies vBulking agent vSurgery vAminosalicylates vTotal Parenteral Nutrition vAntibiotics vIV Therapy Copyright © 2020 Wolters Kluwer All Rights Reserved Diet vOral fluids vLow residue vHigh protein vHigh calorie vVitamin supplements vIron supplements vAvoid foods that exacerbate symptoms Copyright © 2020 Wolters Kluwer All Rights Reserved Nursing Process---Assessment of the Patient With Inflammatory Bowel Disease vPerform health history to identify onset, duration, and characteristics of pain, diarrhea, urgency, tenesmus, nausea, anorexia, weight loss, bleeding, and family history vDiscuss dietary patterns, alcohol, caffeine, and nicotine use vAssess bowel elimination patterns and stool vPerform abdominal assessment Copyright © 2020 Wolters Kluwer All Rights Reserved Nursing Process---Diagnosis of the Patient With Inflammatory Bowel Disease vDiarrhea vAcute pain vDeficient fluid vImbalanced nutrition vActivity intolerance vAnxiety vIneffective coping vRisk for impaired skin integrity vRisk for ineffective therapeutic regimen management Copyright © 2020 Wolters Kluwer All Rights Reserved Collaborative Problems and Potential Complications vElectrolyte imbalance vCardiac dysrhythmias related to electrolyte imbalances vGI bleeding with fluid volume loss vPerforation of the bowel vFistula vToxic megacolon Copyright © 2020 Wolters Kluwer All Rights Reserved Toxic Megacolon vInvolves all layers vCongested, dull, opaque serosa +/- fibrinous exudate vThin friable wall vSevere mucosal ulceration vVascular engorgement Copyright © 2020 Wolters Kluwer All Rights Reserved http://www.medkaau.com/vb/showthread.php?t=8167 Copyright © 2020 Wolters Kluwer All Rights Reserved Nursing Process---Planning the Care of the Patient With Inflammatory Bowel Disease vMajor goals include attainment of normal bowel elimination patterns, relief of abdominal pain and cramping, prevention of fluid volume deficit, maintenance of optimal nutrition and weight, avoidance of fatigue, reduction of anxiety, promotion of effective coping, absence of skin breakdown, increased knowledge of disease process and therapeutic regimen, and avoidance of complications Copyright © 2020 Wolters Kluwer All Rights Reserved Maintaining Normal Elimination Pattern vIdentify relationship between diarrhea and food, activities, or emotional stressors vProvide ready access to bathroom or commode vEncourage bed rest to reduce peristalsis vAdminister medications as prescribed vRecord frequency, consistency, character, and amounts of stools Copyright © 2020 Wolters Kluwer All Rights Reserved Other Interventions vAssessment and treatment of pain and discomfort, anticholinergic medications before meals, analgesics, positioning, diversional activities, and prevention of fatigue vAssess fluid deficit, I&O, daily weight, symptoms of dehydration or fluid loss; encourage oral intake; and initiate measures to decrease diarrhea vProvide optimal nutrition; elemental feedings that are high in protein and low residue or PN may be needed vReduce anxiety, exhibit a calm manner, allow patient to express feelings, listen, and provide patient teaching Copyright © 2020 Wolters Kluwer All Rights Reserved Patient Teaching vUnderstanding of disease process vNutrition and diet vMedications vIleostomy care if applicable vSee Chart 38-5 Copyright © 2020 Wolters Kluwer All Rights Reserved The Patient With an Ileostomy vPreoperative care vPostoperative care vEmotional support vSkin and stoma care vIrrigation of a Kock pouch (continent ileostomy) vDiet and fluid intake vPrevention of complications vSee Chart 38-6 Copyright © 2020 Wolters Kluwer All Rights Reserved Continent Ileostomy (Kock Pouch) https://www.alilamedicalmedia.com/media/4fc96b12-0aa7-11e3-a25b-aba838d062d8-total-proctocolectomy-with-kock-pouch Copyright © 2020 Wolters Kluwer All Rights Reserved Reference vCawley, P. (2020). Management of patients with intestinal and rectal disorders. In M. El Hussein and J. Osuji (Eds.), Brunner & Suddarth's Canadian textbook of medical-surgical nursing (4th ed., pp. 997-1050). Wolters Kluwer. Copyright © 2020 Wolters Kluwer All Rights Reserved REVIEW QUESTIONS Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins vIn Crohn’s disease, the clusters of ulcerations on the intestinal mucosa have a ____________ appearance. A. Ulcerated B. Cobblestone C. Uniform D. Comminuted Copyright © 2020 Wolters Kluwer All Rights Reserved vWhich of the following is the most common cause of ulcerative colitis-related mortality? A. Colonic adenocarcinoma B. Perforated colon C. Toxic megacolon D. Colonic infarction Copyright © 2020 Wolters Kluwer All Rights Reserved vThe patient is postoperative day 3 after a colostomy. The nurse is changing the dressing and notes the stoma is dusky in colour. What might this indicate? A. This is a normal colour postoperatively. B. The patient’s oxygen saturation may be low. C. Circulation to the stoma is compromised. D. The stoma is blocked. Copyright © 2020 Wolters Kluwer All Rights Reserved vTrue or False? o The ileostomy patient with a Koch pouch will not need to use an external fecal collection bag. Copyright © 2020 Wolters Kluwer All Rights Reserved vWhich of the following is a main cause of Crohn’s Disease? A. Stressful life events. B. Unknown, but believed to be related to a bacterial infection. C. An underlying autoimmune disorder. D. H. pylori infection. Copyright © 2020 Wolters Kluwer All Rights Reserved vA 35 year old patient is experiencing severe malnourishment, ulcers in the mouth, diarrhea, and abdominal cramping in the right lower quadrant. Which disease would you suspect your patient has from these symptoms? A. Ulcerative colitis B. Appendicitis C. Diverticulitis D. Crohn’s disease Copyright © 2020 Wolters Kluwer All Rights Reserved vAs a patient undergoing treatment for Crohn’s Disease with flare ups related to different foods, which food should be avoided? A. Fresh salad B. Yogurt C. White rice D. Salmon Copyright © 2020 Wolters Kluwer All Rights Reserved vA patient is undergoing an acute exacerbation of inflammatory bowel disease. They are scheduled to receive total parenteral nutrition (TPN) and lipids. Which is most important when providing care for this patient as a practitioner? A. Monitor I & O continuously. B. Change the administration set every 48 hours. C. Monitor their blood glucose closely. D. Infuse the solution in the saphenous vein. Copyright © 2020 Wolters Kluwer All Rights Reserved vTrue or False? o Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and ulcer formation in the inner lining of the small intestine, specifically the terminal ileum. Copyright © 2020 Wolters Kluwer All Rights Reserved vYou're educating a group of outpatients about signs and symptoms of ulcerative colitis. Which of the following is NOT a typical sign and symptom of ulcerative colitis? A. Rectal bleeding B. Fistula C. Bloody diarrhea D. Anemia Copyright © 2020 Wolters Kluwer All Rights Reserved vA patient is newly diagnosed with mild ulcerative colitis. What type of anti-inflammatory medication is typically prescribed as first-line treatment for this condition? A. 5-Aminosalicylates (Sulfasalazine) B. Immunomodulators (Adalimumab) C. Corticosteroids (Prednisone) D. Immunosupressors (Azathioprine) Copyright © 2020 Wolters Kluwer All Rights Reserved v A patient is receiving treatment for ulcerative colitis by taking azathioprine. Which physician’s order would the nurse question if received? A. Ambulate the patient twice day B. Low-fiber and high-protein diet C. Administer varicella vaccine intramuscularly D. Administer calcium carbonate by mouth daily Copyright © 2020 Wolters Kluwer All Rights Reserved