Inflammatory Bowel Disease (IBD) - Week 5

# Inflammatory Bowel Disease ## Inflammatory Bowel Disease (IBD) - Regional enteritis (Crohn's disease) - Ulcerative colitis - See Table 38-5 for comparison ## Crohn's Disease - A chronic, non-specific inflammatory bowel disorder of unknown origin that can affect any part of the GI tract fro...

# Inflammatory Bowel Disease ## Inflammatory Bowel Disease (IBD) - Regional enteritis (Crohn's disease) - Ulcerative colitis - See Table 38-5 for comparison ## Crohn's Disease - A 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). - Prolonged, variable course - Transmural thickening - Deep, penetrating granulomas - Affects primarily the ileum, ascending colon - Bleeding unusual, mild - Skip lesions - cobblestone - Fistulas common **Image: Endoscopic view of the ileum showing ulcerations due to Crohn's disease.** ## Ulcerative Colitis - Characterized by inflammation and ulceration of the colon and rectum - May occur at any age; peaks between 15 & 25 years - Affects both genders; however, increased in females. - Common in Jewish and upper/middle class urbanites. - Exacerbations/remissions - Mucosal ulcerations - Affects rectum, descending colon - Bleeding may be severe - Continuous ulcerations/lesions **Image: Endoscopic view of the colon showing ulcerations due to ulcerative colitis.** ## Secondary Characteristics of IC - May be directly related to the colitis - May be non-specific complications mediated by a disturbance in the immune system - Joint - Arthritis; "Juvenile Arthritis" - Skin - Erythema nodosum; pyoderma gangrenosum; stomatitis - Malabsorption - Gallstones/kidney stone **Image: Erythema nodosum** **Image: Pyoderma gangrenosum** ## Secondary Characteristics of IC - Blood - Anemia - Eye - Conjunctivitis - Uveitis ## Characteristics of IBD - Characterized by chronic, recurrent inflammation of the intestinal tract. - Clinical manifestations are varied for both conditions. - Long periods of remission interspersed with episodes of acute inflammation. - Both diseases can be debilitating. ## Causes - Unknown etiology, possible causes: - Infectious agent - viral/bacterial resulting from mucosal changes to the bowel - Autoimmune reactions - secondary response r/t other immune related disorders - Food allergies - Heredity or familial - No evidence of psychosomatic cause - Smoking ## Indications of IBD - Frequency, urgency of bowel movements - Abdominal discomfort - Fatigue - Weight loss - Malnutrition - Dehydration - Electrolyte imbalance ## Diagnostic Studies - Labs - CBC, LFTs, Lytes, BUN, creatinine - Inflammatory markers - ESR & C-reactive protein - Nutritional markers - albumin - Stool C&S, O&P - Radiology - Abdominal x-ray - Barium Contrast Studies - CT - MRI - Endoscopy - Colonoscopy - Proctoscopy ## Collaborative Goals - Control inflammation - Pain & symptom management - Optimize nutrition - Decrease bowel movements to tolerable frequency - Maintain skin integrity - Combat infection - Promote healing - psychosocial ## Collaborative Interventions - Rest the bowel - Antidiarrheals - Antispasmodics - Bulking agent - Aminosalicylates - Antibiotics - Corticosteroids - Immunomodulators - Biologic therapies - Surgery - Total Parenteral Nutrition - IV Therapy ## Diet - Oral fluids - Low residue - High protein - High calorie - Vitamin supplements - Iron supplements - Avoid foods that exacerbate symptoms ## Nursing Process - Assessment of the Patient With Inflammatory Bowel Disease - Perform health history to identify onset, duration, and characteristics of pain, diarrhea, urgency, tenesmus, nausea, anorexia, weight loss, bleeding, and family history - Discuss dietary patterns, alcohol, caffeine, and nicotine use - Assess bowel elimination patterns and stool - Perform abdominal assessment ## Nursing Process - Diagnosis of the Patient With Inflammatory Bowel Disease - Diarrhea - Acute pain - Deficient fluid - Imbalanced nutrition - Activity intolerance - Anxiety - Ineffective coping - Risk for impaired skin integrity - Risk for ineffective therapeutic regimen management ## Collaborative Problems and Potential Complications - Electrolyte imbalance - Cardiac dysrhythmias related to electrolyte imbalances - GI bleeding with fluid volume loss - Perforation of the bowel - Fistula - Toxic megacolon ## Toxic Megacolon - Involves all layers - Congested, dull, opaque serosa +/- fibrinous exudate - Thin friable wall - Severe mucosal ulceration - Vascular engorgement **Image: Diagram showing toxic megacolon.** ## Nursing Process - Planning the Care of the Patient With Inflammatory Bowel Disease - Major 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 ## Maintaining Normal Elimination Pattern - Identify relationship between diarrhea and food, activities, or emotional stressors - Provide ready access to bathroom or commode - Encourage bed rest to reduce peristalsis - Administer medications as prescribed - Record frequency, consistency, character, and amounts of stools ## Other Interventions - Assessment and treatment of pain and discomfort, anticholinergic medications before meals, analgesics, positioning, diversional activities, and prevention of fatigue - Assess fluid deficit, I&O, daily weight, symptoms of dehydration or fluid loss; encourage oral intake; and initiate measures to decrease diarrhea - Provide optimal nutrition; elemental feedings that are high in protein and low residue or PN may be needed - Reduce anxiety, exhibit a calm manner, allow patient to express feelings, listen, and provide patient teaching ## Patient Teaching - Understanding of disease process - Nutrition and diet - Medications - Ileostomy care if applicable - See Chart 38-5 ## The Patient With an Ileostomy - Preoperative care - Postoperative care - Emotional support - Skin and stoma care - Irrigation of a Kock pouch (continent ileostomy) - Diet and fluid intake - Prevention of complications - See Chart 38-6 ## Continent Ileostomy (Kock Pouch) **Image: Diagram showing a continent ileostomy with a Kock pouch.** ## Reference - Cawley, 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. ## Review Questions 1. **In Crohn's disease, the clusters of ulcerations on the intestinal mucosa have a ______ appearance.** - A. Ulcerated - B. **Cobblestone** - C. Uniform - D. Comminuted 2. **Which 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 3. **The patient is postoperative day 3 after a colostomy. The nurse is changing the dressing and notes the stoma is dusky in color. 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. 4. **True or False? The ileostomy patient with a Koch pouch will not need to use an external fecal collection bag.** - **True** 5. **Which 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. 6. **A 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** 7. **As 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 8. **A 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. 9. **True or False? 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.** - **False** 10. **You'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 11. **A 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) 12. **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