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IBD

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cdunbar4's version from 2016-11-05 16:47

Description

Question Answer
Two types of IBDimmunologically-related disorders: Crohn's and Ulcerative Colitis
Clinical Manis are poorly understood, but in generalchronic, recurrent inflammation of intestinal tract
Varied manis for both disorders, but both include: long periods of remission interspersed with episodes of acute inflammation; both disease are DEBILITATING
Both occur during what age?Usually during teenage years and early adulthood
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Ulcerative Colitis Etiology/Therapy

Question Answer
Descriptioninflammation & ulceration of colon and rectum (BLOODY)
Peak age range that it occursbetween ages 15-25
Affects more men or women?Equally affects both sexes
Causes?Unknown
Possible causes?infectious agent, autoimmune rxn, food allergies, herdity
Diffuse inflammation affects what layers of mucosa?involves mucosa & submucosa and alternates periods of exacerbations & remissions
Inflammation begins where in GI tract?Usually starts in rectum & sigmoid colon and spreads up in a continuous pattern
Mucosa is hyperemic and edematous in affected area, what does this mean?Lots of blood; colon is extremely rich with blood, so any inflammation produces BLOOD
Abscess develop in intestinal glands, result?Abscesses break through into submucosa and leave ulcerations
Ulcerations can lead to many complications such as: bleeding, diarrhea, fluid/E losses; PRO loss; pseudopolyps; granulation tissue; mucosa musculature thickens (causes colon to shorten)
Two major signs of UC?Bloody diarrhea and Abdominal Pain (can be intestinal or extra-intestinal)
Intestinal Complications hemorrhage, strictures, perforation, toxic megacolon, colonic dilation
Toxic megacolon/colonic dilationsevere episode of colitis with segmental or total dilation of colon; paralysis of colon; associated with perforation→ ER coloectomy!
Extraintestinal complications directly r/t colitismalabsorption
Extraintestinal complications nonspecific, may be mediated by a disturbance in the immune systemjoints-arthritis; skin-erythma mouth-ulcers; eyes-conjunctivitis; kidney stones; osteoporosis
DiagnositicsCBC (anemia, ↑ WBC); stool cultures; sigmoidoscope/colonoscope; biopsy; barium enema
CC goalsrest bowel, control inflammation, combat infection, correct malnutrition, alleviate stress, symptomatic relief
Drug Therapy-Principal drug used?sulfasalazine (Azulfadine) anti-inflammatory (effective in maintenance & mild/moderately-severe attacks
Drug Therapy-Corticosteroids↑ immunity/↓ inflammation/prevent secondary infection
Drug Therapy- 5-ASA (active form of azulfidine)↓ GI inflammation via direct contact with bowel mucosa
Drug Therapy-Immunosuppressants ↓ immune response: prevents migration of leukocytes to inflamed tissues *be careful with these
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Ulcerative Colitis Cont'd

Question Answer
CC-Surgical Therapy is indicated when: failure to respond to treatment; frequent/debilitating exacerbations; massive bleeding or obstruction; development of dysplasia or carcinoma
CC-Total proctocolectomy with ileostomypartial or total reomoval of colon, rectum & anus with closure of the anus with permanent or continent ileostomy (Kock Pouch)
Surgical Therapy postop routinemonitor stoma viability & skin integrity; watch signs of hemorrhage, abdominal abscess, small bowel obstruction, dehydration & other complications
Nutritional Therapy GoalsAdequate nutrition w/o exacerbating sx; correct and prevent malnutrition; replace f/e losses; prevent wt. losses
What kind of nutrition?high-calore, high protein, low-residue diet; vitamin/iron supplements
Nursing assessment autoimmune disorders, use of antidiarrheal meds, family hx, frequent bloody stools, weight loss
Nursing evaluationfewer, firmer stools; ↓ anxiety; maintenance of body weight; no evidence of skin breakdown; healthy coping behaviors
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Crohn's description/Et.

Question Answer
Descriptionchronic-nonspecific inflammatory bowel disorder of unknown origin
Can affect what part of GI tract?ANY from mouth to anus-but mostly affects terminal ileum, jejunum & colon
Can occur at any age, but what is the usual range?15-30, both genders affected
Characterized by: inflammation of segments of GI tract
Inflammation does what to the bowel wall?Thickening and narrowing of lumen with stricture development: inflammation involves ALL layers of wall
Ulceration characteristics, cause what kind of appearance?Abscesses or fistulas that communicate with other loops of bowel, skin, bladder, rectum or vagina→ you can pee Poop!
Skip lesions are characteristic of Crohn's, what else can form?Deep ulcerations that are longitudinal & penetrate b/t islands of inflamed edematous mucosa=> COBBLESTONE appearance.
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Crohn's Manis/Complications

Question Answer
Manis depend on the site of involvement and what other two things?The extent of disease process & the presence or absence of complications
nonspecific complaintsdiarrhea, fatigue, abd pain, weight loss, fever
Principal manisdiarrhea (non-bloody), abdominal pain, pain (severe & intermittent); abdominal cramping/tender; distension; arthritis; finger clubbing
Complications includestrictures & obstruction from scare tissue; fistulas; peritonitis; fat intolerance; gluten intolerance
More complications!liver disease; cholelithiasis
Complication: ankylosing spondylitischronic inflammation of spine
Complication: pyoderma gangrenosumtissue becomes necrotic causing deep ulcers (usually in legs)
Complication: erythema nodosumtender, red bumps, usually found on shins
Complication: Uveitisinflammation of middle later of eye
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Crohn's diagnostics & CC

Question Answer
Diagnostic studies includebarium, endoscopy w biopsy, labs, Upper GI barium studies
Goals of CC?control inflammatory process; relieve symptoms; correct metabolic & nutritional problems; promote healing
Drug therapy includes what drug classes?sulfasalazine, corticosteroids; immunosuppressives; metronidazole; infliximab
Nutritional Therapyelemental diets: FA, A.A., Glucose; parenteral nutrition; low in residue, roughage or fat; high calorie, high protein
Surgical Therapymajority of patients eventually require surgery at least once in the course of their disease; NOT cured by surgery; high recurrence rate
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nursing management Crohn's

Question Answer
similar to patient ulcerative colitis; pay close attention toperianal skin care...patient will need frequent rest periods
Patient teachingclient must realize that there is a probability of unpredictable & lifelong periods of remission & exacerbation
Gerontologic age it usually occurs60 yo; distal colon is usually involved in UC
Colon or SI is more inovlved in Crohn's with Gerontologic?Colon
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Intestinal Obstruction

Question Answer
Mechanical vs. non-mechanical (mech): tumor physically gets in the way (non-mech): neuromuscular
Small intestine obstruction onset and vomiting manisrapid onset; vomit is frequent & copius
Large intestine onset & vomit manisgradual onset; rare vomit
SI Pain manifestationscolicky, cramplike, intermittent
LI pain manislow-grade, cramping abd pain
SI BM manisfeces for a short time
LI BM manisabsolute constipation
SI abd distention ↑ or ↓?greatly increased
LI abd distention ↑ or ↓?increased
CC, what do we do??Surgery if bowel is strangulated, but most can be cured conservatively
Initial medical tx includesNPO, IV fluid resuscitation (NS or RL); addition of K ro I fluids so long as renal function is verified; analgesics for pain
Nursing Implementationsmonitor for sins of dehydration & electrolyte imbalance; administer IV fluids as ordered; watch s./s of fluid overload (may need to ↓ replacement rate)
A patient with a high intestinal obstruction is more likely to have metabolic _______.alkalosis (d/t loss of HCl acid from vomiting or NG intubation)
A patient with an obstruction in the small bowel is likely to have _________ that occurs rapidly.dehydration occurs rapidly
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