What is chronic, recurrent inflammation of the intestinal tract
Periods of remission interspersed with periods of exacerbation?
IBD
What is the Inflammation and ulceration of the colon and rectum?
Ulcerative colitis
What is the Inflammation of segments of the GI tract?
Crohn's disease
What is the peak age of onset for IBD?
ages 15 and 25 years
60's
T/F: IBD is an Autoimmune disease.
True.
What are contributing factors to IBD?
Increase in stress, change in diet, increase in hormones, ETOH, Drug ingestion
What initiates the inflammation in IBD?
Antigen
What does actual tissue damage results from?
inappropriate sustained immune response.
Describe the inflammation pattern of Ulcerative Colitis?
inflammation beginning in the rectum and spreading up the colon in a continuous pattern
Where does inflammation occur in ulcerative colitis?
mucosa and submucosal layers (eats inside out)
In Ulcerative Colitis, Ulcerations destroy the mucosal epithelium, causing what?
bleeding and diarrhea
bleeding and diarrhea in Ulcerative Colitis can lead to what?
Fluid and electrolyte losses
Protein loss
Pseudopolyps develop.
What are the two major S/S of Ulcerative Colitis?
Bloody diarrhea�moderate and severe cases
Abdominal pain
Pain may range from the mild lower abdominal cramping associated with diarrhea to the severe, constant pain associated with acute perforations.
What are two other symptoms concurrent with Ulcerative Colitis?
Tenesmus
Rectal bleeding
What are the GI complications of Ulcerative Colitis?
Hemorrhage
Strictures
Perforation (with possible peritonitis)
Toxic megacolon
Dilation and paralysis of the colon
Associated with perforation
May need emergency colectomy
What is Crohn's dz?
A chronic, nonspecific inflammatory bowel disorder of unknown origin
Can affect any part of the GI tract from the mouth to the anus
Most often seen in the terminal ileum and colon
What layers of the GI are involved with Crohns?
All layers, deep and longitdinal
Skip lesions are a characterstic of which form of IBD?
Crohns
Narrowing of the lumen with stricture development in Crohn's disease can lead to what?
May cause bowel obstruction
What symptom in Crohn's can cause an allowance of bowel contents into peritoneal cavity?
Microscopic leaks
What is the first sign of a bowelbladder fistula?
Urinary tract infections are usually the first sign of a bowel/bladder fistula, and feces is sometimes seen in the urine. Fistulas between the bowel and vagina allow feces to leak out through the vagina, and feces leaks onto the skin if a cutaneous fistul
Describe what can occur when all layers of the bowel are tunneled to external parts in Crohn's disease:
Abscesses or fistulous tracts that communicate with other loops of bowel, skin, bladder, rectum, or vagina may occur.
S/S of Crohn's disease?
Diarrhea
Colicky abdominal pain
Weight loss may occur if small intestine is involved.
Rectal bleeding sometimes occurs with Crohn's disease, although not as often as with ulcerative colitis.
what are Crohn's Disease Complications?
Bowel obstruction
Peritonitis
Fistulas
Fluid/electrolyte imbalances
What are Diagnostic Studies for IBD?
History and physical examination
Blood studies
CBC (might see an increase in WBC)
Serum electrolyte levels
Serum protein levels (protein, albumin)
Stool cultures (blood in ulcerative not as often in crohns)
Sigmoidoscopy and colonoscopy
Biopsy specimens -
What are the goals for treatment for IBD?
Rest the bowel. - NPO, Bedrest w/ bathroom privleges, want to slow down peristalisis, limit physical activity
Control inflammation.
Combat infection. (ANTI
Correct malnutrition.
Relieve symptoms.
Improve quality of life.
Two major concerns for patients with IBD:
F/E Balance and Ntr Status
Describe the drug therapy for IBD:
Aminosalicylates inflammatory
Antimicrobials infection
Corticosteroids decrease inflammatory
Immunosuppressants can be on immunosuppresents for life
give corticosteriods only short term
T/F: Surgery produces remission, and a low recurrence rate.
False; Surgery produces remission, but a high recurrence rate.
What is the nursing role in Ileostomy?
Monitoring of
Stoma viability
Peristomal skin integrity
Output may be as high as 1500 to 2000 mL per 24 hours.
Self-care instructions given and reviewed before discharge
What does the stoma look like right after surgery vs normal?
Red, purple, right after surgery and then moist, pink/red looking
What is Ileostomy/Colostomy Care?
Care of skin around stoma
Empty bag of
Stool
Flatus
Replacement of wafer/ bag
Clothing
What are the nutritional considerations for a patient with IBD?
High-calorie
High-protein
Low-residue diet
Vitamin and iron supplements
Elemental diet
Dietary consultant
Provide adequate nutrition without exacerbating symptoms.
Correct and prevent malnutrition.
Replace fluid and electrolyte losses.
Prevent weight loss
What nursing dx are related to IBD?
Impaired skin integrity
Anxiety
Ineffective coping
Imbalanced nutrition: Less than body requirements
What are the Overall goals for IBD?
Experience a decrease in number and severity of acute exacerbations
Maintain normal fluid/electrolyte balance
Free from pain or discomfort
Improve quality of life
How would the nurse Evaluate the status of the patient with IBD?
Fewer, firmer stools
Decreased anxiety
Use of effective coping strategies
Maintenance of body weight
No evidence of skin breakdown
Healthy coping behaviors
What Teaching should be completed with IBD?
Importance of rest and diet management
Perianal care
Action and side effects of drugs
Symptoms of recurrence
When to seek medical care
Use of diversional activities to reduce stress
What are the gerontological considerations for the patient with IBD?
Occurs around late 50s
Distal colon is usually involved in ulcerative colitis.
Less recurrence of Crohn's disease in older patients treated with surgical resections
The colon rather than the small intestine tends to be involved in Crohn's disease.
Older a
Describe proper care of the ostomy site.
keep clean, prevent breakdown (barrier wafer), stool can touch in bag and stoma - we do not want stool to touch skin
Describe the following components of small bowel obstruction:
Onset
Vomiting
Pain
Bowel movement
Abdominal distention
Onset - quicker onset
Vomiting - quick prefuse
Pain - colicy pain (sharp, acute)
Bowel movement - Yes
Abdominal distention - quicker onset of distention in small bowel
Describe the following components of large bowel obstruction:
Onset
Vomiting
Pain
Bowel movement
Abdominal distention
Onset - slower onset
Vomiting - would have to have a very large obstruction to produce s/s of vomiting
Pain - low, dull pain (sharp, acute)
Bowel movement - No
Abdominal distention - as gas builds up, may take up to a couple of days
What are causes of Bowel Obstruction?
Mechanical and Nonmechanical
What are types of mechanical causes?
Adhesions
Hernia
Neoplasms
Volvulus
Diverticular disease
What are types of nonmechanical causes?
Paralytic ileus
Inflammatory responses
Electrolyte abnormalities
Spinal fractures
How do you allow bowel to kick start self?
1. Don't eat 2. Don't Drink 3. Insert NG tube (NPO status)
what is the treatment goal for bowel obstruction?
allow bowel to kick start self
Why don't we perform surgery on all bowel obstructions?
would cause scare tissue called psedopolyps, leading to further obstruction of GI pathway
How do we dx bowel obstruction?
History and Physical
Abdominal x-rays/US
Barium enemas
Colonoscopy
Labs : CBC, CMP, stools for occult blood
Describe the nursing management of bowel obstruction: assessment, diagnosis, and planning
Assessment
Dietary history, BS, N/V, VS, pain
Diagnosis
Pain, Alteration in elimination, Risk for injury, Alteration in nutrition
Planning
Adequate nutrition status, Comfort level, No complications
Name how nurses can treat bowel obstruction.
Bowel rest�NPO, NGT
I/O
Comfort management
Oral care
Fluid and electrolytes
Preparation for possible surgical intervention
After teaching the patient with inflammatory bowel disease about dietary modifications, the nurse determines that teaching was effective when the patient chooses which of the following menus?
1. Baked cod, baked sweet potato, and canned pears
2. Barbecued
2