10.C Inflammatory Bowel Disease

The client diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the client supports thing diagnosis? 1. "My pain goes away when I have a bowel movement." 2. "I have bright red blood in my stool all the time." 3. "I have episodes of diarrhea and constipation." 4. "My abdomen is hard and rigid and I have a fever."

1. "My pain goes away when I have a bowel movement."

A physician has prescribed a patient with a severe case of Crohn's Disease to take a drug that works by suppressing the immune system. This medication achieves this by blocking a protein that plays a role the inflammatory process. Which drug does this describe? A. Azathioprine B. Sulfasalazine C. Infliximab D. Prednisone

C. Infliximab Infliximab (Remicade) is a TNF-blocker (biologic drug) which blocks tumor necrosis factor which plays a role in the inflammatory response system. Azathioprine is an immunosupressor which suppresses the immune system but does NOT block TNF. Sulfasalazine is an 5-Aminosalicylate which is an anti-inflammatory medication. Prednisone is a corticosteroid which decreases inflammation.

A physician is explaining to a patient that the patient has a type of Crohn's Disease that is found in both the ileum and colon. As the nurse, you know this type of Crohn's Disease is called? A. Gastroduodenal Crohn's Disease B. Granulomatous Colitis C. Ileitis D. Ileocolitis

D. Ileocolitis This patient has ileocolitis which affects parts of the colon and ileum. Gastroduodenal Crohns affects the stomach and duodenum which is the first part of the small intestine. Granulomatous colitis affects only the colon. Ileitis affects the ileum.

True or False: NSAIDs are used as first-line treatment for pain relief with patients with ulcerative colitis.

False The answer is FALSE. NSAIDs should be avoided in patients with ulcerative colitis because they can cause a "flare-up" in the condition. Tylenol should be used instead or a similar medication that isn't an NSAID.

Which of the following increases an individual's risk for developing inflammatory bowel disease? [SATA] a. United States/Northern European origin b. Southern Europe origin c. Being an American Jew d. African American/Caucasian American e. Hispanic/Asian

a, c, d

What is the predominant manifestation of ulcerative colitis a. Diarrhea b. Vomiting c. Abdominal pain d. Anorexia

a. Diarrhea

Affects the mucosa and submucosa of the colon and rectum a. Ulcerative colitis b. Crohn's disease

a. Ulcerative colitis

A patient with Crohn's Disease is MOST likely to have the disease is what part of the GI tract? A. Rectum B. Duodenum of the small intestine C. Terminal Ileum D. Descending colon

C. Terminal Ileum Crohn's disease is MOST likely to affect the terminal ileum. However, it may affect any area of the GI tract.

The client diagnosed with IBD is prescribed total parental nutrition (TPN). Which intervention should the nurse implement? 1. Check the client's glucose level 2. Administer an oral hypoglycemic 3. Assess the peripheral intravenous site 4. Monitor the client's oral food intake

1. Check the client's glucose level

The client diagnosed with ulcerative colitis has an ileostomy. Which statement indicates the client needs more teaching concerning the ileostomy? 1. "My stoma should be pink and moist." 2. "I will irrigate my ileostomy every morning." 3. "If I get a red, bumpy, itchy rash I will call my HCP." 4. "I will change my pouch if it starts leaking."

2. "I will irrigate my ileostomy every morning."

The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement? 1. Provide a low-residue diet 2. Rest the client's bowels 3. Assess vital signs daily 4. Administer antacids orally

2. Rest the client's bowels

The client diagnosed with Crohn's disease is crying and tells the nurse "I can't take it anymore. I never know when I will get sick and end up here in the hospital." Which statement is the nurse's best response? 1. "I understand how frustrating this must be for you." 2. "You must keep thinking about the good things in your life." 3. "I can see you are very upset. I'll sit down and we can talk." 4. "Are you thinking about doing anything like committing suicide?"

3. "I can see you are very upset. I'll sit down and we can talk."

The client is diagnosed with an acute exacerbation of IBD. Which priority intervention should the nurse implement first? 1. Weigh the client daily and document in the client's chart 2. Teach coping strategies such as dietary modifications 3. Record the frequency, amount, and color of stools 4. Monitor the client's oral fluid intake every shift

3. Record the frequency, amount, and color of stools

The client diagnosed with ulcerative colitis is prescribed a low-residue diet. Which meal selection indicates the client understands the diet teaching? 1. Grilled hamburger on a wheat bun and fried potatoes. 2. A chicken salad sandwich and lettuce and tomato salad. 3. Roast pork, white rice, and plain custard. 4. Fried fish, whole grain pasta, and fruit salad.

3. Roast pork, white rice, and plain custard.

The client with type 2 diabetes is prescribed prednisone, a steroid, for an acute exacerbation of inflammatory bowel disease. Which intervention should the nurse discuss with the client? 1. Take this medication on an empty stomach 2. Notify the HCP if experiencing a moon face 3. Take the steroid medication as prescribed 4. Notify the HCP if the blood glucose is over 160

3. Take the steroid medication as prescribed

Mild to moderate ulcerative colitis is characterized by __ or fewer stools per day

6

You're providing diet teaching to a patient with ulcerative colitis about what types of foods to avoid during a "flare-up". Which foods below should the patient avoid? SELECT-ALL-THAT-APPLY: A. Ice cream B. White Rice C. Fresh apples and pears D. Popcorn E. Cooked carrots

A, C, D Patients experiencing a flare-up with ulcerative colitis should avoid dairy products (ice cream), food that are high in fiber (fresh apples or pears) (cooked fruits without the skin would be okay), and foods that are hard to digest (popcorn). Instead, patients should consume foods low in fiber (low residue) like cooked vegetables (carrots), bland foods (white rice) etc.

Select ALL of the following that are complications associated with Crohn's Disease: A. Cobble-stone appearance of GI lining B. Lead-pipe sign C. Toxic megacolon D. Fistula E. Abscess F. Anal Fissure

A, D, E, F These are all complications found with Crohn's Disease. Lead-pipe sign and toxic megacolon are complications associated with ulcerative colitis.

You're educating a group of outpatients about signs and symptoms of ulcerative colitis. Which of the following are NOT typical signs and symptoms of ulcerative colitis? SELECT-ALL-THAT-APPLY: A. Rectal Bleeding B. Abdominal mass C. Bloody diarrhea D. Fistulae E. Extreme Hungry F. Anemia

B, D, E Rectal bleeding, bloody diarrhea, and anemia are present in ulcerative colitis. However, an abdominal mass or fistulae tends to be present with Crohn's Disease. Loss of appetite rather than extreme hungry presents in ulcerative colitis.

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

True or False: A patient with Crohn's Disease can experience inflammation in the large intestine that affects mainly the mucosa (inner layer) of the bowel.

False A patient with Crohn's Disease can experience inflammation throughout the GI Tract (mainly in the terminal ileum and beginning of the colon) from the mouth to anus (not just the large intestine) and it affects the WHOLE bowel lining (not just the mucosa layer).

Severe ulcerative colitis can lead to more than ____ to ____ bloody stools/day

Severe ulcerative colitis can lead to more than 6-10 bloody stools/day

Which is more common, ulcerative colitis or Crohn's disease?

Ulcerative colitis, twice as many people develop ulcerative colitis as Crohn's disease

Usually begins at the rectosigmoid area of the anal canal and progresses proximally. Begins with inflammation at the base of the crypts of Lieberkuhn in the distal large intestine and rectal mucosa. Microscopic, pinpoint mucosal hemorrhages occur, and crypt abscesses develop. a. Ulcerative colitis b. Crohn's disease

a. Ulcerative colitis

The client with ulcerative colitis is scheduled for an ileostomy. The nurse is aware the client's stoma will be located in which area of the abdomen? 1. R Iliac region 2. L Iliac region 3. Epigastric region 4. R Hypochondriac region

1. R Iliac region

Which sign/symptoms should the nurse expect to find in a client diagnosed with ulcerative colitis? 1. Twenty bloody stools a day 2. Oral temperature of 102 degrees Fahrenheit 3. Hard, rigid abdomen 4. Urinary stress incontinence

1. Twenty bloody stools a day

The client diagnosed with IBD is prescribed sulfasalazine (Asulfidine), a sulfonamide antibiotic. Which statement best describes the rationale for administering this medication? 1. It is administered rectally to help decrease colon inflammation. 2. This medication slows gastrointestinal motility and reduces diarrhea. 3. This medication kills the bacteria causing the exacerbation. 4. It acts topically on the colon mucosa to decrease inflammation.

4. It acts topically on the colon mucosa to decrease inflammation.

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)

A. 5-Aminosalicylates (Sulfasalazine) 5-Aminosalicylates (Sulfasalazine) are usually prescribed for mild to moderate cases of ulcerative colitis as first-line treatment. If Aminosalicylates are not working (or the patient is allergic to sulfa) corticosteriods are prescribed. Corticosteriods may be used in combination with immunosupressors. Immunosupressors and immunomodulators are used in severe cases of ulcerative colitis when other medications have not worked.

A patient with Crohn's Disease is taking corticosteroids. The patient is complaining of extreme thirst, polyuria, and blurred vision. What is your next nursing action? A. Check the patient's blood glucose B. Give the patient a food containing sugar (ex: orange juice) C. Administer oxygen via nasal cannula D. Assess bowel sounds

A. Check the patient's blood glucose A side effect of corticosteroids is hyperglycemia. Extreme thirst, polyuria, and blurred vision are classic signs and symptoms of hyperglycemia. Therefore, the nurse should check the patient's blood glucose to confirm the hyperglycemia.

Your patient with Crohn's Disease is admitted with an opening that has formed between the bowel and bladder. As the nurse, you know this is what type of complication associated with this disease? A. Enterovesical Fistula B. Rectovaginal Stricture C. Enteroenteric Fistula D. Perianal Fissure

A. Enterovesical Fistula These scenario describes a fistula which is an abnormal passage that forms deep in the wall of the intestine to form an opening between intestine to intestine, intestine to organ, or intestine to skin's surface. This specific patient is experiencing an enterovesical fistula which is an abnormal passage between the bowel and bladder.

A patient is receiving treatment for Crohn's Disease. Which food found on the patient's food tray should the patient avoid? A. Fresh Salad B. White rice C. Baked chicken D. Cooked skinless apples

A. Fresh Salad Patients who are experiencing flare-ups of Crohn's Disease should avoid high fiber foods, foods that are hard to digest, spicy foods, dairy products etc. Therefore, the patient should avoid a fresh salad. This contain vegetables which are high in fiber and hard to digest. The gut needs to rest. It is best for the patient to consume low fiber and high protein foods. White rice and fruits/vegetables that are cooked/skinless are low in fiber. Baked chicken is a good source of protein for the patient.

A patient with ulcerative colitis is scheduled for ileoanal anastomosis (J-Pouch) surgery. You know that this procedure: A. Removes the colon and rectum which allows a pouch to be created that will attach to the ileum. This will allow stool to pass from the small intestine to the anus. B. Removes the colon and rectum and creates a permanent ileostomy. C. Removes the colon and creates a temporary colostomy. D. Removes the rectum which allows a pouch to be created from the colon. This will allow stool to pass from the colon to the anus.

A. Removes the colon and rectum which allows a pouch to be created that will attach to the ileum. This will allow stool to pass from the small intestine to the anus. A J-pouch surgery (ileoanal anastomosis) removes the colon and rectum which allows a pouch to be created that will attach to the ileum. This will allow stool to pass from the small intestine to the anus.

You're providing education to a patient with severe ulcerative colitis about Adalimumab. Which statement by the patient is CORRECT? A. "This medication is used as first-line treatment for ulcerative colitis." B. "My physician will order a TB skin test before I start taking this medication." C. "This medication works by increasing the tumor necrosis factor protein which helps decrease inflammation." D. "This medication is a corticosteroid. Therefore, I need to monitor my blood glucose levels regularly."

B. "My physician will order a TB skin test before I start taking this medication." Before starting Adalimumab, the physican may order the patient to be checked for TB. Adalimumab is a immunomodulator (NOT corticosteriod) that suppresses the immune system by BLOCKING (not increasing) the tumor necrosis factor protein which helps decrease inflammation. Therefore, the patient is at risk for developing infections such as TB (tuberculosis). In addition, if the patient has or had TB, this medication could exacerbate the disease. This medication is used for only severe cases (NOT first-line treatment).

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

C. Administer varicella vaccine intramuscularly Azathioprine is an immunosuppression medication that decreases the immune system. Therefore, the patient should never receive a live vaccine, such as Varicella. Other vaccinations that are live include: MMR, Shingles, Nasal influenza mist etc.

You're providing teaching to a patient who has been newly diagnosed with Crohn's Disease. Which statement by the patient's spouse requires re-education? A. "Crohn's Disease can be scattered throughout the GI tract in patches with some areas appearing healthy while others are diseased." B. "There is no cure for Crohn's Disease." C. "Strictures are a common complication with Crohn's Disease." D. "Crohn's Disease can cause the haustra of the large intestine to lose its form."

D. "Crohn's Disease can cause the haustra of the large intestine to lose its form." All the statements are true except option D. ULCERATIVE COLITIS can cause the haustra of the large intestine to lose its form. This is not common with Crohn's Disease.

A patient experiencing a flare-up with Crohn's Disease is ordered complete bowel rest by the physician. You are administering TPN (total parental nutrition) per physician order. When developing the patient's nursing plan of care, which nursing diagnosis is MOST important to include in the care plan? A. Risk for allergy response B. Risk for unstable blood glucose level C. Risk for imbalance nutrition: more than body requirements D. Risk for imbalanced nutrition: less than body requirements

D. Risk for imbalanced nutrition: less than body requirements Patients with Crohn's Disease are at risk for undernourishment due to how the disease process effects the body (small intestine is inflamed which is the area of the gut that absorbs most of the nutrients from food). With severe cases of Crohn's Disease, the physician may order complete bowel rest (where the patient will be nothing by mouth (NPO) and nothing will enter the GI system....so the patient is at even more risk for imbalance nutrition. Physicians may prescribe an IV solution (total parental nutrition) which will be given through a central line that contains nutrients (so it enters the bloodstream...bypassing the gut). However, there is still a risk for imbalanced nutrition (less than body requirements) for the patient. The nurse must monitor the patient's nutrition status very closely such as daily weights, hydration status, electrolytes, skin, etc.

A patient diagnosed with pancolitis is experiencing extreme abdominal distension, pain 10 on 1-10 scale in the abdomen, temperature of 103.6 'F, HR 120, and profuse diarrhea. What complication due you suspect the pain is experiencing? A. Fistulae B. Stricture C. Bowel obstruction D. Toxic megacolon

D. Toxic megacolon Pancolitis affects all the colon and is a very severe form of ulcerative colon. The patient is at risk for toxic megacolon. In toxic megacolon, the large intestine dilates due to the overwhelming inflammation. The large intestine is unable to function properly and becomes paralyzed. Typical signs and symptoms of toxic megacolon include: abdominal distention, fever, diarrhea, abdominal pain, dehydration, and tachycardia.

Can affect any portion of the GI tract from the mouth to the anus, but usually affects the terminal ileum and ascending colon. a. Ulcerative colitis b. Crohn's disease

b. Crohn's disease

Typically begins as a small inflammatory apthoid lesion (a shallow ulcer with a white base and an elevated margin, similar to a canker sore) of the mucosa and submucosa of the bowel. The lumen of the affected bowel eventually assumes a cobblestone appearance. a. Ulcerative colitis b. Crohn's disease

b. Crohn's disease

Which of the following is a major factor in the prevention of IBD? a. Reducing alcohol intake b. Smoking cessation c. Increase carbohydrate intake d. Increase water intake

b. Smoking cessation