Inflammatory bowel disease

Which organs does Crohn's disease (CD) involve?

any segment of GI tract

what is long-term complication of IBD?

colon cancer

what medication is contraindicated with contrast in abd CT?

metformin

does diarrhea with blood and mucous obvious in Crohn's disease?

no obvious in UC

Which organs does ulcerative colitis (UC) involve?

rectum and the colon

how is the pts' nutritional status with CD?

significant vitamin and mineral deficits anemia wt loss

what does stool look like after barium upper GI series?

stool will be white after use of barium for 2-3 days

complications of UC?

toxic megacolon, perforation, hemorrhage

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

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

where is pain located in UC and Crohn's disease?

LLQ for UC RLQ for CD

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by client indicates a need for further instruction? 1. "I should increase the fiber in my diet" 2. "I will need to avoid caffeinated beverages" 3. "I'm going to learn some stress reduction techniques" 4. "I can have exacerbations and remissions with Crohn's disease"

1

The nurse provides instructions to a client about measures to treat IBD. Which statement by the client indicates a need for further teaching? 1. I need to limit my intake of dietary fiber 2. I need to drink plenty, at least 8-10 cups daily 3. I need to eat regular meals and chew my food well 4. I will take the prescribed meds because they will regulate my bowel patterns

1

The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the HCP? 1. Stoma is beefy red and shiny 2. purple discoloration of the stoma 3. skin excoriation around the stoma 4. semiformed stool noted in the ostomy pouch

2

A patient's colostomy stoma is scheduled to be irrigated on the fifth postoperative day. Which does the nurse understand to be the main purpose of the irrigation? 1. Act as an enema 2. Help to stimulate emptying of the colon 3. Remove any blood clots 4. Assess the patency of the colostomy

2 Rationale: - A new colostomy may require irrigation to train, or regulate, the colon for its modified function. The patient should also be instructed to contract abdominal muscles and to massage the abdomen from right to left to stimulate peristalsis. Although colostomy irrigation may act as an enema to facilitate a bowel movement, its greater purpose is the regulation of the colon. Blood clots should not be present, and an irrigation is never used to assess the patency of the colostomy.

A pt in the outpatient testing department is recovering after having a colonoscopy. What should discharge instructions the nurse include? 1. It is normal not to have a BM for 3-4 days 2. The patient's stools will have some melena for up to 5 days 3. The patient should call the physician if the abdomen becomes distended and painful 4. Diarrhea for the first 24 hours should be anticipated

3 Rationale: - A client will not have diarrhea after a colonoscopy, nor will they have melena - Although it is normal to not have a BM for a day or 2 after coloscopy, DO NOT teach the pt that it is normal to not have BM for 3-4 days

Which medications are used in the treatment of Crohn's Disease and ulcerative colitis? SELECT-ALL-THAT-APPLY 1. Guanylate Cyclase-C agonists 2. Anticholinergics 3. 5-Aminosalicylates 4. Antacids 5. Corticosteroids 6. Immune suppressors

3, 5, 6

the client just had surgery to create an ileostomy. the nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? 1. folate deficiency 2. malabsorption of fat 3. intestinal obstruction 4. fluid and electrolyte imbalance

4

The nurse provides education about a double-barreled stoma for a group of nursing students and includes which information? 1. It has a distal functioning stoma called a mucus fistula. 2. It involves the creation of a proximal nonfunctioning stoma. 3. It is usually performed on a patient who requires a permanent ostomy. 4. It involves bringing both the proximal and distal ends through the abdominal wall as two separate stomas.

4 Rationale: - A double-barreled stoma is created by bringing both the proximal and distal ends as two separate stomas through the abdominal wall. It involves the formation of distal nonfunctioning stoma called a mucus fistula. - The double-barreled stoma involves the formation of a proximal functioning stoma. - Usually performed on a temporary basis.

A client who is scheduled for surgery to create an ileostomy has been asked to discontinue the use of corticosteroids. The nurse should closely monitor the client for? 1. cerebral anoxia 2. cardiac dysrhythmias 3. hypothyroidism 4. adrenal insufficiency

4 Rationale: - If discontinue the use of corticosteroids stat, adrenal glands are not going to function properly

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 Rationale: - 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.

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. D. Assess bowel sounds

A Rationale: - 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.

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 Rationale: - 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 is 8 hours post-opt from an colostomy placement. Which finding requires immediate nursing action? A. The stoma is swollen and large. B. The stoma is black. C. The stoma is not draining any stool. D. The patient states the site is tender.

B Rationale: - An assessment finding of a stoma being black is not a normal finding but represents compromised circulation to the stoma. It requires immediate physician notification. The stoma should look red and be shiny/moist. It is normal for a stoma to be swollen and large after surgery (this will subside after a few months), and it is normal for the site to be tender due to the surgery (this will subside as well) and for the stoma to not be draining any stool yet. It can take approximately 2 day before stool drains from a colostomy.

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 a 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 Rationale: - 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).

______________ is most commonly found in the terminal ileum and beginning of the colon Ulcerative Colitis Crohn's Disease

Crohn's Disease

A patient had a colonoscopy which showed a "cobble-stone" appearance of the GI lining. This is found in: Ulcerative Colitis Crohn's Disease

Crohn's Disease Rationale: - The reason for the "cobble-stone" appearance is because with Crohn's Disease there will be healthy areas of lining with diseased lining. This will give it a cobble-stone appearance. In ulcerative colitis, the diseased areas are continuous and there are not areas of healthy lining with diseased.

fistulas, ulcerations, and abscesses are common in which disease?

Crohn's disease; because the entire bowel wall is involved

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

A patient has the following symptoms: urgent and frequent bowel movements of diarrhea that contains blood with pus and mucous, low hemoglobin/hematocrit, potassium level of 2.0. Based on the patient's signs and symptoms, which disease does this describe?

Ulcerative Colitis