Inflammatory Bowel Disease- Crohn's Disease, Ulcerative colitis, & Diverticulitis

When damage to the entire thickness of the intestinal wall results in intestinal dilation with paralysis and abdominal distension (toxic megacolon is considered a rare form of fulminant colitis)

How does fulminant colitis occur?

-The client demonstrates absence of GI distress -The client and family demonstrate successful management of medications without side effects -The client demonstrates no signs or symptoms of infection -The client verbalizes attainment of a positive body image -The client demonstrates integration of relaxation techniques into daily life

List some expected outcomes of nursing care for the client with IBD. (Nursing Process-Evaluation)

Inflammatory bowel disease

The term for a collection of chronic inflammatory conditions of the intestine?

Surface of the right abdominal wall

Where is a ileostomy typically located on a client after surgery?

-Risk or FVD -Imbalanced nutrition -Constipation -Diarrhea -Acute/chronic pain -Disturbed body image

What are some potential nursing diagnosis for the client with IBD? (Nursing Process- Diagnosis)

-Ileostomy -Ascending/transverse -Descending

What are the 3 types of ostomy types?

-Mesalamine -Olsalazine

What type of IBD drug causes fewer adverse effects than sulfasalazine. Their mechanism of action is the same as that of a sulfasalazine. These drugs are availabe as suppositories, suspension for enema, or oral tablets.

Vitamin B12 deficiency

What type of vitamin deficiency can Crohn lead to?

-Carbs -Proteins -Fats -Vitamins -Folate

When the jejunum and ileum are affected by Crohn, what type of nutrients may have impaired absorption?

-Check for allergies (tape, latex) -Chucks -Washcloth/towel -Stoma paste -Scissors -Skin barrier (protectant wipes, water) -Measuring device -1 or 2 piece system with clamp

Pouching- step #1

-Apply gloves -Empty pouch -Remove old system -Clean skin, remove any old -Measure stoma and cut opening -No more than 1/16 inch larger than stoma

Pouching- step #2

Diarrhea Rationale: The client with Crohn's disease is likely to have diarrhea with no obvious blood or mucus in the stools. Frothy stools are NOT characteristic of Crohn's disease. Abdominal pain in Crohn's disease is typically cramping or steady and located in the LOWER RIGHT QUADRANT or around the umbilicius. A clinical manifestation of ulcerative colitis is cramping in the lower left quadrant relieved by defecation.

A nurse is caring for a client with Crohn's disease who was admitted last night. Which of the following manifestations would the nurse expect to note for this client? (End of chapter quiz)

Less than 10%

About what percentage of clients develop fulminant colitis?

-q6-12months due to their increased risk of developing colorectal cancer

According to the American College of Gastroenterology (ACG), client's who have had IBD for 8-10 years are recommended to receive colonoscopies with multiple biopsies how often?

Cobblestone appearance, with areas of normal tissue surrounded by ulceration and fissures

Appearance of mucosa in Crohn disease?

-Granular -Dull -Hyperemic -Friable -Disease uniform in affected bowel -Possibly pseudopolyps

Appearance of mucosa in ulcerative colitis?

-Persistent diarrhea -Liquid or semiformed stools that typically do NOT contain blood (although blood may be present if the colon is involved) -Abdominal pain and tenderness -RLQ pain relieved with defecation -Palpable RLQ mass

Crohn disease can be diverse and present manifestations differently among clients, however, list some clinical manifestations that the majority of individuals with Crhon disease may experience?

-In addition to the transverse colon dilating more than 6 cm, the resulting paralysis allows excessive amount of intestinal gas to collect and cause severe abdominal distention -May result in a perforation of the bowel if left untreated -Causes include: hypokalemia and the use of anit-diarrheals, opiates, anti-spasmodics, and certain anti-depressants

Describe some clinical manifestations for toxic megacolon?

Unknown but factors such as environment, lifestyle habits (smoking) infectious agents, and altered immune responses are also thought to play a role in IBD

Etiology for both ulcerative colitis and crohn disease (IBD)

-Current manifestation -Number of stools/day -Abdominal pain/cramping -Diet -Food intolerances -Medications -Previous treatment/diagnostic tests

Explain the health history assessment to be performed for a client suspected with IBD. (Nursing Process-Assessment)

In general teaching should include: How the stoma and pouch will affect defecation, how to care for the stoma, how to care for the ileostomy pouch, principles of good skin and hygiene care, principles of infection prevention, nutrition and fluid guidelines, and S/S to report to a physician

Give a generalized teaching plan that could be given to clients for home care of an ileostomy.

-Monitor lab results: hemoglobin, hematocrit, serum electrolytes, total serum protein and albumin levels -Provide the prescribed diet: high kilocal, high protein, low fat diet with restricted milk and milk products -Provide parenteral nutrition as necessary if the client is unable to absorb enteral nutrients

How would you help the client with IBD to promote adequate nutritional intake? (Nursing Process-Implementation)

-Accept the client's feelings and self-perception to establish trust -Encourage discussion of physical changes and their consequences as they relate to self-concept -Encourage the client to make choices/decisions regarding care to increase the client's sense of control over the disease -Discuss possible treatment options -Involve the client in care, teaching and demonstrating. This encourages a sense of independence -Be accepting and non-judgemental in providing care -Arrange for interaction with other clients/groups with IBD

How would you help the client with IBD to promote healthy body image? (Nursing Process-Implementation)

-Left sided colostomy sites only -Cone tipped irrigator, not an enema set -500-700 cc tap water slowly over 10 minutes -Takes about 60 minutes total

Irrigation of a colostomy

-Fever -Tachycardia -Hypotension -Dehydration -Abdominal tenderness/cramping -Change in number of stools per day

List some clinical manifestations of a Megacolon in IBD?

-Perforation -Peritonitis -Abscess formation -Bleeding

Name some potential problems/complications associated with diverticulitis?

-Fever -Malaise -Weight loss -Anemia

Name some systemic manifestations of Crohn disease?

Obstruction

Name the term for a blockage in the bowel preventing or reducing the passage of fecal material?

Impaction

Name the term for a mass or collection of hardened feces in the folds of the rectum?

Diarrhea

Name the term for a passage of liquid stool?

Bowel cancer

Name the term for abnormal growth cells in the bowel?

Bowel incontinence

Name the term for an inability to control release of feces?

Constipation

Name the term for an infrequent passage of hard stool?

Diverticulum

Term for a saclike herniation of the lining of the bowel that extends through a defect in the muscle layer?

Loop Ileostomy

Term for a type of procedure where a loop of the ileum is brought to the body surface to form a stoma and allow stool drainage into an external pouch follwing an IPPA when the ileostomy is no longer necessary?

Continent Ileostomy

Term for an intra-abdominal resevoir that is constructed and a nipple valve is formed (the ileum is folded back on itself) from the terminal ileum before brought to the surface of the abdominal wall. Stool collects in the pouch; the nipple valve prevents stool from leaking through the stoma and a catheter is inserted into the pouch to drain the stool.

Ileostomy

Term for an ostomy made in the ileum of the small intestine where the colon, rectum, and anus are usually completely removed?

Diverticulitis

Term for infection and inflammation of diverticula?

Diverticulosis

Term for multiple diverticul without inflammation?

Ulcerative colitis

The term for a condition that affects the mucosa and submucosa of the color and rectum. The client experiences periods of symptom-free remissions with sporadic periods of active disease (flares)?

Crohn Disease

The term for a disease that can affect any portion of the GI tract from the mouth to the anus, but usually affects the terminal ileum and ascending colon. The client experiences periods of symptom-free remissions with sporadic periods of active disease (flares)?

False Clients should only take laxatives recommended by the primary care provider only and should be avoided during a flare of the disease

True or False? Clients should take laxatives during a flare of disease?

False: Diverticular disease is associated with a low-fiber diet High fiber diets should be encouraged

True or False? Diverticular disease is associated with a high-fiber diet?

-Mild/severe pain in lower left quadrant -Nausea -Vomiting -Fever -Chills -Leukocytosis

What are some common symptoms seen in a patient with diverticulitis?

-Advanced age -Obesity

What are some factors that can preclude and IPPA?

-Bowel obstruction is the leading indication in Crohn disease -Other complications include: perforation, internal/external fistula, abscess, and perianal complications -Surgical interventions depend on disease and the portion of the bowel affected

What are some indications that a client may need surgical interventions for IBD?

-Teach how to insert rectal suppositories or administering a retention enema -Shake suspension forms well before using -Notify HCP if adverse effects occur, diarrhea is the most common side effect

What some health education topics to teach clients and the family when administering mesalamine or olsalazine?

Total colectomy with an ileal pouc-anal anastomosis (IPPA)

What would be the surgery of choice for extensive ulcerative colitis?

May occur anywhere in the intestine but is most common in the sigmoid colon.

Where does diverticular disease occur?

Rectosigmoid area of the anal canal and progresses proximally In most clients, the disease is confined to the rectum and sigmoid colon but stops at the ileoccecal junction

Where does the inflammation process begin in ulcerative colitis?

Because nutrients have a shorter length to travel through the intestines resulting in less absorption of water from the intestinal track. As a result, clients with an ileostomy are more likely to have soft stools that contain high percentages of water, and this water is excreted instead of being absorbed by the body. In addition the stoma site allows exposure of the internal tissues to the outside environment, and the body does not have a built-in method to prevent evaporation of water from tissues. Therefore the body looses more water via evaporation than in clients who do not have an ileostomy.

Why is a client with an ileostomy at risk for dehydration?

Decompression until peristalsis occurs

Why would a nurse utilized a nonsurgical management of an NG tube for a client with IBD

-Administer bowel training -Treat with surgery -Remove fecal impaction if present -Diet adjustment (avoid alcohol, caffeine; increase fiber) -Administer medications (laxatives, anti-diarrheal drugs, stool softeners)

List some intervention/therapies for a client with bowel incontinence.

-The stoma will require that you wear a collective device at all times -Once the ileostomy is closed, you can expect to have 6-bowel movements through the anus daily -The temporary ileostomy is usually maintained for 2-3 months while the bowel heals, then is closed Rationale: A client with ulcerative colitis having a total colectomy with an ileal pouch-anal anastomosis and ileostomy can expect that the anal anastomosis will be healed in 2-3 months. The ileostomy is then closed. Meanwhile, the client will not have control of the bowels and must always wear a collection device. Once the bowel is healed and the ileostomy is closed, the client can expect to have 6-8 bowel movements/day.

A client who has ulcerative colitis is scheduled for a total colectomy with an ileal pouch-anal anastomosis (IPPA) and a temporary ileostomy. When the client asks the nurse what to expect related to bowel function and care after surgery, the nurse accurately responds with the follwing? (End of chapter quiz)

-"I can understand how this can be a real concern. Let's go find a place to talk where we can have privacy." Rationale: Youth adult clients typically have concerns about managing sexual activity with an ileostomy. Validating these concerns and helping these individuals obtain the knowledge they are seeking will help them cope more effectively with this significant threat to self-image. The nurse should indicate that she understands this client's concern and then ensure that the two of them can have privacy to discuss sensitive questions. The United Ostomy Association and its local chapters have printed materials available on this topic, but simple handing the patient a brochure is not the best strategy to address the client's needs.

A young client with IBD has just undergone a temporary ileostomy. He tells the nurse that he is not sure how he can handle any future sexual encounters. What is the best response the nurse might provide? (End of chapter quiz)

-Carefully document the client's I/O -Make sure the client and family members use sterile technique when changing the central venous catheter dressing Rationale: Essential content with TPN instruction includes teaching about central venous line dressing changes using sterile technique and the need to carefully monitor the client's I/O.

An alert adult client with severe IBD requires short-term total parenteral nutrition (TPN) following discharge home. Which nursing actions are particularly important when teaching this client and family members about TPN? (End of chapter quiz)

-General appearance -Weight -Vitals: including orthostatic and temperature -abdomen assessment including: shape, contour, BS, palpation for tenderness and masses, presence of stoma or scars

Explain the physical assessment to be performed for a client suspected with IBD. (Nursing Process-Assessment)

-Avoidance/cessation of smoking

List a preventative measure to take with Irritable Bowel disease (IBD)?

-Age at onset Peaks in 15-30 year olds -Diarrhea 5-30 stools/day with blood and mucous -Abdominal pain Cramping in left lower quadrant; relieved by defecation -Nutritional deficit Common, involving anemia, hypoalbuminemia, and weight loss -Constitutional manifestations/metabolic process Fever (rare), possible associated arthritic, skin, or other organ involvement, such as erythema nodosum or uveitis

List some clinical characteristics for ulcerative colitis?

-Age at onset Peaks in 15-30 year olds -Diarrhea Common, usually less severe than in colitis, with no obvious blood or mucus in stool -Abdominal pain Cramping, or steady right lower quadrant or periumbilical pain; tenderness and mass noted in right lower quadrant -Nutritional deficit Common and significant, involving anemia, weight loss, and multiple vitamin and mineral deficits -Constitutional manifestations/metabolic process Fever, malaise, fatigue; possibly some associated conditions and urinary complications

List some clinical characteristics of Crohn disease?

-Pale mucous membranes -Thirst -Light-headedness -Hypotension -Reduced I/O

List some clinical manifestations involving a hemorrhage in IBD?

-Frequent loose stools -Abdominal tenderness/cramping -Stool that may or may not contain blood -Thirst -Dehydration -Hypovolemia -Malnutrition

List some clinical manifestations involving diarrhea in IBD?

-Possible asymptomatic between bowel loops -Between bowel and bladder= frequent UTI's -Between bowel and abdominal cavity= abscess, chills, fever, a tender abdominal mass, and leukocytosis -Between small bowel and colon= weight loss, malnutrition, possible exacerbation of diarrhea

List some clinical manifestations involving fistulas in IBD?

-Extensive colon involvement -Anemia -Hypovolemia -Malnutrition -Fecal urgency and tenesmus (painful but ineffective urge to defecate) -LLQ cramping relieved by defication -Fatigue, anorexia, and weakness

List some clinical manifestations of severe ulcerative colitis?

-Blood transfusions -Iron supplements -IV fluid -Possible surgery to remove damaged bowel -Vasoconstrictive medications

List some clinical therapies involving a hemorrhage in IBD?

-Fecal disimpaction -Enemas -Suppositories -Bowel decompression -Colonoscopic decompression -Bowel habit retraining -Total abdominal colectomy

List some clinical therapies involving a megacolon in IBD?

-Monitoring I/O -IV fluid -Anti-diarrheal medications (should be avoided in severe ulcerative colitis) -Possible guaiac testing

List some clinical therapies involving diarrhea in IBD?

-Symptomatic treatment= anti-biotics, anti-diarrheals, IV fluid -Possible dissection of section of bowel with fistula if tissue cannot be repaired

List some clinical therapies involving fistulas in IBD?

-Obstruction (acute) -Fistulization (acute) -Abscess formation (acute) -Malabsorption (acute) -Colon cancer (long term)

List some complications of Crohn disease?

-Toxic megacolon (acute) -Perforation (acute) -Massive hemorrhage (acute) -Colorectal cancer (long term)

List some complications of ulcerative colitis?

-Stool exam Allows examination for blood and mucus in stool to rule out infectious causes -CBC Shows anemia from chronic inflammation, blood loss, and malnutrition, as well as leukocytosis, and possible abscess formation -Serum albumin May decrease because of malabsorption, malnutrition, protein loss through intestinal lesions, and chronic inflammation -Folic acid and serum levels Decrease due to malabsorption -Liver function test May show elevated liver enzymes such as ALT, alkaline phophatase, AST, GGTP, and LDH -Bilirubin levels If sclerosing cholangitis is present -Sigmoidoscopy -Colonoscopy -Barium upper and lower x-ray

List some diagnostic tests utilized to establish the diagnosis of IBD?

-Encourage fluid intake of at least 2L/day -Eat soft foods with increased fiber, such as cooked vegetables -Participate in an individualized exercise -Use bulk laxatives (psyllium) and stool softeners

List some implementations for a client with Diverticulitis? (Nursing process-implementation)

-Manual removal may be necessary -Administer enema as necessary -Increase fluid and fiber intake to prevent recurrence -Evaluate medication profile for GI side effects -Improve defecation habits, and reduce constipation

List some interventions/therapies for a client who has an impaction?

-Remove blockage surgically -NG tube to relieve abdominal pressure

List some interventions/therapies for a client with an obstruction.

-Take preventive measures, and make an early diagnosis -Remove surgically -Administer chemotherapy or radiation therapy

List some interventions/therapies for a client with bowel cancer.

-Increase fluid and fiber intake -Increase activity level -Administer enema -Medications: laxative, stool softener, cathartics -Evaluate medication profile for GI side effects

List some interventions/therapies for a client with constipation.

-Increase fluid intake -Administer anti-diarrheal medication -Assess for cause (diet, medication, infection)

List some interventions/therapies for a client with diarrhea.

-Early cancer: possibly no symptoms -Blood in the stool -Persistent change in bowel habits -Abdominal pain -Unexplained weight loss -Anemia -Bowel obstruciton -Vomiting

List some manifestations of bowel cancer?

-Leakage of feces from anus -Loss of pelvic muscle control -Lack of ability to respond to urge to defecate

List some manifestations of bowel incontinence?

-Straining with defecation -Lumpy/hard stools -Sensation of incomplete emptying -Fewer than 3 bowels/week

List some manifestations of constipation?

-Frequent, runny stools -Hyperactive BS -Bowel incontinence -Abdominal cramps -Fever -Dehydration

List some manifestations of diarrhea?

-Constipation -Fecal incontinence -Abdominal cramping -Straining during defecation -Small, semi-formed stools -Loss of bladder control

List some manifestations of impaction?

-Abdominal distention and cramping -Abdominal fullness -Constipation or diarrhea -Vomiting -Inability to pass gas

List some manifestations of obstruction?

-Client will have normal elimination patterns -Client will be free of pain, relief, and absence of complications

List some plans to care for a client with diverticulitis (Nursing Process-Planning)

-Bowel obstruction -Colorectal cancer -Polyps -Ulcerative colitis -Crohn's disease -Necrotic bowel -Diverticulitis

List some reasons a client may need an ostomy?

-American Jews of european descent are 4-5 times more likely to develop IBD, then African Americans and Whites, then Hispanics, then Asians -Genetics -Immune system -Environmental/Lifestyle -Use of medications, especially nonsteroidal anti-inflammatory drugs and anti-biotics -Diet can be a trigger

List some risk factors for Inflammatory bowel disease (IBD)?

-Colostomy Stool is liquid/mushy -Ostomy -Ileostomy Stool is ALWAYS fluid

List some surgical interventions for IBD?

-Arthritis involving one or several joints -Skin/mucous membrane lesions or uveitis (inflammation of the uvea, the vascular layer of the eye, which may involve the sclera and cornea as well) -Development of thromboemboli -Sclerosing cholangitis (inflammation leading to scarring and narrowing of the bile ducts) more common in men than women

List some systemic clinical manifestations of severe ulcerative colitis?

Carefully clean the perianal skin with a mild cleanser Rationale: Frequent diarrhea results in irritated or denuded perianal skin. Gentle cleansing agents such as Peri-Wash, tucks, diaper wipes, and cotton balls saturated with witch hazel can be both soothing and facilitate healing. Protective creams like zinc oxide-based products also help to protect the skin around the anus from breakdown. Anti-biotics are not routinely placed around the anus. Maintaining good fluid intake will lessen the risk of having dehydrated skin that is more susceptible to excoriation.

The nurse is evaluating the client's understanding regarding care of the skin during an acute exacerbation of IBD with frequent stooling. The nurse determines that teaching goals have been met when the client indicates he will follow which actions for self-care? (End of chapter quiz)

-Medications should be continued even when the child has no symptoms -These children often require surgery at some point to manage the disease or its complications -Typical treatment regimens include systemic and locally-acting anti-inflammatory drugs, corticosteroids, and anit-diarrheal agents Rationale: Children with ulcerative colitis typically present with pancolitis which tends to be aggressive and may require clients to undergo bowel surgery to manage the disease and its complications. The primary pharmacologic treatment involves systemic and locally-acting anti-inflammatory drugs, corticosteroids, and anit-diarrheal agents. Because of compromised nutrient absorption from the inflamed bowel, dietary supplementation is needed. Children with ulcerative colitis, like adults, are at greater risk for developing cancer of the colon. It is also very important for affected individuals to adhere to a strict medication regimen even when asymptomatic.

Parents of a 9-year-old diagnosed with ulcerative colitis following a hospitalization for pancolitis ask the nurse to teach them more about the disease, its progression, and the typical treatment regimen. The nurse can accurately share what information with the parents? (End of chapter quiz)

-Typically begins as a small inflammatory aphthoid lesion (a shallow ulcer with a white base and elevated margin, similar to a canker sore) of the mucosa and submucosa of the bowel -If inflammation progesses, deeper ulcerations, granulomatous lesions, and fissures develop; this inflammatory process involves the entire bowel wall (transmural) -The lumen of the affected bowel assumes a cobblestone appearance as fissures and ulcers surround islands of intact mucosa over edematous submucosa -As the disease progresses, fibrotic changes in the bowel wall cause it to thicken and lose flexibility, taking on a 'rubber like' appearance -Inflammation, edema, and fibrosis can lead to local obstruction, the development of abscesses, and the formation of fistulas between loops of bowel or between the bowel and other organs -Depending on severity, malnutrition may develop as ulcers prevent absorption of nutrients

Pathophysiology of Crohn Disease

-Inflammation starts at the base of the crypts of Lieberkuhn in the distal large intestine and rectal mucosa -Micro sized mucosal hemorrhages occur and crypts abscesses develop -Abscesses penetrate the superficial submucosa and spread laterally, leading to necrosis and sloughing of bowel mucosa -Mucosa becomes red and edematous to vascular congestion, friable (easily broken), and ulcerated -Tonguelike projections (pseudopolyps) of bowel mucosa into the lumen may develop as the epithelial lining of the bowel regenerates -Chronic inflammation leads to atrophy, narrowing, and shortening of the colon with loss of its normal haustra

Pathophysiology of ulcerative colitis

-Rub finger around opening to soften edges -Use skin barrier protectant -Remove backing and apply to stoma -Apply paste around opening of flange to fill in any creases before closing system -Use hand to "heat activate" the adhesive

Pouching- step #3

-Two piece system: apply as described -Snap seal to secure site (like sealing a tupperware bowl) -Fold bottom of open ended pouches over the clamp -Change q24h if skin irritation occurs -Change q3-7 days

Pouching- step #4

Ostomy

The term for a surgically created opening between the intestine and the abdominal wall that allows passage of fecal material?

Enterovesical fistulas

The term for fistulas that occur between bowel and bladder?

The manifestations of Crohn's disease vary widely among individuals with this condition. Rationale: The S/S of Crohn disease vary widely since any portion of the GI tract, from the mouth to the anus, can be affected. Early manifestations of the disease can be insidious, and it is not uncommon for individuals to learn they have the disease when they develop an intestinal obstruction of abscess. Careful adherence to drug therapy plays a key role in terminating acute illness episodes and in preventing relapse. In spite of frequent diarrhea, clients with Crohn disease on long-term corticosteroid therapy may experience Cushingoid effects (abnormal fat deposition in the face and trunk, osteoporosis).

The nurse and pharmacist are planning an educational session for families of newly-diagnosed clients with Crohn's disease. Content they should cover include which facts about his chronic condition? (End of chapter quiz)

Enterocutaneous fistulas

The term for fistulas that occur between bowel and skin?

Enteroenteric fistulas

The term for fistulas that occur between loops of bowel?

-Several small feedings each day -Limit fiber intake to decrease intestine motility in inflammation -Peel fruits and avoid large quantities of whole grains and nuts -Offer high calorie meals-cream soups, milkshakes, pudding, and custards -Provide liquid dietary supplements -Watch for foods that cause intestinal problems -Prevent mealtimes from becoming a reason for family strife -Provide/Administer elemental enteral nutrition and supplements as ordered -Including family members in teaching and dietary discussions

What are some dietary instructions for children with IBD? (Nursing Process-Implementation)

-Take oral prep after meals to increase intestinal transit time -Drink at least 2 quarts of fluid per day to reduce the risk of kidney damage -Use sunscreen to prevent burns due to increases sensitivity to sun -Avoid during pregnancy and lactation -Notify HCP if rash, sore throat, bleeding gum, joint pain, easy bruising, or fever develop

What are some health education topics to teach clients and the family when administering a sulfasalazine?

-Do not stop abruptly, the dose will be tapered gradually when the drug is discontinued -Notify HCP if adverse or Cushingoid effect occurs -Take with food/milk to decrease GI effects -Monitor weight, notify HCP if gain of more than 5 pounds -Moderate salt intake and avoid foods/snacks high in sodium. Increase foods in potassium, such as fruits, vegetables, and lean meats -Carry a card or wear a bracelet at all times identifying corticosteroid use

What are some health education topics to teach the client and the family when administering corticosteriods?

-Use a stool chart to record the frequency, amount, and color of stools; measure I/O -Monitor vitals q4h: tachycardia, tachypnea, fevers could all be signs of FVD -Weigh daily -Assess for indications of FVD -Maintain bowel rest by keeping client NPO or limiting oral intake to elemental feedings as indicated -Administered anti-inflammatory and anti-diarrheal medications as indicated -Maintain fluid intake by mouth of IV as indicated -Provide good skin care -Assess perianal area for irritation or denuded skin from diarrhea

What are some implementations for a client with IBD? (Nursing Process- Implementation)

-Hemorrhage Most common, often resulting in anemia -Perforation Occurs when the intestinal wall is weakened due to chronic inflammation and ulceration resulting in the formation of an opening; the opening allows the intestinal contents to leak into the abdomen and cause peritonitis -Rupture of the bowel -Fulminant colitis (may advance to toxic megacolon)

What are some intestinal complications associated with the clinical manifestations of ulcerative colitis?

-Anorectal lesions such as fissures -Intestinal obstruction -Ulcers -Fistulas -Abscesses -Nausea, vomiting, and epigastric pain if the stomach and duodenum are involved

What are some intestinal complications associated with the clinical manifestations or Crohn disease?

-Contraindicated in clients with peptic ulcer disease, glaucoma, or cataracts, diabetes, or psychiatric disorders -Obtain baseline vital signs and weight; monitor both routinely during therapy -Monitor for edema -Monitor for desired effects: reduced diarrhea, less blood and mucus in stool, and less abdominal cramping -Monitor for adverse effects: Hyperglycemia, hypokalemia, edema, hypotension, S/S of HF, peptic ulcer formation and possible GI hemorrhage

What are some nursing considerations when administering corticosteroids?

-Assess for possible contraindications such as pregnancy, lactation, or hypersensitivity -If more than one dose per day is ordered, space doses evenly over the 24-hour period -Evaluate for adverse effects such as nausea, diarrhea, abdominal cramps, CNS effect, rash or itching, and flu-like symptoms

What are some nursing considerations when administering mesalamine or olsalazine?

-Assess for contraindications, including hx of hypersensitivity -Assess baseline values for renal function tests, liver tests, and CBC -Suppositories or retention enemas are to be administered at bedtime, administer oral forms with a full glass of water -Have resuscitation equipment available in the event of anaphylactic response -Monitor for skin rash, uticaria, evidence of blook dyscrasias such as bleeding, fever, leukopenia, thrombocytopenia, changes in I/O, evidence of hepatitis

What are some nursing considerations when administering sulfasalazine?

-Client will achieve resolution of discomfort from symptoms such as diarrhea -Client will maintain adequate hydration -Client will maintain optimal nutritional status -Client will demonstrate positive, healthy coping skills -Client will describe appropriate home self-care, including administering medication, making dietary choices, and preventing exacerbation

What considerations should be involved when planning care for a client with IBD? (Nursing Process- Planning)

-Usually peaks between ages 15-30 but can also occur in the pediatric population -More common in male pediatrics than female pediatrics -Children suffer more from Crohn disease than ulcerative colitis; opposite is true for adults -Location of the disease is different in pediatrics than in adults -Children present the disease differently than that of an adult -A consequence of malabsorption of adequate nutrition in children can result in failure to grow -Children with this disease may also have a lower bone density than children without the disease

What could be some lifespan and cultural considerations involving IBD?

The frequency of stools -Mild/moderate 6 or fewer stools per day & Intermittent rectal bleeding and mucus -Severe 6 or more bloody stools per day

What is the difference between mild/moderate ulcerative colitis and severe ulcerative colitis?

Sulfasalazine

What type of IBD drug is an anti-inflammatory drug used for its local effecct on the intestinal mucosa. The active part of the drug is mesalamine, which inhibits prostaglandin production in the bowel. Prostaglandin is an important mediator of the inflammatory process; blocking its production and reducing inflammation.

Corticosteroids

What type of IBD drugs are hormones produced by the adrenal cortex. These hormones are necessary for the stress response. Cortisol, the main glucosteroid, has potent anti-inflammatory effects. Used to treat acute episodes of IBD because of their multiple and significant side effects, they are not used to maintain remission.

Clients with extensive chronic ulcerative colitis

What type of clients would require a total colectomy (surgical resection and removal of the colon)?

Ileal pouch-anal anastomosis (IPPA)

What type of procedure removes the entire colon and rectum, has formation of a pouch from the terminal ileum into the pelvis and anastomosed (connected) to the anal canal that's generally performed at the same time and is maintained for 2-3 months to allow the anal anastomosis to heal?

Use sunscreen while taking the medication Rationale: Sulfasalazine makes the client more susceptible to sunburn, so the client is instructed to use sunscreen when outside. The medication should be taken following meals rather than before meals to increase intestinal transit time. Should be taken with a full glass of water and daily fluid intake should be increased to a minimum of about 2000 mL (2 quarts) rather than 1.5mL

When teaching a client with IBD about prescribed oral sulfasalazine, the nurse should instruct the client to? (End of chapter quiz)