Inflammatory Bowel Disease M.10-3
An adolescent with a new ileostomy is observed crying. Which action is best for the nurse take at this time? -Sit next to the patient. -Pull the curtains closed to provide privacy. -Call the parents to come into the room. -Reassure the patient that everything will be okay.
Sit next to the patient. Before responding, the nurse should find out why the patient is crying. Sitting quietly may help the patient feel comfortable enough to speak with the nurse. Simply closing the curtains and walking away is not supportive of the patient's feelings. It is also not the best action to just call the parents to come in and sit with the patient. The nurse does not know what the family dynamics are between this patient and the parents. The patient may not feel comfortable speaking with the parents at this time. Providing reassurance is not appropriate until the nurse knows what is causing the patient to cry.
The nurse is teaching the parents of a child newly diagnosed with inflammatory bowel disease (IBD). Which statement by the parents should indicate to the nurse that teaching has been effective? -"We will provide several small feedings a day." -"We will increase fiber intake." -"We will avoid liquid dietary supplements to minimize protein overload." -"We will restrict calories to prevent abdominal discomfort."
"We will provide several small feedings a day." When caring for a child with IBD, the nurse should advise the parents to feed the child with multiple small meals during the day, which may be better tolerated than larger meals. The parents should avoid high-fiber foods in order to decrease intestinal motility and inflammation. Children with IBD require increased protein and calories to minimize the risk of malnutrition.
The nurse notes that a patient with inflammatory bowel disease (IBD) has lost 3 pounds since the day before. Which should be the priority intervention by the nurse? -Administering intravenous fluids as prescribed -Administering an anti-inflammatory drug -Assessing the perianal area -Filling in the stool chart
Administering intravenous fluids as prescribed The loss of a few pounds from one day to the next indicates fluid volume deficit or dehydration. The priority is to administer fluids to promote good hydration. Anti-inflammatories will not address the patient's decreasing weight. Assessing the perianal area does not provide information about fluid status. Filling in the stool chart can give insight into why the patient is dehydrated, but this is not the priority intervention.
The nurse prepares materials about ulcerative colitis (UC) for a community health fair. Which age group should the nurse focus on when preparing this material? -Between the ages of 15 and 30 years -Between the ages of 5 and 15 years -Between the ages of 25 and 55 years -Between the ages of 30 and 60 years
Between the ages of 15 and 30 years The most common age of onset for ulcerative colitis is between 15 and 30 years, with a secondary peak between the ages of 50 to 70 years. The most common age of onset for ulcerative colitis is not between 5 and 15, 25 and 55, or 30 and 60 years.
The nurse is caring for a patient with severe ulcerative colitis (UC). Which clinical manifestation should the nurse anticipate to assess in this patient? -Bloody diarrhea occurring at least six times per day -Diarrhea with semiformed stools and abdominal cramping -Diarrhea fewer than six times per day -Leakage of intestinal contents into the abdomen
Bloody diarrhea occurring at least six times per day Severe ulcerative colitis is characterized by 6 to 10 bloody stools per day and can cause anemia, hypovolemia, and malnutrition. Mild UC is characterized by fewer than 6 stools per day. Patients who have Crohn disease have diarrhea and abdominal cramps. Intestinal perforation causes leakage of intestinal contents into the abdomen.
A patient suspected of having Crohn disease is scheduled to have a colonoscopy. Which finding should the nurse expect from the colonoscopy if the patient has Crohn disease? -Cobblestone appearance of bowel -Red, edematous, and friable tissue -Continuous inflammatory lesions of bowel -Inflammation that begins at the crypts of Lieberkühn in the distal large intestine and rectum
Cobblestone appearance of bowel With Crohn disease, the bowel lumen begins to appear like "cobblestones," as fissures and ulcers surround islands of intact tissue over edematous submucosa. The inflammatory lesions are not continuous and often occur as "skip" lesions with intervals of normal-appearing bowel. Patients with ulcerative colitis have a bowel that appears red, edematous, and friable. The inflammation of ulcerative colitis begins at the crypts of Lieberkühn in the distal large intestine and rectum.
The nurse is caring for a patient with inflammatory bowel disease (IBD). Which intervention should the nurse make a priority for this patient? -Maintaining skin integrity -Weighing every other day -Encouraging deep breathing and coughing -Discussing coping strategies
Maintaining skin integrity Interventions for a patient with inflammatory bowel disease primarily focus on preventing infection, monitoring weight daily, maintaining skin integrity, promoting nutritional balance, and maintaining fluid balance. Encouraging deep breathing and coughing may be an appropriate intervention, but this is not a primary focus for this patient. Teaching coping skills, especially how they relate to IBD and the treatment effects, is important but is not the primary focus for this patient.
A patient with inflammatory bowel disease (IBD) has an allergy to sulfonamides. Which medication prescription should the nurse question? -Sulfasalazine -Ciprofloxacin -Clarithromycin -Metronidazole
Sulfasalazine Sulfasalazine combines a sulfonamide antibiotic that is poorly absorbed from the GI tract with mesalamine, which acts topically on the colonic mucosa to inhibit the inflammatory process. The other medication choices are antibiotics that do not contain sulfa and would not cause an allergic reaction in the patient.
The nurse is caring for a young female adult with Crohn disease who was married a few weeks ago. Which question should the nurse include in the assessment interview? -"Are you considering starting a family soon?" -"Do you have any menstrual cycle problems?" -"Is your husband aware of your condition?" -"Do you have a history of breast cancer in your family?"
"Are you considering starting a family soon?" Women with IBD are at increased risk of severe preeclampsia, medically indicated preterm delivery, preterm premature rupture of membranes, and delivering infants with low Apgar scores and major congenital malformations. It is essential for women of childbearing age to be proactive in planning pregnancy to optimize their health and medications. The nurse should ask about plans to get pregnant so that this process can get started. There is no relationship between IBD and menstrual cycles or breast cancer. It is not necessary for the nurse to ask whether the patient's husband is aware of the condition.
The nurse is conducting a support group for parents of young children with ulcerative colitis (UC). Which suggestion made by a parent requires the nurse to intervene? -"Try giving two to three larger meals per day to allow the bowel to rest in between feedings." -"Offer cream soups or milkshakes if your child won't eat." -"High-protein dietary supplements can help increase protein intake." -"Try using a food diary to monitor for foods that can cause intestinal problems."
"Try giving two to three larger meals per day to allow the bowel to rest in between feedings." Children may tolerate multiple small feedings throughout the day better than they may two to three larger meals. The remaining statements are appropriate for parents with children with UC. It is important to offer high-calorie meals or protein shakes to prevent malnutrition and the use of a food diary can help to identify foods that aggravate the child's symptoms.
The nurse is caring for a patient with a strong family history of Crohn disease. Which action should the nurse suggest to help prevent this patient from developing the disease? -Eliminate smoking -Avoid dietary fats -Reduce caffeine intake -Decrease protein intake
-Eliminate smoking Crohn disease occurs more commonly among smokers. If the patient is a nonsmoker, the nurse should emphasize the importance of not starting the habit. Dietary habits or behaviors are not associated with a reduction in the risk of developing Crohn disease.
The nurse is caring for an older adult patient with a new diagnosis of ulcerative colitis (UC). Which medication prescription should the nurse anticipate for this patient? -An immunosuppressive agent -Anti-inflammatories -High-dose probiotics -Total parenteral nutrition (TPN)
An immunosuppressive agent Older adult patients are usually treated with immunosuppressive agents as a first-line medication for UC. Despite this, there is insufficient evidence as to the effectiveness of this type of medication. Anti-inflammatories and high-dose probiotics are not the first treatment prescribed for an older adult with UC. TPN is sometimes used to provide patients with bowel rest, but it is not routinely prescribed for patients with UC.
The nurse is assessing a patient with Crohn disease for systemic manifestations. For symptoms of which disorder should the nurse assess this patient? -Arthritis -Headache -Edema -Decreased urine output
Arthritis Systemic effects of inflammatory bowel disease (IBD) may include arthritis, uveitis, and thromboemboli. Headache, edema, and decreased urine output are associated with a variety of conditions but not IBD or Crohn disease.
A patient is scheduled for stricturoplasty surgery. For which health problem should the nurse prepare teaching for this patient? -Bowel strictures -Bowel obstruction -Bowel strangulation -Bowel perforation
Bowel strictures Bowel strictures are a narrowing of the lumen of the bowel. Stricturoplasty opens up these narrowed spaces to facilitate passage of stool and prevent obstruction. These surgical techniques are not used to treat bowel obstruction, strangulation, or perforation.
The nurse notes that a patient with severe ulcerative colitis (UC) has decreased hemoglobin and hematocrit levels. Which complication should cause the nurse to have the most concern? -Hemorrhage -Perforation -Fulminant colitis -Toxic megacolon
Hemorrhage Hemorrhage is the most common complication of UC, which results in large amounts of blood in the stool and decreasing hemoglobin and hematocrit levels on a CBC. Perforation leads to holes in the intestine and leakage of fecal material into the abdomen. Fulminant colitis occurs when there is intestinal dilation and paralysis. Toxic megacolon is a severe form of fulminant colitis and causes excessive gas to accumulate in the bowel, which can lead to perforation if not relieved.
An adolescent patient with ulcerative colitis (UC) is hospitalized for severe diarrhea. Which nursing intervention should the nurse implement for the patient? -Infuse intravenous fluids as prescribed. -Weigh every other day. -Avoid anti-inflammatory medications. -Avoid the use of cream on the perianal region.
Infuse intravenous fluids as prescribed. Severe diarrhea most likely is causing the patient to be dehydrated. The nurse should provide intravenous fluids as prescribed. Daily weights should be performed to help assess the patient's hydration status. Anti-inflammatory medications should be administered as prescribed to help ameliorate the diarrhea episodes. The nurse should assess the perianal region for irritation or excoriation and apply a protective cream to the irritated areas as indicated.
A patient with diarrhea containing both blood and mucus experiences seven to eight stools per day. The nurse notes decreased red blood cells on the patient's complete blood count (CBC). Which condition should the nurse suspect in this patient? -Severe ulcerative colitis -Mild ulcerative colitis -Fulminant colitis -Crohn disease
Severe ulcerative colitis Severe ulcerative colitis (UC) is characterized by 6 to 10 bloody stools per day and can cause anemia, hypovolemia, and malnutrition. Mild UC is characterized by fewer than 6 stools per day. Fulminant colitis is a severe complication of UC and can lead to intestinal dilation with paralysis and abdominal distention. Patients who have Crohn disease do not have stools that contain blood or mucus.
The nurse is caring for a patient with persistent diarrhea. Which assessment finding should indicate to the nurse that the patient is experiencing ulcerative colitis (UC)? -Stools with blood and mucus -Right-sided abdominal cramping -Palpable mass in the lower right quadrant -Anorectal lesions
Stools with blood and mucus UC is characterized by frequent diarrhea with blood or mucus in the stool. Right-sided abdominal cramping and a palpable mass in the abdomen is characteristic of Crohn disease. Anorectal lesions are seen in patients with Crohn disease.
The nurse is discussing the incidence of inflammatory bowel disease (IBD) with a community group. Which information should the nurse include? -The disease is often linked to heredity. -Inflammatory bowel disease does not affect older adults. -Environmental factors have no effect on the etiology of inflammatory bowel disease. -The disease occurs less frequently in the United States and northern European nations than it does elsewhere in the world.
The disease is often linked to heredity. A family history of IBD is the most important independent risk factor. Peak onset occurs between ages 15 and 30 years, with a second smaller peak between ages 50 and 70 years. Several environmental factors act as triggers or preventive factors. North America and Northern Europe have the highest incidence and prevalence of ulcerative colitis.
The nurse is planning care for a patient with inflammatory bowel disease (IBD). Which outcome should the nurse consider as most appropriate for this patient? -The patient has no symptoms of infection. -The patient's skin excoriation is improving. -The patient recognizes the early signs of a flare-up. -The patient loses less than 5% of pre-illness body weight.
The patient has no symptoms of infection. The most correct outcome for the patient with inflammatory bowel disease is for the patient to demonstrate no signs of an infection. The patient should have no loss of skin integrity or weight loss.
The nurse is caring for a patient newly diagnosed with Crohn disease. Which lifestyle change should the nurse suggest to this patient? -"Increase dietary fiber to add bulk to stools." -"Increase intake of dairy products to increase calcium levels." -"Limit protein to prevent irritation of the bowel." -"Avoid anti-inflammatory medications to minimize irritation of the stomach lining."
"Increase dietary fiber to add bulk to stools." A patient with inflammatory bowel disease (IBD) may require changes to their diet in order to manage the symptoms. Increasing dietary fiber can reduce diarrhea. Some patients may need to eliminate dairy products, not increase intake. Patients may need higher intake of protein to ensure that they are not malnourished. Anti-inflammatory medications can reduce inflammation in the bowel and do not need to be avoided.
A patient seeks medical attention for ongoing diarrhea. Which question should the nurse ask to confirm a diagnosis of ulcerative colitis (UC)? -"Is there blood or mucus in your stool?" -"What is your weight?" -"What medications are you taking?" -"Do you have right-sided abdominal pain?"
"Is there blood or mucus in your stool?" Patients with UC often have blood or mucus in their stool. Asking about those symptoms can help the nurse identify UC or potential complications. The nurse should ask about weight but will also actually weigh the patient as part of the assessment. Current medications are important but do not distinguish UC. UC has cramping abdominal pain in the left lower quadrant; right-sided abdominal pain is a symptom of Crohn disease.
A patient prescribed bowel rest for an acute exacerbation of Crohn disease asks what food is permitted. Which response should the nurse make to this patient? -"We will put a tube into your stomach and give you a special type of high-protein and high-calorie solution." -"You won't be able to eat or drink anything for several days or weeks until the bowel has healed." -"You can only eat soft, bland foods until the bowel has healed." -"We will give you IV fluids so that you don't become dehydrated, but you won't be able to eat for a few days."
"We will put a tube into your stomach and give you a special type of high-protein and high-calorie solution." When a patient is placed on bowel rest, enteral or parenteral feedings are initiated to ensure adequate nutrition. If tolerated, enteral feedings are preferred due to the decreased risk of complications. The patient should not be completely without any nutrition due to the higher risk of malabsorption or malnutrition. A large-bore IV for fluids does not address the patient's nutritional needs. Even a soft, bland diet is contraindicated in a patient on bowel rest.
The nurse is preparing to assess a group of patients. Which patient should the nurse anticipate to be at a higher risk for developing inflammatory bowel disease (IBD)? -A Jewish male with a history of high NSAID use -A female of Asian descent with a history of a high-fat diet -A female of Hispanic descent with a prior surgical history of appendectomy -A South American male with a history of high animal-protein intake
A Jewish male with a history of high NSAID use People of Ashkenazi Jewish ethnicity have a rate of ulcerative colitis that is three to five times higher than that of other ethnic groups, which suggests another genetic link. African Americans and Caucasian Americans are more likely to develop the disease than Hispanic Americans or Asian Americans. Use of NSAIDs, antibiotics, and smoking are also risk factors associated with IBD. Diet does not trigger IBD but can aggravate its symptoms. There is also evidence that having an appendectomy in the early adult years may prevent development of ulcerative colitis.
A patient seeks medical care for diarrhea and lower abdominal pain. Which diagnostic test should the nurse anticipate being prescribed for this patient? -Colonoscopy -Abdominal flat plate -PET scan -CT scan
Colonoscopy The patient is experiencing signs of Crohn disease, and the provider is likely to prescribe a colonoscopy to look for the characteristic findings associated with the disease, such as the cobblestone appearance of bowel mucosa. An abdominal flat plate will not evaluate tissue characteristics. PET or CT scans will not be able to see the lesions in the bowel for the diagnosis of Crohn disease.
A patient seeks medical attention for blood in the stool. Which laboratory test should the nurse anticipate to be prescribed first for this patient? -Complete blood count (CBC) -Liver enzymes -BUN/creatinine -Blood chemistry panel
Complete blood count (CBC) The nurse should be most concerned about hemorrhage in this patient and anticipate the provider prescribing a CBC to evaluate blood loss or anemia. Liver function, renal function, and blood chemistry labs are not initially indicated for this patient because the priority is determining whether there is a hemorrhage that needs to be addressed first.
A patient with severe exacerbation of Crohn disease is prescribed bowel rest. Which additional prescription should the nurse anticipate for this patient? -Placement of a nasogastric tube for enteral feedings -Initiation of a large-bore IV for fluid administration -Soft, bland diet -Insertion of a central line for parenteral feedings
Placement of a nasogastric tube for enteral feedings When a patient is placed on bowel rest, enteral or parenteral feedings are initiated to ensure adequate nutrition. If tolerated, enteral feeds are preferred due to the decreased risk of complications. The nurse would anticipate the placement of a nasogastric tube in order to initiate feedings. A large-bore IV for fluids does not address the patient's nutritional needs. Even a soft, bland diet is contraindicated in a patient on bowel rest. It is not within a nurse's scope of practice to insert a central line.
A patient with a history of being treated with antibiotics and steroids for Crohn disease is being considered for surgery because of strictures in the colon. Which surgery should the nurse anticipate for the patient? -Strictureplasty -Sigmoidoscopy -Bowel resection -Total colectomy ileal pouch-anal anastomosis
Strictureplasty The patient is likely to undergo a strictureplasty. Longitudinal incisions are made in the narrow bowel segments to relieve strictures. A sigmoidoscopy is a procedure to inspect the bowels for changes and, if needed, to take biopsies. A bowel resection is aimed at reducing inflammation by removing the diseased part of the bowel. The total colectomy ileal pouch-anal anastomosis (IPAA) is usually performed on patients with ulcerative colitis.
A patient with ulcerative colitis is scheduled for surgery to remove the bowel and place a temporary ostomy. For which surgical procedure should the nurse prepare teaching material for this patient? -Total colectomy ileal pouch-anal anastomosis (IPAA) -Pyloroplasty -Stricturoplasty -Gastric resection
Total colectomy ileal pouch-anal anastomosis (IPAA) A total colectomy IPAA is a treatment for a patient with ulcerative colitis. It entails the removal of the entire colon and rectum and the formation of a temporary or loop ileostomy at the same time. The ileostomy is used for 2 to 3 months. A stricturoplasty is used to treat bowel strictures and does not involve the removal of the bowel or creation of an ostomy. A gastric resection is the removal of part of the stomach, not the bowel. It does not involve the creation of an ostomy. A pyloroplasty is a surgical procedure to widen the opening of the pyloric valve at the lower portion of the stomach. It does not involve the removal of the bowel or the creation of an ostomy.
A patient with inflammatory bowel disease (IBD) asks about dietary supplements to help with the symptoms. Which suggestion should the nurse make to this patient? -Probiotics -Energy drinks -Glucose tablets -Vitamin K tablets
Probiotics There is some preliminary evidence that suggests some probiotics may improve symptoms of IBS; however, benefits have not been conclusively demonstrated, and not all probiotics have the same effects. Glucose is needed for cellular energy. Vitamin K is used for clotting. Energy drinks contain sugars and electrolytes. Neither of these is considered an anti-inflammatory agent.
The nurse reviews the pathophysiology of Crohn disease with a patient who is newly diagnosed with the disorder. Which information about the patient's colonoscopy results should the nurse include in the discussion? -Cobblestone appearance of bowel -Red, edematous, and friable tissue -Continuous inflammatory lesions of bowel -Inflammation that begins at the crypts of Lieberkühn in the distal large intestine and rectum
Cobblestone appearance of bowel With Crohn disease, the bowel lumen begins to appear like "cobblestones," as fissures and ulcers surround islands of intact tissue over edematous submucosa. The inflammatory lesions are not continuous and often occur as "skip" lesions with intervals of normal-appearing bowel. Patients with ulcerative colitis have a bowel that appears red, edematous, and friable. The inflammation of ulcerative colitis begins at the crypts of Lieberkühn in the distal large intestine and rectum.
A patient with inflammatory bowel disease (IBD) reports taking nutritional supplements that help reduce the inflammation. Which supplement should the nurse anticipate to be used in the treatment of this disorder? -Probiotics -Energy drinks -Glucose tablets -Vitamin K tablets
Probiotics There is some preliminary evidence that suggests some probiotics may improve symptoms of IBS; however, benefits have not been conclusively demonstrated, and not all probiotics have the same effects. Glucose is needed for cellular energy. It is not considered an anti-inflammatory agent. Vitamin K is used for clotting. It is not considered an anti-inflammatory agent. Energy drinks contain sugars and electrolytes. They are not considered anti-inflammatory agents.
