Care of Patient with Inflammatory Intestinal Disorders

Question 1

Inflammation of the mucous membranes of the stomach and intestinal tract - primarily small bowel
Causes diarrhea and/or vomiting
Affects mainly the small bowel
Usually self limiting - not do anything about it; do something if severely dehydrated
Types

Answer 1

Gastroenteritis

Question 2

Viral (most common)
Bacterial - antibiotics

Answer 2

Types - Gastroenteritis

Question 3

Norovirus is the leading foodborne disease: cruise ship
Transmitted via the fecal-oral route from person to person and from contaminated food and water

Answer 3

Viral (most common)

Question 4

Campylobacter enteritis, Escherichia coli, Shigellosis

Answer 4

Bacterial - antibiotics

Question 5

Recent travel out of the country or has eaten at any restaurant in the past 24 to 36 hours

Answer 5

Gastroenteritis assessment: History

Question 6

N/V
Some Abdominal cramping
Diarrhea
Immunosuppressed or older adults can become dehydrated easily - at risk pats; monitor for signs of dehydration

Answer 6

Gastroenteritis assessment: Clinical Manifestations

Question 7

Poor skin turgor
Dry mucous membranes
Orthostatic blood pressure changes and hypotension
Oliguria
Acute confusion in the older adult may be the only clinical manifestation present

Answer 7

Gastroenteritis assessment: Symptoms of dehydration:

Question 8

Oral rehydration or IV fluids - replace fluids lost
Monitor VS, I/O, weight - fluids
Monitor electrolytes - esp if v&d
Drugs that suppress intestinal motility are usually not administered
Antibiotics to treat bacterial gastroenteritis and anti-infective to treat shigellosis may be needed (depends on type and severity of illness)- if identify bacteria
Prevent transmission to others

Answer 8

Gastroenteritis treatment

Question 9

Potassium may be needed for patients with excessive diarrhea

Answer 9

Monitor electrolytes - esp if v&d

Question 10

These drugs can prevent the infecting organisms from being eliminated from the body
Not give anti-diarrheals because v&d getting rid of organism - let run its course; sometimes give ammodium
If determined they are necessary, loperamide (Imodium) is the drug of choice

Answer 10

Drugs that suppress intestinal motility are usually not administered

Question 11

Hand hygiene
Sanitize environmental items
Proper food preparation
Not share food

Answer 11

Prevent transmission to others

Question 12

Begins in rectum and proceeds toward the cecum - only colon

Answer 12

Location - Chronic inflammatory bowel disease - Ulcerative colitis

Question 13

Unknown

Answer 13

Etiology - Chronic inflammatory bowel disease - Ulcerative colitis

Question 14

15-25 and 55-65

Answer 14

Age of incident - Chronic inflammatory bowel disease - Ulcerative colitis

Question 15

10-20 liquid, bloody

Answer 15

stools per day - Chronic inflammatory bowel disease - Ulcerative colitis

Question 16

Hemorrhage
Nutritional deficiencies

Answer 16

Complications - Chronic inflammatory bowel disease - Ulcerative colitis

Question 17

Infrequent

Answer 17

Need for surgery - Chronic inflammatory bowel disease - Ulcerative colitis

Question 18

Most often in terminal ileumm can also involve colon with patchy involvement through all layers of bowel - all areas bowel

Answer 18

Location - Chronic inflammatory bowel disease - Crohn’s disease

Question 19

Unknown

Answer 19

Etiology - Chronic inflammatory bowel disease - Crohn’s disease

Question 20

15-40

Answer 20

Age of incident - Chronic inflammatory bowel disease - Crohn’s disease

Question 21

5-6 soft, loose nonbloody

Answer 21

stools per day - Chronic inflammatory bowel disease - Crohn’s disease

Question 22

Fistualas (more common)
Malabsorption and nutritional deficiencies - not absorping nutrient properly
Obstructions due to inflammation and scaring

Answer 22

Complicatins - Chronic inflammatory bowel disease - Crohn’s disease

Question 23

Frequent

Answer 23

Need for surgery - Chronic inflammatory bowel disease - Crohn’s disease

Question 24

Chronic inflammatory disease of the small intestine (most often), the colon, or both
Presents as inflammation that causes a thickened bowel wall
Etiology: unknown, but may include genetic, immune, and environmental factors
Clinical Manifestations:
Lab findings: nutritional labs
Diagnostic testing:

Answer 24

Crohn’s disease

Question 25

5-6 soft, loose stools per day, non-bloody Abdominal pain Low-grade fever Weight loss - nutritional deficits

Answer 25

Clinical Manifestations: - Crohn’s disease

Question 26

Anemia - not as much Decreased folic acid and Vitamin B12 Decreased albumin levels Elevated C-reactive protein and ESR - indicators of inflammation

Answer 26

Lab findings: nutritional labs - Crohn’s disease

Question 27

X-ray/CT: shows narrowing, ulcerations and strictures Magnetic resonance enterography (MRE): determine bowel activity/motility Abdominal ultrasound Abdominal computerized tomography Colonoscopy GI bleeding scan - look for a bleed

Answer 27

Diagnostic testing:- Crohn’s disease

Question 28

Immunomodulators are given to suppress the immune system - autoimmune and inflammatory thing Glucocorticoids are used during exacerbation to decrease inflammation Aminosalicylates are used to decrease inflammation - on all the time Antidiarrheals are given cautiously - not all time

Answer 28

Crohn’s disease treatment - Drug therapy:

Question 29

NPO TPN - until bowel calmed down Nutritional supplements

Answer 29

Crohn’s disease treatment - Nutrition therapy

Question 30

If do: Treatment includes nutrition and electrolyte therapy, skin care, and prevention of infection - fistula: high risk for infection and skin issues; NPO and TPN so fix fistula and not have comps

Answer 30

Crohn’s disease treatment - Fistulas (abnormal tracts between two or more body areas) are common

Question 31

Not as successful because inflammation occurs along all areas of the bowel Not cure For obstruction

Answer 31

Crohn’s disease treatment - Surgery may be needed

Question 32

Creates widespread inflammation of mainly the rectum and rectosigmoid colon but can extend to the entire colon when the disease is extensive Etiology: unknown; but genetic, immunologic (treat with immunomodulators), and environmental factors likely contribute to disease Clinical manifestations: Lab findings: Diagnostic testing:

Answer 32

Ulcerative colitis

Question 33

10-20 liquid, bloody stools per day Stool may contain mucus Tenesmus (an unpleasant and urgent sensation to defecate) Lower abdominal colicky pain relieved with defecation Malaise Anorexia Anemia Dehydration Fever Weight loss

Answer 33

Clinical manifestations: - Ulcerative colitis

Question 34

Anemia - H&H if low Increased WBC - inflammation Elevated C-reactive protein and ESR - inflammation Decreased electrolytes - more issues with these

Answer 34

Lab findings: - Ulcerative colitis

Question 35

Magnetic resonance enterography (MRE) - check motility Colonoscopy - inside bowel Abdominal computerized tomography Barium enema

Answer 35

Diagnostic testing: - Ulcerative colitis

Question 36

Immunomoduators are given to suppress the immune system Glucocorticoids are used during exacerbation to decrease inflammation Aminosalicylates are used to decrease inflammation Antidiarrheals are given cautiously

Answer 36

Ulcerative colitis treatment - Drug therapy:

Question 37

NPO - exacerbation TPN Avoid caffeine, alcohol, raw vegetables, high fiber foods, lactose containing foods

Answer 37

Ulcerative colitis treatment - Nutrition therapy:

Question 38

Can reduce intestinal activity, provide comfort, and promote healing Not want increase activity

Answer 38

Ulcerative colitis treatment - Restrict activity

Question 39

Hbg and Hct Electrolyte values VS

Answer 39

Ulcerative colitis treatment - Monitor for GI bleeding

Question 40

Removal of colon - pouch internally/ostomy

Answer 40

Ulcerative colitis treatment - Surgery may be required if medical therapies alone are not effective

Question 41

Hemorrhage Perforation Abscess formation Toxic megacolon Malabsorption - HUGE; not absorbing nutrients Bowel obstruction Fistulas Colorectal cancer Extraintestinal complications Osteoporosis

Answer 41

Comps of chronic IBS

Question 42

Most common in Crohn’s

Answer 42

Fistulas

Question 43

Higher risk in patients with ulcerative colitis greater than 10 years

Answer 43

Colorectal cancer

Question 44

Diverticulosis Diverticulitis Etiology: unknown Clinical manifestations of diverticulosis: Clinical manifestations diverticulitis: Lab findings for diverticulitis: Diagnostic testing:

Answer 44

Diverticular disease

Question 45

Presence of many abnormal pouchlike herniations (diverticula) in the wall of the intestine; wall of intestines

Answer 45

Diverticulosis

Question 46

Inflammation of diverticula Outpouchings of intestines inflammed

Answer 46

Diverticulitis

Question 47

Usually has no symptoms May go undiagnosed

Answer 47

Clinical manifestations of diverticulosis:

Question 48

Abdominal pain (LLQ) Temperature > 101 F Lower GI bleeding May develop peritonitis if ruptures - CONCERN; med emergency

Answer 48

Clinical manifestations diverticulitis:

Question 49

Elevated WBC - infection Decreased Hbg and Hct - esp if having bleeding

Answer 49

Lab findings for diverticulitis:

Question 50

Abdominal x-rays - tells if have diverticulosis/diverticulitis Abdominal computerized tomography (CT) Abdominal ultrasound (US)

Answer 50

Diagnostic testing: - Diverticular disease

Question 51

IV fluids Drug therapy: Avoid laxatives or enemas as they increase intestinal motility - not want stimulate bowels; rest bowels: NPO and NGT - not severe go to clear liquids; move way up once inflammation down Assess electrolyte imbalance Avoid increasing intra abdominal pressure - not want rupture Diet modification NGT Surgery

Answer 51

Diverticulitis treatment

Question 52

Antimicrobial such as metronidazole (Flagyl) , Bactrim or Septra, and Cipro - GI infections Mild analgesic for pain or opioid analgesic - abdominal pain

Answer 52

Drug therapy: - Diverticulitis treatment

Question 53

lifting, straining, coughing, or bending

Answer 53

Avoid increasing intra abdominal pressure - not want rupture - Diverticulitis treatment

Question 54

NPO, clear liquids, or low fiber diet Fiber containing diet is gradually introduced when inflammation has resolved and bowel function returns to normal

Answer 54

Diet modification - Diverticulitis treatment

Question 55

If N/V or abdominal distention is severe

Answer 55

NGT - Diverticulitis treatment

Question 56

Indicated if peritonitis, bowel obstruction or pelvic abscess is present Colon resection, with or without colostomy Or perferates Often not permanent If have diverticulosis - low residual diet: no nuts - could cause diverticulitis

Answer 56

Surgery - Diverticulitis treatment

Question 57

Chronic inflammation of the small intestinal mucosa that can cause bowel wall atrophy and malabsorption Causes: Varying clinical manifestations with cycles of remission and exacerbation Classic symptoms: Treatment: Dietary management of gluten-free diet - common

Answer 57

Celiac disease

Question 58

Combination of genetic, immunologic, and environmental factors

Answer 58

Causes: - Celiac disease

Question 59

Some patients have no symptoms, some have classic symptoms, some have atypical symptoms that affect every body system; some vary

Answer 59

Varying clinical manifestations with cycles of remission and exacerbation - Celiac disease

Question 60

anorexia diarrhea and/or constipation steatorrhea (fatty stools) abdominal pain abdominal bloating (LOTS) and distention weight loss

Answer 60

Classic symptoms: - Celiac disease