IBD drug therapy

Question 1

What does LORES stand for when considering a pt w/ IBD diet?

Answer 1

Limited fat
0 (zero) milk
Red fresh fish/ground meat
Eggs boiled
Strained foods

Question 2

If a pt. has severe s/s what should their nutritional therapy be?

Answer 2

NPO to promote bowel rest

Question 3

If a pt is severely ill/malnourished or if needs to be NPO for >7days or is unable to eat what should be there nutritional therapy be?

Answer 3

TPN

Question 4

If a pt has less severe s/s what should their nutritional therapy be?

Answer 4

Elemental formulas like Boost, absorbed in s.bowel and reduce bowel stimulation

Question 5

If a pt has even less severe s/s but are still significant what should their nutritional therapy be?

Answer 5

Low residue diet {low fiber} (trial of removing lactose from diet bc often poorly tolerated)

Question 6

What is the typical rate for TPN?

Answer 6

83.3

Question 7

What are some important s/s of life-threatening fluid shifts that are essential to look out for in a pt on TPN?

Answer 7

Edema, crackles/rales

Question 8

If TPN is temporarily not available what should you give until it is?

Answer 8

10% dextrose/water or 20% D/W

Question 9

What is used to treat mild-to-moderate IBD?

Answer 9

Locally acting and systemic anti-inflammatory drugs

Question 10

What is used to treat severe IBD?

Answer 10

Immunosuppressant drugs

Question 11

What are the 2 used aminosalicylates?

Answer 11

Sulfonamides and/or nonsulfonamides

Question 12

What are some commonly used sulfonamides?

Answer 12

Sulfasalazine or Olsalazine

Question 13

What are some commonly used nonsulfonamides?

Answer 13

Asacol, Pentasa, Rowasa

Question 14

What are some important nursing considerations when a pt is taking a aminosalicylates?

Answer 14

Give w/ food, adequate fluid intake, inform about possible changes in urine color and to notify doc, photosensitivity, monitor labs

Question 15

Aminosalicylates are what that can cause the pt to have dark or orange urine, jaundice, tired, anorexia, light colored stools and labs can increase?

Answer 15

Hepatoxicity

Question 16

What are the common corticosteroids used in IBD?

Answer 16

Prednisone or Methylprednisolone

Question 17

What is the major concern w/ corticosteroids?

Answer 17

Osteoporosis

Question 18

What are some important nursing considerations when a pt is taking corticosteroids?

Answer 18

Don’t stop abruptly, don’t take on empty stomach, monitor wts/glucose/electrolytes, warn about bruising easily and can mask/worsen infections, may need vitamin/calcium supplements

Question 19

What do biologics/immunomodulators/immunosuppressents do?

Answer 19

Alter bodies immune response/allow for w/draw from corticosteroids

Question 20

What are some common biologics drugs?

Answer 20

Mercaptopurine (6-MP), Imuran, Cyclophosphamide, remicade (Infliximab) or Certolizumab (Cimzia)

Question 21

What are some important nursing implications for biologics?

Answer 21

Avoid crowds, monitor for bleeding/bruising/infection and monitor renal/hepatic function

Question 22

What are common antibiotics prescribed for IBD?

Answer 22

Cipro or Flagyl

Question 23

What are some other meds that can be prescribed?

Answer 23

Anti-diarrheals, laxatives, iron supplements, B12 shots, calcium/vitamin D

Question 24

Important preop teaching?

Answer 24

Emotional prep, discuss managements of postop, description of external devices, preop bowel prep, intensive fluid/blood/protein replacement, continue corticosteroids via IV in postop, discontinue anticoagulants @ least 1wk before, low residue diet followed by clear liquid until NPO day of

Question 25

Important postop care?

Answer 25

Abd wound care, observe stoma for color/size, monitor ileostomy for fecal drains (24hrs), effluent very damaging skin, accurate I/O, F/E replacement (additional 500ml IV and 2-3L @ home to prevent dehydration), may need antidiarrheals, progression of diet and psychosocial considerations