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MS2 Exam 2 > IBD: UC > Flashcards

IBD: UC Flashcards

1
Q

UC Definition

A

-chronic disease characterized by diffuse mucosal inflammation limited to the colon

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2
Q

UC Clinical Manifestations

A
  • 5 to 30 stools per day with blood and mucus (severe)
  • Cramping in LLQ abdomen relieved by BM
  • Common nutritional deficits
  • anemia, decreased albumin, weight loss
  • fever (rare)
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3
Q

Severe UC

A

-bloody stool frequency of more than 5 per day with any one of the following:

  • tachycardia (over 90 bpm)
  • temp (over 37.8 C)
  • anemia (less than 10.5 Hg)
  • raised ESR (over 30)
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4
Q

Clinical Manifestations of Severe Complications

A
  • arthritis 1 or more joints
  • skin and mucous membrane lesions
  • uveitis
  • thromboemboli
  • sclerosing cholangitis
  • hemorrhage with anemia
  • perforation
  • rupture of bowel
  • toxic megacolon
  • carcinoma
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5
Q

Assessment for UC

A
  • weight loss/pallor
  • abdominal distension
  • tenderness in the area of involvement
  • abnormal bowel sounds
  • presence of an inflammatory mass are common
  • perianal abscess, fistula, skin tags, or anal stricture
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6
Q

UC Medical Therapy

A

-medication tx is based on the severity of symptoms

Five major classes used:

  • aminosalicylates (5 ASA)
  • glucocorticoid
  • immunomodulators
  • antibiotics
  • biologic
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7
Q

UC Diagnosis

A
  • rule out other infectious causes through stool cultures
  • blood workup, check for anemia and infection
  • prometheus panel
  • small bowel follow through
  • endoscopic exam: sigmoidoscopy, total colonoscopy
  • chromoendoscopy
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8
Q

Goals for the Management of Acute Ulcerative Colitis

A
  • induction of remission
  • prevention of relapse
  • tx of complications
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9
Q

UC Surgery

A

indications:

  • fails to respond to tx
  • exacerbations are frequent and debilitating
  • massive bleeding, perforation, strictures and/or obstructions
  • tissue changes suggest dysplasia is occurring
  • cancer

25-40% of patients will need surgery

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10
Q

Steps to Surgery for UC

A

2 steps, 8 to 12 weeks apart

  1. Colectomy, rectal mucosectomy, ileal reservoir construction (temp. ileostomy)
  2. Closure of ileostomy to direct stool toward new reservoir 3-6 months
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11
Q

UC Surgery results

A
  • decreased # BMs/day

- control of defecation at anal sphincter

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12
Q

Types of Ostomies

A
  • Ileostomy

- Colostomy

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13
Q

Ileostomy description

A

opening into ileum to allow passage of intestinal content.

Intestine is sutured onto the skin surface creating a stoma

All portions of the large intestine are removed.

Can be permanent or temporary

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14
Q

Colostomy

A

opening into colon to allow passage of intestinal content

intestine is sutured onto the skin surface creating a stoma

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15
Q

Preoperative Care

A
  • psych support and explanation
  • enterostomal clinician for optimal placement of stoma
  • diet modifications
  • general preop teaching
  • NG or intestinal tube post op
  • antibiotics day before surgery
  • laxatives, enemas evening before and morning of surgery
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16
Q

Preop diet modifications

A
  • ↑ calorie
  • ↑ protein
  • ↑ carbs
  • ↓ residue week before
  • NPO after midnight
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17
Q

Ileostomy

A
  • usually done for Crohn’s disease and ulcerative colitis
  • permanent ostomy in RLQ abdomen
  • Pouch must be worn at all times for liquid to semi-liquid drainage
  • skin breakdown and fluid/electrolyte imbalance occur easily
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18
Q

Ileostomy Dietary Concerns

A

Goal: return to normal pre-surgical diet and avoid foods that cause diarrhea, gas, or obstruction

4-6 wks: low fiber diet

  • prone to food blockage with non-digestible fiber intake (knows signs)
  • use care when eating high fiber foods
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19
Q

Blockages

A
  • Keep NPO
  • Remove pouch if stoma swollen
  • warm bath 15 minutes
  • peri-stomal massage (knee chest position if possible)
  • may use warm saline irrigation if other measures do not work
  • do not irrigate routinely to regulate frequency of BM
  • if blockage lasts for 2 hours or starts to vomit, call doctor, ostomy nurse or go to the ER
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20
Q

Colostomy Types

A
  1. Ascending colostomy
  2. transverse double barrel colostomy
  3. sigmoid colostomy
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21
Q

Ascending colostomy

A
  • RUQ abdomen
  • all portions distal are removed
  • permanent colostomy
  • feces is semiliquid
  • skin breakdown common
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22
Q

Transverse Double Barrel Colostomy

A
  • usually temporary
  • may be permanent if distal portion is removed later
  • semi-liquid to semi-formed feces
  • distal end left to mature; has mucus in it
23
Q

Sigmoid Colostomy

A
  • single barrel
  • usually permanent
  • formed feces
  • drainage may be regulated by irrigation
  • ostomy appliance may eventually not be needed
24
Q

General Post-op Care

A
  • NPO: NG or intestinal decompression until bowel sounds return, progress from clear liquid to solid, low fiber diet for 6-8 weeks
  • Monitor I&O, keep electrolytes balance
  • observations of stoma and drainage
  • first few days, beefy red and swollen
  • gradually swelling recedes and color is pink or red
  • notify MD immediately if stoma is dark blue, blackish, or purple
  • drainage mucus or serosanguinous for first 1-2 days
  • begins to function 3-6 days after surgery
25
Q

Promote positive adjustment to ostomy

A
  • encourage to look at stoma
  • encourage early participation in care
  • reinforce positive aspects of colostomy
  • principles of skin care
  • clean skin gently and pat dry, do not rub
  • pouch opening 1/16th inch to 1/8th inch larger than stoma
  • skin barrier to protect skin immediately surrounding stoma
  • pouch is applied by pressing adhesive area to skin for 30 seconds
  • empty appliance immediately when seal breaks or when 1/4 to 1/3 full
26
Q

Thicken stool

A
  • applesauce
  • creamy PB
  • bananas
  • boiled milk
  • buttermilk
  • cheese
  • pasta
  • rice
  • pretzels
  • tapioca
  • toast
  • yogurt
27
Q

Loosen stool

A
  • alcohol
  • broccoli
  • grean beans
  • fresh fruit except bananas
  • grape juice
  • prunes or prune juice
  • spicy foods
  • spinach
28
Q

Causes gas

A
  • beans
  • beer
  • broccoli
  • brussel sprouts
  • cabbage
  • carbonated beverages
  • corn
  • cauliflower
  • cucumbers
  • mushrooms
  • spinach
  • peas
29
Q

Causes stool odor

A
  • asparagus
  • brussel sprouts
  • cabbage
  • cauliflower
  • eggs
  • fish
  • garlic
  • onions
  • some spices
30
Q

May contribute to food blockage

A
  • apple peels
  • raw cabbage
  • corn
  • raw celery
  • coconut
  • chinese veges
  • dried fruits
  • grapes
  • meats with casings (hotdogs or sausage)
  • mushrooms
  • nuts
  • pineapple
  • potato peels
  • large seeds
31
Q

Discolor stool

A
  • beets

- red gelatin

32
Q

Irrigating colostomy

A
  • only a colostomy can be irrigated, distal colon or rectum
  • never use an enema set to irrigate a colostomy
  • 500-1000mL lukewarm water through lubricated cone slowly over 5-10 minutes
  • remove cone and allow 30-45 minutes for the solution and feces to return
  • close off irrigating sleeve after 10-15 minutes; most has returned to ambulate
  • clean, rinse, dry and peristomal skin well. apply stoma cap or pouch
  • wash and rinse all equipment and hang to dry
33
Q

The Perfect Stoma

A
  • pre-op sited
  • budded
  • visible to patient
  • no complications
34
Q

Imperfect Stoma

A
  • flush

- retracted or recessed

35
Q

Common post-op complications

A
  • necrosis
  • bleeding
  • prolapse
  • mucocutaneous separation
  • parastomal hernia
36
Q

Healthy color

A
  • increased vascularity
  • rose, reddish pink or brick red
  • edema
  • mild to moderate is normal intially
  • bleeding
  • small amount normal when touched
  • skin around stoma
  • most sensitive to pain and irritation
37
Q

Skin irritation is…

A

avoidable

  • keep clean and dry
  • skin breakdown is a problem

-use warm tap water or other recommended products

38
Q

Drainage

A
  • minimal 24-48 hours after: serosanguinous until peristalsis returns
  • liquid to semi-liquid: 1000 to 1800 mL/day
  • decreases to 500mL with proximal bowel adaptation
  • Na++ and K+ significant lost with drainage
39
Q

Assessment/Care of Stoma

A
  • change wafer q3-7 days and prn
  • stoma changes or wafer sizing 1/16th inch to 1/8th inch larger than stoma
  • drainage pouch
  • empty when 1/4 to 1/3 full
  • can use tissue to clean stoma
  • can clean pouch with cool to lukewarm water
40
Q

Pouch application

A

“less is more”

  • begin with minimum of accessories and add as needed
  • peristomal skin must be clean and dry
  • can shave hair with electric razor if necessary to avoid folliculitis
  • avoid oils, lotions, creams, soaps
  • select optimal time for pouch change
41
Q

Paste

A

caulk to fill skin defects

42
Q

powder

A

moisture absorption for weeping skin

43
Q

adhesive removal wipes

A

breaks adhesive bond

44
Q

skin sealant

A

defats skin; avoid with extended wear wafer unless recommended by ostomy nurse

45
Q

belt

A

secures appliance more closely to abdomen

46
Q

Leakage prevention

A
  • stoma opening sized correctly
  • correct appliance
  • pouch been emptied regularly
  • empty when 1/4 to 1/3 full
  • what is patient doing when pouch fails?
47
Q

Followup teaching

A
  • make followup appt
  • call doctor right away if you have any of the following:
  • changes in stoma
  • drainage
  • fever
  • N/V
  • pain
  • no gas or stool after 24 hrs
48
Q

Pre-op Education

A
  • consistent education
  • non-judgemental
  • support groups/individuals (ostomy visitors)
49
Q

Diet with flare up

A
  • low residue diet=low fiber diet
  • small frequent meals
  • avoid “trigger foods”…no universal ones for IBD
  • limit sugar, artificial sweeteners, spicy foods, caffeine, lactose
  • replace fluid and electrolyte loss
  • parenteral IVF or enteral feedings
  • TPN for bowel rest
  • prevent weight loss
50
Q

Diet in Remission

A

Goal: adequate nutrition without exacerbating symptoms

-Best…balanced diet…increase protein, increase calorie, decrease fat, decrease fiber

51
Q

Nursing intervention to promote rest during flare-ups

A
  • freq. breaks and rest
  • good quality sleep
  • alternative therapies such as acupuncture, yoga, or homeopathy
  • planning ahead and reducing stress
  • physiotherapy and exercise
  • flexible work hours
52
Q

Intervention body image

A
  • listen to patient’s feelings and self perception
  • encourage patient to discuss physical changes
  • encourage patient to discuss their concerns about the disease and tx on close personal relationships
  • encourage the patient to make choice and decisions about own care, increases sense of control
53
Q

Discharge teaching

A
  • importance of rest
  • perianal care
  • action and SE of meds
  • symptoms of recurrence of disease
  • when to seek medical care
  • use of diversional activities to reduce stress
  • teaching resources from Chrohn’s and Colitis Foundation of America

MS2 Exam 2 (9 decks)

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