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NURS 205 > lecture 15: Management of Inflammatory Bowel Disease > Flashcards

lecture 15: Management of Inflammatory Bowel Disease Flashcards

1
Q

what is inflammatory bowel disease

A
  • GI tract disorders
  • Characterized by idiopathic inflammation and ulceration
  • varied clinical manifestations
  • autoimmune**
  • can be debilitating
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2
Q

what does inflammatory bowel disease have

A

unpredictable periods of remission and exacerbation

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3
Q

what is the etiology of inflammatory bowel disease

A
  • etiology unclear; multifactorial

potential causes:
- infectious agents, autoimmune response, environmental influences or allergies, genetics

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4
Q

who has elevated risk of developing IBD

A

immigrants from non-western countries who arrive in Canada as children and their Canadian-born offspring have increased risk than immigrants who arrive later in life

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5
Q

ulcerative colitis

A
  • inflammation and ulceration of the colon and rectum
  • diffuse inflammation of the mucosa and submucosa
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6
Q

crohn’s disease

A
  • inflammation can also occur in the small intestine, mouth, esophagus, and stomach
  • inflammation occurs deeper in the intestinal wall
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7
Q

out to inside of the intestine

A

OUT
serosa
muscularis externa
submucosa
muscosa

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8
Q

onset of ulcerative colitis

A
  • any age
  • usually starts 15-25
  • 2nd, smaller peak between 60-80
  • both sexes equally
  • runs in all families
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9
Q

most common clinical manifestations of ulcerative colitis

A
  1. abdominal pain
  2. bloody diarrhea
    - fever, malaise, anorexia, anemia, tachycardia, and dehydration
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10
Q

mild ulcerative colitis

A

up to 4 loose stools per day, stools may be bloody, mild abdominal pain

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11
Q

moderate ulcerative colitis

A

4-6 stools/day, stools may be bloody, moderate abdominal pain, anemia

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12
Q

severe ulcerative colitis

A

more than 6 bloody loose stools per day, fever, anemia, and tachycardia

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13
Q

very severe (fulminant) ulcerative colitis (about stools)

A

10+ loose stools/day, constant blood in stools, abdominal tenderness/distension, may require transfusion, potentially fatal

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14
Q

intestinal complications of ulcerative colitis

A

abscesses, pseudopolyps, hemorrhage, perforation, toxic megacolon, and colonic dilation

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15
Q

extraintestinal complications of ulcerative colitis

A

can involve the joints, skin, mouth, eyes, and hematological system
- cause of this is unknown

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16
Q

how many patient with ulcerative colitis have complications

A

50%

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17
Q

someone who has had ulcerative colitis for 10+ yrs is at greater risk of

A

colorectal cancer

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18
Q

2 most important risk factors of colorectal cancer

A
  1. extent of colitis
  2. duration of disease
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19
Q

pts w IBD are at higher risk for ____________ and related ____________ as well as _______________

A
  1. osteoporosis
  2. fractures
  3. arthritis
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20
Q

one of the most frequent co-morbidities seen in ppl w ulcerative colitis

A

diabetes mellitus
- suggests genetic component

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21
Q

components to diagnosis of ulcerative colitis

A
  • history and physical
  • colonoscopy or sigmoidoscopy
  • ultrasound
  • CT scan
  • barium enema
  • blood tests
  • stool tests
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22
Q

what is a sigmoidoscopy

A

view the rectum, sigmoid colon, and descending colon

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23
Q

colonoscopy

A

view the entire large intestine

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24
Q

what does normal colon lining look like

A

mucosa is healthy and pink

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25
Q

what does mildly active ulcerative colitis look like?

A
  • mucosa edematous and red
  • white areas are superficial ulcers with mucous exudate
26
Q

active ulcerative colitis

A
  • mucosa is very red and inflamed
  • mucosa is very edematous with bleeding occurring
27
Q

barium enema

A
  • night prior: instructed to drink magnesium citrate; will cause diarrhea
  • x-ray of colon after filling colon with barium, a chalky white solution
  • barium shows clear view of colon, and any abnormalities present
28
Q

3 types of blood studies for ulcerative colitis

A
  1. complete blood cell count (CBC)
    - hemoglobin: blood loss
    - high leukocyte: may indicate toxic megacolon or perforation
  2. electrolytes
    - decreases in sodium, potassium, chloride, bicarbonate, magnesium due to fluid/electrolyte losses
  3. serum protein levels
    - hypoalbuminemia - present with severe disease due to breakdown of cells
29
Q

aminosalicylates

A
  • contain 5-aminosalicyclic acid (5-ASA)
  • help control GI inflammation
  • can be given orally or rectally
30
Q

sulfasalazine

A
  • drug to control ulcerative colitis
  • combo w sulfapyridine and 5-ASA
  • anti-inflammatory and antibacterial properties
  • side effects: nausea, vomiting, heartburn, diarrhea, and headache
  • maintenance dose is usually continued 1 yr
31
Q

what does the sulfapyridine component do in sulfasalazine

A
  • carries anti inflammatory 5-ASA to intestine
32
Q

other 5-ASA agents

A

oral:
- olsalazine
- mesalazine
- balsalazide

suppositories:
- mesalazine

33
Q

ascending colon

A

orally given
- local release of mesalamine

34
Q

decending colon

A

enemas
- reach the splenic fissure

35
Q

sigmoid colon

A

foams

36
Q

rectum

A

suppositories

37
Q

corticosteroids

A
  1. oral prednisone: mild-moderate disease
  2. IV methylprednisolone or hydrocortisone: moderate to severe disease or 5-ASA ineffective

not recommended long-term

38
Q

corticosteroid sympt

A
  • weight gain, acne, facial hair, hypertension, diabetes, mood swings, increased risk of infection

not recommended for long-term use

39
Q

immunosuppressants

A
  • reduce inflammation by suppressing immune response (used in more severe cases of ulcerative colitis)
  • for pts who have not responded to 5-ASAs or corticosteroids or who are dependent on corticosteroids
  • slow acting and may take 6+ months b4 full benefit
  • ex: azathioprine, cyclosporine
40
Q

newer immunosuppressants (immunomodulators)

A
  • biologics: infliximab, adalimumab, golimumab
  • associated w risk of infection and certain cancers
41
Q

other meds

A
  • antibiotics
  • antidiarrheal meds
  • pain relievers (acetaminophen)
  • *NOT NSAIDS
  • iron supplements
42
Q

what causes imbalanced nutrition

A
  • less than body requirements
  • decreased intake, decreased absorption, increased loss by:
    anorexia, weight loss, weakness, lethargy, anemia
43
Q

what is nutritional therapy

A

mild->moderate disease or flare up

  • high calorie, high protein, low residue diet may be prescribed
44
Q

low residue diet

A

Excludes:
- alc and fruit juices w pulp
- whole grain breads and cereals
- fried, smoked, pickled or cured meats
- fried or uncooked eggs
- most cheeses and fruit yogurt
- raw and unstrained vegetables, beans
- raw fruits, skins, seeds, nuts

45
Q

if sympt of UC become severe

A
  • nutritional supplements
  • NPO
  • parenteral nutrition
  • total parenteral nutrition (TPN)
46
Q

goal of TPN

A
  • to meet client’s nutritional needs and allow growth of new body tissue
  • short or long term
47
Q

commercially prepared TPN solutions

A
  • available for central and peripheral use
  • standardized or customized
  • peripheral: 10-12.5% dextrose supplies 340-425 Kcal/L
  • central: 20-50% dextrose supplies 680-1700 Kcal/L

*trace elements and electrolytes added by pharmacy

48
Q

methods of administration

A
  • central parenteral nutrition: given thru catheter whos tip lies in SVC
  • peripherally inserted central catheters: placed and advanced into central circulation
  • peripheral parenteral nutrition: short term
49
Q

central vs. peripheral parenteral nutrition

A
  • differe in tonicity which is measured in milliosmoles
  • standard IV solutions of D5W are essentially close to isotonic (280)
  • central TPN are hypertonic - at least 1600 - must be infused in a central vein
  • PPN is hypertonic but less so - can be admin thru large peripheral vein
50
Q

infection complications of TPN

A
  • fungus (gram +’ve, gram -‘ve)
  • all TPN is prepared under strict aseptic technique
  • placement of PICC catheter is done under sterile conditions
  • local manifestations of infection
51
Q

metabolic complications of TPN

A
  • hyper/hypoglycemia
  • at beginning - hyperglycemia can occur
  • to prevent, solution is infused at a gradually increasing rate for 24-48 hrs
  • blood glucose levels checked every 4-6 hrs w a glucose testing meter
  • keep glucose below 8 mmol/L
52
Q

administering of solution

A
  • infusion pump
    check every 30-60 min
  • independent double check**
53
Q

mechanical complications of TPN

A
  • insertion (air embolus, pneumothorax, hemothorax, hemorrhage)
  • dislodgement
  • thrombosis of great vein
  • phlebitis
54
Q

never increase or decrease flow rate by more than…

A

10%

55
Q

% of pts requiring surgery to remove colon

A

25-40

56
Q

complications requiring emerg surgical intervention for UC

A
  • perforation of colon
  • massive bleeding in colon
  • sudden, severe ulcerative colitis
  • toxic megacolon
57
Q

standard surgical procedure for ulcerative colitis is

A

proctocolectomy
(removes colon and rectum)

58
Q

unlike crohn’s disease, which can recur after surgery, ulcerative colitis is…

A

“cured” once colon and lining of rectum is removed

59
Q

what is total proctocolectomy w permanent ileostomy

A
  • 1 stage surgery
  • removal of colon, rectum and anus
  • end of terminal ileum forms a stoma in RLQ
60
Q

what is a total colectomy with ileoanal reservoir

A
  • pt must be highly motivated
  • must b free of crohn’s and colorectal CA
  • must have competent anorectal sphincter

1-3 stages 12 weeks apart

61
Q

postoperative care

A
  • routine care for abdominal surgery
  • stoma viability and output
  • peristomal and perianal skin integrity
  • urinary cath
  • IV fluids
  • psychosocial
  • education

NURS 205 (18 decks)

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