Care of Patients with Inflammatory Intestinal Disorders Chapter 60 Care of Patients with Inflammatory Intestinal Disorders Crohn's disease (left) and ulcerative colitis (right). Inflammatory bowel disease symptoms vary, according to the disorder.

Inflammatory Disorders Intestinal Appendicitis Peritonitis Bowel Gastroenteritis (acute) Crohn’s disease (chronic) Ulcerative colitis (chronic) Crohn’s-dis of small intestine, colon or both. Most commonly affects the terminal ileum. Slowly progressive,unpredictable. Like UC, it is recurrent with remissions & exacerbations. Strictures & deep ulcerations give a cobblestone appearance putting pt at risk for bowel fistulas. UC: inf affects mucosal lining of colon or rectum. Can result in loose stools containing blood & mucus, poor absorption of vital nutrients, and thickening of the colon wall.

Inflammatory Disorders (cont’d) Anal Anorectal abscess Anal fissure Parasitic infections Food poisoning Salmonellosis Staph E. coli Botulism

Group Activity for Inflammatory Disorders Individualized questions Appendicitis Signs/symptoms before and after rupture Priorities when caring for a pt with an appendectomy that ruptured & turned in to peritonitis Peritonitis What are the 2 types? Teaching plan for surgical patient and is being discharged home. Gastroenteritis Classifications & Medications used Ulcerative colitis Profile of “typical” patient; dietary teaching plan What labs are important? What are the various surgeries for this diagnosis?

Group Activity for Inflammatory Disorders (cont’d) Crohn’s disease Teaching plan post-op & when discharged to home Quality of life issues if going home with an ileostomy (physical, psychological, & Social needs). Diverticulosis vs. diverticulitis Compare/contrast Anorectal abscess, anal fissure, anal fistula Key differentiations Food poisoning Teaching plan regarding organisms

Individual Student Paper Write a 10 minute paper on the “typical” patient with Crohn’s disease. Include the history, signs & symptoms, plausible causes, and psychosocial concerns.

Diverticula Several abnormal outpouchings, or herniations, in the wall of the intestine, which are diverticula. These can occur anywhere in the small or large intestine but are found most often in the sigmoid, as shown in this figure. Diverticulitis is the inflammation of a diverticulum that occurs when undigested food or bacteria become trapped in the diverticulum.

McBurney’s Point (Appendicitis) McBurney’s point is located midway between the anterior iliac crest and the umbilicus in the right lower quadrant. This is the classic area for localized tenderness during the later stages of appendicitis.

Peritonitis

Crohn’s Disease Note cobblestone appearance of intestine.

Ulcerative Colitis Photo shows severe mucosal edema and inflammation with ulcerations and bleeding.

Anorectal Fissure Common sites of anorectal abscesses and fistulas. Inflammation often begins in the anal crypts.

Fistulas The types of fistulas that are complications of Crohn’s disease.

Anal Fistula Common sites of anal fistulas.

Skin Barriers Skin barriers, such as wafers (A), are cut to fit 1/8 inch around the fistula. A drainable pouch (B) is applied over the wafer and clamped (C) until the pouch is to be emptied. Effluent should drain into the bag and not contact the skin.

Chapter 60 NCLEX Questions 17

Question 1 An older patient diagnosed with bacterial gastroenteritis reports abdominal cramping, diarrhea, nausea and vomiting, and fatigue for the past 24 hours. The nurse should monitor the patient for what priority assessment? Dehydration Hypokalemia Hypernatremia Perineal skin breakdown Answer: A Rationale: In older adults, dehydration occurs with viral and bacterial gastroenteritis and may require hospitalization. Electrolyte imbalances are also common, especially hypokalemia and hypernatremia. The aging skin is also at risk of compromise from frequent exposure to enzymes in the stool.

Answer Answer: A Rationale: In older adults, dehydration occurs with viral and bacterial gastroenteritis and may require hospitalization. Electrolyte imbalances are also common, especially hypokalemia and hypernatremia. The aging skin is also at risk of compromise from frequent exposure to enzymes in the stool.

Question 2 A patient has recently been placed on corticosteroids as treatment for ulcerative colitis. The nurse should monitor the patient’s laboratory results for evidence of which condition? Hypernatremia Hypercalcemia Hyperglycemia Hyperkalemia Answer: C Rationale: Long-term adverse effects that commonly occur with steroid therapy include hyperglycemia, osteoporosis, peptic ulcer disease, and increased risk for infection.

Answer Answer: C Rationale: Long-term adverse effects that commonly occur with steroid therapy include hyperglycemia, osteoporosis, peptic ulcer disease, and increased risk for infection.

Question 3 What priority laboratory analysis should the nurse review when caring for a patient with Crohn’s disease? C-reactive protein Serum albumin Hemoglobin Potassium Answer: C Rationale: Crohn’s disease presents as transmural inflammation that causes a thickened bowel wall, strictures, and deep ulcerations that result in severe diarrhea and malabsorption of vital nutrients. Anemia is common, usually from iron deficiency or malabsorption issues. C-reactive protein may be monitored as a marker of inflammation, albumin to assess nutritional status, and potassium related to losses from diarrhea.

Answer Answer: C Rationale: Crohn’s disease presents as transmural inflammation that causes a thickened bowel wall, strictures, and deep ulcerations that result in severe diarrhea and malabsorption of vital nutrients. Anemia is common, usually from iron deficiency or malabsorption issues. C-reactive protein may be monitored as a marker of inflammation, albumin to assess nutritional status, and potassium related to losses from diarrhea.