Inflammatory Bowel Disease NPN 200 Medical Surgical I

Inflammatory Bowel Disease Inflammation and ulceration of the lining of the intestines 2 types –Ulcerative colitis – begins in the rectum and extends upward with remission and exaberations –Crohn’s disease or regional enteritis – can effect any area but usually the terminal ilium. May involve regional lymph nodes and fistulas to the bladder, vagina, and perianal area. Treatment for both is similar, except for surgical approach Cause is unknown / more young Jew’s

Ulcerative Colitis Patho –Loose stools with blood and mucus –Poor absorption of nutrients –Thickening of colon wall and may form abscess’s –Can have minor problems or may be serious –Acute episodes may involve bleeding and ulcerations –Chronic stage may have fibrosis, muscle atrophy, and narrow and shortened colon

Ulcerative Colitis Complications of Ulcerative colitis –Perforation and peritonitis with fistula formation –Toxic megacolon –Hemorrhage –^ risk of colon cancer –Malabsorption –Bowel obstruction

Ulcerative Colitis Subjective symptoms –Abd cramping and pain –Nausea –Loss of appetite –Irritability –Anxiety –weakness Objective symptoms –Bloody diarrhea, with pus and mucus (up to 10-20/d) –Spastic rectum and anus –Weight loss –Vomiting

Ulcerative Colitis Diagnosis –H&P –CT –Stool exam –Sigmoidscopy –Colonoscopy –Barium enema –Lab studies

Ulcerative Colitis Medical treatment –Steriods –Immunosuppressants –Antidiarrheals –Antibiotics –Aminosalicylates (5- ASA) –Iron and Vit B 12 –Low roughage diet –No milk –Sometimes TPN –Surgery - total colectomy with ileostomy is the cure but not don until nothing else will work

Ulcerative Colitis Nursing care –Report S/S of problems –Provide emotional support –Skin care –Record # of stools and type –Monitor bowel sounds –Vitals and I/O –Watch for dehydration –Monitor H & H, E- lytes –Weigh daily –Dietary consult –Watch for complications –If OR, follow routine

Crohn’s Disease 1.Both subjective and objective symptoms are relatively identical to colitis 2.Assessment are identical 3.Diagnostic tests are the same except: 1.With Crohn’s will find string sign (segments of stricture seperated by normal bowel) 2.With colonoscopy will find patchy areas of inflammations 3.Need biopsy for definitive diagnosis

Crohn’s Disease Nursing care –Identical to colitis –Watch for internal bleeding –Medications Sulfasalazine for antiinflammatory effects Steriods Antibiotics Anticholinergics RX for diarrhea –Dietary changes Restricted fiber diet with no raw fruit or vegetables and no nuts or whole grains Low fat diet to reduce fatty stools

Crohn’s Disease May need surgery for partial removal of diseased portion of bowel Follow routine care for client with bowel surgery

Inflammatory Bowel Disease Highly stressful, long term disease process Need support from health care and family Difficult to follow regimen of medication and diet Refer client to national organization for support Keep regular appointments with physician