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Inflammatory Bowel Disease

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

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Inflammatory Bowel Disease

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  1. Inflammatory Bowel Disease NPN 200 Medical Surgical I

  2. 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

  3. 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

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

  5. 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

  6. Ulcerative Colitis • Diagnosis • H&P • CT • Stool exam • Sigmoidscopy • Colonoscopy • Barium enema • Lab studies

  7. 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

  8. 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 Ulcerative Colitis

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

  10. 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

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

  12. 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

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