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EXAM 2 MED SURG
IBD, CD, UC, CONSTIPATION, DIARRHEA
| Question | Answer |
|---|---|
| Inflammatory Bowel Disease Clinical Manifestations | Onset 15-25 yr, occurs evenly in both sexes, most common in Caucasians. It is an autoimmune disease, that results from an immune response to intestinal tract. Results in wide-spread inflammation and tissue destruction, |
| Risk Factors of IBD | Age, race, ethnicity, family history, smoking, NSAIDs |
| Diagnosis of IBDs | Blood tests, fecal occult blood tests, endoscopy, X-ray, CT scan, and MRI |
| IBD Treatments include | a combination of 5-aminosalicylates, glucocorticoids, immunosuppressants, immunomodulators, and antibiotics, as well as the following: Anti-inflammatory drugs, Antidiarrheal medications, Pain reliever (not NSAID), Iron supplements, Calcium and Vitamin D supplements |
| Nursing Management for IBD | Low-fat, high-fiber diet, avoid irritants such as spicy or acidic foods, alcohol, caffeine, and tobacco as they all increase gastric acid production. Avoid food or drinks 2 hours before bedtime or lying down after eating. |
| Chron's Disease (CD) | Inflammation involving all layers of the bowel wall, occurs anywhere in GI tract |
| CD Clinical Manifestations | Common symptoms are weight loss, malnutrition, anemia, cramping after meals, diarrhea, steatorrhea, and abdominal pain that is not relieved by defecation |
| Ulcerative Colitis (UC) | Disease of the mucosal layer of the colon and rectum, Typically starts in rectum and moves inward, Best viewed on colonoscopy, Damage to mucosa, breakdown of cells, and possible formation of pseudopolyps |
| Ulcerative Colitis Clinical Manifestations | Diarrhea with marked fluid loss, often blood in diarrhea which may contain mucus or pus, left lower quadrant pain that is relieved by defecation, intermittent tenesmus, vomiting, dehydration, anorexia, and passage of six or more liquid stools per day |
| CD presents with pain in the | RLQ |
| UC presents with pain in the | LLQ |
| Main Diagnostic for Crohn's Disease | CT Scan |
| CT Scan & MRI in CD | Highlights bowel wall thickening and mesenteric edema, as well as obstructions, abscesses, and fistulas - considered the more sensitive test in diagnosing CD and helps specify abscess formation and location, guiding percutaneous access and drainage |
| Barium Study in CD Patients | Traditional Study of the upper GI tract that shows a "string sign" on an x-ray image of the terminal ileum, indicating the constriction of a segment of the intestine |
| Ulcerative Colitis Assessment Findings | Pain in LLQ, inflamed mucosa and exudate with ulcerations during colonoscopy |
| Crohn's Disease Assessment Findings | Deep ulcerations, skip lesions which are areas of healthy and areas of diseased tissue, creating a cobblestone appearance. |
| Abnormal Labs in UC | Low hematocrit and hemoglobin levels. Elevated WBC, low albumin levels, and electrolyte imbalances. C-Reactive protein levels are elevated. Elevated antineutrophil cytoplasmic antibody levels are common |
| Abnormal Labs in CD | Hematocrit and hemoglobin levels may be decreased, and WBC may be elevated. Erythrocyte sedimentation rate (ESR) is usually elevated. Albumin and protein levels may be decreased indicating malnutrition |
| Diagnostic Tests for UC | X-Rays can be useful for determining the cause of symptoms. Free air in the peritoneum and bowel dilation or obstruction should be excluded as the source of symptoms |
| Main Diagnostic Test to Diagnose UC | Colonoscopy |
| IBD Surgical Procedures that CURE | Proctocolectomy with ileostomy (for UC) |
| IBD Surgical Procedures that PROVIDE RELIEF | Laparoscope-guided strictureplasty, small bowel resection, Intestinal Transplant |
| Proctocolectomy | Surgical excision of the colon and rectum |
| Intestinal Transplant | Available for children to young/middle aged adults who have lost intestinal function. May improve quality of life |
| Total Colectomy | Surgical excision of entire colon |
| Strictureplasty | In which blocked or narrowed sections of the intestines are widened, leaving the intestines intact |
| Ileostomy | A surgical opening in the ileum by means of a stoma to allow drainage of bowels, often used after a total colectomy or proctocolectomy |
| Planning Care/Interventions for a patient with IBD | Keep food diary, Medication adherence, Observe and record stool. Remove stool promptly, Restart oral fluid intake gradually, Offer clear liquids hourly, Avoid cold fluids. |
| Caring for a patient with Parenteral Nutrition for CD | Initiate slow and advance gradually each day as desired and as the patient's fluid and dextrose tolerance permits. Monitor lab test results and the patient's response to therapy. |
| I&O's? | Accurate recording and calculations can aid in the assurance of fluid balance and effectiveness of therapy |
| Blood Glucose? Why? How Often? | Titrated up during the beginning of infusion cycle and down at the conclusion of infusion to prevent hypo/hyperglycemia respectively |
| Weight? Why? How Often? | Daily, at the same time, under the same conditions for accurate comparison to ensure weight maintenance or gain. May be decreased to monitoring 2-3 times per week once patient is stable |
| Constipation | Fewer than 3 bowel movements per week, abdominal distention, abdominal pain, and bloating, sensation of incomplete evacuation, straining at stool, and small-volume elimination, lumpy, hard stools |
| Tenesmus | Ineffective and sometimes painful straining and urge to eliminate feces - or low back pain |
| Functional Constipation | which involves normal transit mechanisms of mucosal transport. This type of constipation is most common and can be successfully treated by increasing intake of fiber and fluids. |
| Slow-Transit Constipation | which is caused by inherent disorders of the motor function of the colon (e.g., Hirschsprung disease), and is characterized by infrequent bowel movements. |
| Defecatory Disorders | which are caused by dysfunctional motor coordination between the pelvic floor and anal sphincter. |
| Opioid-Induced Constipation | which includes new or worsening symptoms that occur when opioid therapy is initiated, changed, or increased and must include two or more symptoms of functional constipation (see later discussion). |
| Valsalva maneuver | forcibly exhaling with the glottis closed. Increased arterial pressure can occur with defecation. Straining at stool has a striking effect on arterial blood pressure. This pressure tends to collapse the large veins in the chest. |
| Hemorrhoids | Develop as a result of perianal vascular congestion caused by straining. Dilated portions of anal veins |
| Anal Fissures | Result from the passage of the hard stool through the anus, tearing the lining of the anal canal |
| Clinical Manifestations of External Hemorrhoids | Inflamed, reddened veins in the anus. Symptoms typically include Rectal itching, pain, or burning. |
| Clinical Manifestations of Internal Hemorrhoids | Soft swelling and difficult to palpate unless prolapsed. They can bleed daily with or without defecation. |
| Thrombosed Hemorrhoids | Blue, shiny, edematous mass on the anus. Patient will express they are very uncomfortable and requires immediate attention |
| Clinical Manifestations of Steatorrhea | Bulky, fatty, greasy, loose, foul smelling stools |
| Clinical Manifestations of Tenesmus | Spasms or straining associated with forced or painful elimination. Often described as persistent spasms of the rectum associated with the need to defecate |
| Clinical Manifestations of Anal Fissures | Linear break on the margin of the anus often caused by the passage of large hard stool. Patient presents with bleeding, pain, and itching. |
| Diarrheal meds should never be administered | At the start, as it is the body's protective mechanism to rid itself of bacteria and toxins |
| C Diff | Gram-Positive anaerobic organism and the most commonly identified bacterium in antibiotic-associated diarrhea |
| Chronic Diarrhea | Persists for more than 4 weeks and may return sporadically |
| Acute Diarrhea | Lasts 1-2 days |
| Persistent Diarrhea | Lasts between 2-4 weeks |
| Diarrhea | Increased frequency of bowel movements, of more than 3 per day with alternate consistency |
| Noninflammatory Diarrhea | Large Volume |
| Inflammatory Diarrhea | Small Volume |
| Types of Chronic Diarrhea | Secretory, Osmotic, Malabsorptive, Infectious, and Exudative |
| Secretory Diarrhea | High volume diarrhea associated with bacterial toxins and chemotherapeutic agents used to treat neoplasms, it is caused by increased production and secretion of water and electrolytes by the intestinal mucosa in the intestinal lumen |
| Osmotic Diarrhea | Occurs when water is pulled into the intestines by osmotic pressure of unabsorbed particles, slowing the reabsorption of water. Can be caused by lactase deficiency, pancreatic dysfunction, or intestinal hemorrhage. |
| Malabsorptive Diarrhea | Combines mechanical and biochemical actions. Inhibiting effective aborption of nutrients. Low serum albumin levels lead to intestinal mucosa swelling and liquid stool |
| Infection Diarrhea | Results from infectious agents invading the intestinal mucosa. |
| Exudative Diarrhea | Caused by changes in mucosal integrity, epithelial loss, or tissue destruction by radiation or chemotherapy |
| Unknown Diarrhea | Diagnostic tests should be performed such as CBC, Serum Chemistries, Urinalysis, Routine Stool Examination, and Stool Exam for infectious or parasitic organisms, bacterial toxins, fat, electrolytes, and WBC |
| Assessment Priorities | In long-term diarrhea, monitor for dehydration & electrolyte imbalance |
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