Intestinal & Colorectal Disorders

Crohn’s Disease

Inflammation of the GI tract

Results in lesions (the “cobblestone” appearance)

Overtime scar tissue develops, this thickened bowel wall makes it harder to stool/content

CM of crohns

Cramping diarrhea

Cramping pain, esp. after eating

Nausea/vomiting

RLQ pain/tenderness

Extraintestinal manifestations: skin lesions, eye lesions, joint abnormalities, and liver disease

crohns is dangerous because it can lead to

Can lead to severe malabsorption, secondary anemia, and weight loss especially when small intestine is involved

what can a X-rays, CT scan, MRI show for crohns?

bowel wall thickening

obstructions

abscesses

fistulas

Ulcerative Colitis

Characterized by multiple ulcerations & diffuse inflammation → continual breakdown with impaired mucosal and submucosal layers

rectum and colon only

can change up immune system

UC CM

this one has exacerbations/remissions

diarrhea with mucus, blood, pus

LLQ and rectal cramps/pain

rectal bleeding

anorexia, fever, WL, vomiting, dehydration

skin lesions, eye lesions, joints, liver disease

UC diagnosing

Colonoscopy:

Shows friable, inflamed mucosa with exudate and ulcerations

May include biopsy

Stool sample:

Blood?

Pus/mucous?

toxic megacolon

colon distends bc of inability for muscles to contract

Colonoscopy:

Shows friable, inflamed mucosa with exudate and ulcerations

May include biopsy

Stool sample:

Blood?

Pus/mucous?

UC can cause what other unrelated issue

High risk of osteoporotic fractures from decreased bone mineral density

UC medical treatment

Aminosalicylates (e.g. mesalamine): first-line meds for UC (could take 4-6 weeks to reach remission)

Next line for both: systemic corticosteroids (i.e. prednisone)

crohns med treatment

Corticosteroids (local: budesonide): first-line meds for Crohn’s (could take 8-12 weeks for remission)

Next line for both: systemic corticosteroids (i.e. prednisone)

nutrition for ibd

Oral fluids encouraged

Low-residue initially, high-protein, high-nutrition diet

Vitamins & iron replacement therapy

May need calcium & vitamin D (if taking corticosteroids)

Identification of individualized triggers– dairy??

Avoid cold foods and smoking

A nurse is caring for a client who was admitted with acute ulcerative colitis with noted frank blood in stools. What should be included in the nurse’s review and assessment when planning care for this client? Select all that apply.

Trends in BP and pulse

Trends in complete blood count

Current weight

Intake and output

Skin turgor

all of them:

vitals to monitor hypovolemia and shock

cbc to see hgb and htc, anemia, blood loss

weight to see if weight loss

i/o to see fluid balance

skin trugor to see dehydration and proper fluid balance

A client is admitted with a diagnosis of an acute exacerbation of Crohn’s disease. Which of the following should be included in the nurses' plan of care? Select all that apply.

Administer antidiarrheals and medications at scheduled times

Ambulate in halls hourly

Assess pain using OLDCART

Provide education on a high fiber diet

Cluster care with tech during rounding

assess pain

cluster care

• antidiarrheals should be avoided because they can cause toxic megacolon and retention

• exacerbation requires rest, not ambulation

• no high fiber

The nurse is caring for a client admitted with acute exacerbation of ulcerative colitis. The client has had 15 loose bloody stools in the last 24 hours. Assessment reveals dry mucous membranes, LLQ pain, & pallor

Vitals: HR 110, BP 100/60Labs: K 3.0, Hgb 7, WBC 13, Creatinine 1.8, BUN 28

Which of the following orders placed by the provider would the nurse question?

0.45% NaCl c 20mEq/L KCL continuous at 75ml/hour

Transfuse 2 Units Packed Red Blood Cells

Docusate sodium 100mg suppository daily

Morphine 0.5 mg IV q 4 hours prn

a. is fine because the nacl will fix the low volume and the kcl is fine because it will fix the low k

b. blood is fine, pt needs it

c. this is the answer. do not give antidiarrheals to a patient with exacerbation of IBD, will lead to toxic megacolon

d. morphine is fine, they need pain med and no CI with them

parenteral nutrition and what to monitor if a pt has one

give nutrition via IV

electrolytes, glucose, infection, clotting

how long can peripheral access for parenteral nutrition be used

5-7 days

postop of ostomy

general post op stuff (early ambulate, pain, prevent complication, educate)

strict i/o

gi assessments

care of the stoma

eating after a ostomy

first pt might be npo, but as they start to eat we want to reintroduce food one at a time

what is a major risk for ileostomy

dehydration

increase fluid intake by 500-750

what kind of meds may be given to prevent dehydration on a ileostomy pt

Antidiarrheals or stool thickeners/slowers may be prescribed

4 complications of an ostomy and the proper assessments for it

1. skin irritation/breakdown - does it fit properly

2. diarrhea - how often do you empty the bag? do they have any triggers

3. stenosis from scar tissue at stoma site - does this limit the output coming out

4. kidney/bladder/gall stones - report to provider, are they getting enough fluid

colorectal cancer is common with patients with a history of

ibd

colerectal cancer symptoms

many do not have early signs or symptoms

Later stages: changes in bowel habits and/or rectal bleeding

most common diagnostic and screening tool for colorectal cancer

colonoscopy

obesity treatment

Lifestyle modification: activity increase, behavioral changes, meet with dietician, weight loss

Pharmacologic therapy: coupled with lifestyle modifications

Surgical management: performed after non-surgical attempts have failed

Roux-en-Y gastric bypass

a type of weight-loss surgery that divides the stomach into a small upper pouch and reroutes the small intestine to limit food intake and calorie absorption.

Sleeve gastrectomy

a surgical weight-loss procedure that removes about 75% to 80% of the stomach, leaving behind a narrow, banana-shaped tube

diet changes after bariatric surgery

Slow introduction of GI intake after surgery is essential: NPO sugar-free or low-sugar liquids pureed soft

It may take up to 8 weeks to get to regular, solid foods

Helps to prevent GI distress like nausea, vomiting, reflux, diarrhea

Administer antiemetics

STOP PO intake when feeling full or nauseated

after bariatric surgery what is one thing you can never do

insert NG tube

early signs of dumping syndrome

fullness

weakness

faintness

dizziness

palpitation

sweating

cramping

diarrhea

high hr

n/v

late signs of dumping syndrome

rapid elevation of blood glucose, followed by increased insulin secretion (reactive hypoglycemia)