management of a patient w/ a lower GI disorder pt 2

what falls into inflammatory bowel disease?

crohn’s disease and ulcerative colitis

what are characteristics of IBD?

can be debilitating

characterized by chronic, recurrent inflammation of the intestinal tract

periods of remission and exacerbation

what can cause IBD?

infectious agents, auto-immune, food allergies, smoking, familial genetic predisposition, oral contraceptives

how is IBD managed?

aimed at decreasing or eliminating symptoms

improving quality of life

therapeutic agents will be selected based on symptoms severity and drug side effects

what is ulcerative colitis?

affects: the mucosa and sub-mucosa of the colon

manifestations: blood diarrhea w/ mucous, LLQ abdominal pain, tenstous, hypovolemia, low albumin

complications: hemorrhage, perforation of the bowel, and mega colon

describe crohn’ s disease

affects: anywhere in GI, ileum and colon mostly

involves: small shallow ulcers

manifestations: diarrhea, fatigue, RLQ abd pain, weight loss, malnutrition, low albumin, anemia

complications: fistula, bowel obstruction

compare Crohn’s and UC

UC: only in mucosa and sub mucosa, LI

Crohn’s: entire thickness, anywhere

how is IBD diagnosed?

history, clinical evaluation, radiographic studies (CT and MRI), endoscopy, colonoscopy, fecal occult blood test, and CBC

how is IBD managed?

nutritional treatment (TPN), bowel rest (severe), medications, surgery

what is nursing care like for IBD?

pain relief, maintain hydration, maintain optimal nutrition, promote rest, reduce anxiety, prevent skin breakdown, medication education, fewer firmer stools

what are the different kinds of ostomys?

ileostomy: from ileum, liquid

colostomy: can be in many different parts of colon and can range from more liquid to solid

what is the pre op prep for colostomy surgery?

physical prep: diet, cleaning bowel, NG placement, pain/antiemetic therapy, I/O, lyte balance

education on surgical procedure, post op, and stoma care

emotional support for pt and family

what does an enterostomal therapist do?

identify ability to perform self car, support systems, potential adverse factors, and how to obtain additional supplies.

begin education on ostomy, mark site of stoma before surgery, monitor self care ability

what is post op like for a colostomy?

observe and record: wound, skin integrity, stoma characteristics, drainage from stoma, flatus, fecal drainage, assess for increase abdominal distension

what do different stoma color characteristics mean?

rose to brick red: viable stoma

pale: may indicate anemia

blanching, dark red, purple to black: indicates inadequate blood supply to stoma or bowel from adhesions, low floe, or excessive tension on the bowel at the time of construction (emergency)

describe stoma edema

mild to moderate: normal in the initial post-op period

moderate to sever: obstruction of the stoma, an allergic reaction, or gastroenteritis

what should bleeding be like for a stoma?

small amount: oozing from the stoma mucosa when touched is normal because of high vascularity

moderate to large: moderate to large amounts from the stomal mucosa could indicate coagulation deficiency, stomal varicose secondary to portal hypertension or lower GI bleed

what are some nursing interventions for stomas?

clear liquid diet once ordered

pain management

IS, SCD

provide private time for pt to discuss self image and sexual concerns

aseptic technique for dressing changes

ostomy care

what is discharge planning for stoma care?

wound care, involve home health nurse and ET nurse, avoid heavy lifting, involve ostomy society, diet/hydration, discuss potential adjuvant therapies and follow up care