tachycardia, hypotension, fever •persistent bloody diarrhea •crampy abdominal pain - LLQ •abdominal distention/ tenderness- rebound tenderness •weight loss – S/S = fluid deficit •hyperactive Bowel sounds
Ulcerative colitis s/s
CBC/ESR – (blood loss) •electrolytes •low K, Ca- cardiac •WBC (infection) •serum albumin •stool (√ bacteria) •CT
Contraindicated if risk of perforation ↑- friable mucosa
•colonoscopy /sigmoid
•Barium enema
Diagnostic for ulcerative colitis
Goal: to reduce inflammation, pain and cramping
•Azulfidine/Asacol
•steroids
•immunosuppressants - Imuran
•Biologic – Remicade (RA- approved for UC use )
•Abx- Flaygl, Cipro
Drug therapy for ulcerative colitis
Pt usually fear diversions •high protein/high caloric/bland/ ↓ residue diet •no smoking •foods to avoid •alcohol •fruit juice with pulp •whole grains/bran/nuts •fried/smoked/pickled/cured meats •raw veggies/Milk/Cream and veg soups •No cold food •No spicy food
Patient education for ulcerative colitis
- Intestinal
- perforation
- rectal bleeding
- malignant neoplasms
- nutritional deficiencies
- Extraintestinal
- kidney/gallstones
- cardiac dysrhythmia related to electrolytes
- Increased risk for arthritis (40 times)
- conjunctivitis/skin lesions
Complications of ulcerative colitis
Chronic Inflammatory Bowel Disease
involves entire mucosal wall any portion of GI Tract
Crohn’s disease
- insidious onset/exacerbations and remission
- non-bloody diarrhea
- RLQ pain/tenderness unrelieved by defecation
- episodes of abdominal pain after eating
- pain episodes increase in
- frequency, duration and severity
- flatulence
- oral ulcers
- diarrhea after milk, fat, spices
History of Crohn’s disease
abdominal pain in RLQ •diarrhea -soft, semiliquid, no blood •weight loss – anorexia- s/s fluid deficit, malnourished •anemia •weakness/fatigue •perianal fistulas •fever/leukocytosis
•Extraintestinal: arthritis, clubbing
Physical Assessment of Crohn’s disease
•CBC - leukocytosis
•electrolytes-low K
•serum protein/albumin- ↓
•stool- steatorrhea
•Barium study*-UGI tract- string sign
•BaE*- cobblestone
•endoscopy/colonoscopy*
•sigmoidoscopy with biopsy
•CT Scan
* not done in acute episodeDiagnostic for Crohn’s disease
NPO- rest bowel, IV therapy, may require TPN •progress to bland → small frequent feedings (5) •No fat •No-residue •No milk or milk products •high calorie •Avoid •cold foods as these increase intestinal motility •smoking •greasy, fried foods •foods that aggravate •Weigh daily •Stress management imortant
Nursing. Interventions for Crohn’s disease
- fistulas (1/3), abscess
- intestinal obstruction
- fluid and electrolyte imbalance
- malnutrition
- bowel cancer
- cirrhosis, gallstones, kidney stones(oxalate)
- pancreatitis
Complications of Crohn’s disease
- Administer pain meds
- Bedrest
- Position patient in knee flexed position
- Apply heat q 2 h
- Encourage deep breathing and relaxation
Nursing intervention for Crohn’s disease
Straining at stool
Tenesmus
Acute increase in abdominal pain
Rigid abdomen
Vomiting
Hypotension
Perforation
Abdominal distention Deceased or absent bowel sounds AMS Fever Tachycardia Hypotension Dehydration F/E imbalance
Toxic megacolon
Surgical creation to the ileum or small intestine Performed after a total colectomy Drainage of fecal matter Liquid to unformed stool Occurs at frequent intervals
Ileostomy
Continent ileal reservoir
Diverting a portion of the distal ileum to the abdominal wall and creating a atoms
Eliminates the need for an external fecal collection
Continent ileostomy
Kock pouch
And intraluminal obstruction or a mural obstruction from pressure on the intestinal wall occurs examples include: Intususception Polyploid Tumors Neoplasm Stenosis Strictures Adhesions Hernias Abscesses
Mechanical obstruction
The intestinal musculature cannot propel the contents along the bowel example or Emma deuces muscular dystrophy endocrine disorders such as diabetes neurological disorders such as Parkinson’s the blockage also can be temporary and result in the manipulation of the bowel during surgery
Functional obstruction
Saclike herniation of the bowel that extends through a defect in the middle layer
-may occur anywhere in the small intestine or colon
Most commonly in sigmoid colon
Diverticulum
Exist when multiple diverticula are present w/o inflammation or symptoms
Diverticulosis
Results when food and bacteria retained in a Diverticulum produce infection and inflammation that can impede drainage and lead to perforation or abscess formation
Diverticulitis
Abscess Fistula formation Obstruction Perforation Peritonitis Hemorrhage
Symptoms of diverticulitis
- LLQ-crampy/constant and radiates to the back
- constipation alternating with diarrhea
- abdominal distention
- palpation: sausage-shaped mass LLQ
- fever, leukocytosis, chills, N/V
Symptoms of diverticulosis
