Describe Crohn’s:
Be able to recognize the differences from ulcerative colitis
- Granulomatous
- Skip lesions, cobblestone
- Mostly in the terminal end of the ilium but can be in both large and small intestine
- Submucosa
- Mnfts w diarrhea, wt loss, colicky abdm pain
- Complications: Fistulas, abscesses, stricture
Describe ulcerative colitis:
- Continuous, proximal from rectum
- Mucosa
- Ulcers (duh)
- Crypt abscesses
- Pseudopolyps
- Mnfts w bloody diarrhea, cramping, wt loss (less than crohn’s though)
For someone experiencing multiple repeating episodes of IBD exacerbations, what nursing diagnosis could you make? what are some interventions to help with this?
Diagnosis:
Risk for ineffective therapeutic regimen management related to insufficient knowledge concerning the process and management of the disease
Interventions:
Provide pt with information regarding preventative measures eg nutritional management; a bland, low-residue, high-protein, high-calorie, and high-vitamin diet relieves symptoms and decreases diarrhea. Also providing info about the importance of the prescribed drugs.
Why are corticosteroids used to treat IBD?
These are used because they suppress the immune response, thus limiting the damage caused to the bowel by the immune system reacting to the normal flora and reducing inflm.
Side effects of steroids:
- Decreased immune fx and wound healing
- Increased blood glucose
- Osteoporosis
- Wt gain, moon face
- Increased risk of ulcers and mood disorders
- ‘lyte imbalances
How can you reduce the risks associated with steroids?
- Short periods of time
- Decrease dose over time
- Give w food
- Alt day doses
- Give locally instead of systemic
Why is important to slowly decrease steroid doses?
To allow time for recovery of adrenal Fx and minimize withdrawal side effects.
What are symptoms of steroid withdrawal?
- Hypotension
- Hypoglycemia
- Myalgia
- Arthralgia
- Fatigue
T or F:
Crohn’s can be transmural.
T, this can cause the complications: fistulas, abscesses, stricture, possible perforation = peritonitis
Steatorrhea may be seen in pts with Crohn’s, what is this?
Abnormal quantities of fat in stool, may be whitish in color.
Erythema nodosum may be seen in pts with Crohn’s, what is this?
Bruises in the adipose tissue layer, usually seen on the front of the legs below the knees
Ulcerative colitis causes increased risk of developing what 4 conditions?
- Toxic Megacolon
- Perforation
- Colon Cancer
- Nephrolithiasis
What is the gold standard for Dx IBD?
Proctosigmoidoscopy or Colonoscopy with biopsy
5 Dx for IBD (not including scoping):
- Barium enema
- Upper GI series (Barium study)
- CT scan
- CBC, Alb, K+, Na+, RFTs
- Stool culture
4 surgical interventions for IBD:
- Total Colectomy (ileostomy)
- Continent ileostomy (K- pouch)
- Temporary loop ileostomy
- Ileoanal anastomosis with J-pouch
Who is at the greatest risk for developing IBD?
People between 15 and 30 years of age are at the greatest risk of developing IBD, followed by people between 50 and 70 years of age.
NSAIDs have been found to _________ IBD.
Exacerbate
In Crohn’s, where would you expect your pt to be experiencing the most pain?
In the LRQ
T or F:
The pain experienced w Crohn’s is relieved by defecation.
F
Why is pain with IBD especially prominent after meals?
Because food induces peristalsis
Classification of Infliximab?
- Therapeutic: antirheumatics (DMARDs), gastrointestinal anti-inflammatories
- Pharmacologic:monoclonal antibodies
Mechanism of action and indication of Infliximab
- Action: Neutralizes and prevents the activity of tumor necrosis factor-alpha (TNF-alpha), resulting in anti-inflammatory and antiproliferative activity
- Indication: Rheumatoid arthritis, Crohn’s
disease, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis
Common side effects and interactions of Infliximab
- Fatigue
- Headache
- Upper resp infct
- Abdm pain, naus/vom
- Dysuria
- Many more
Nursing considerations for Infliximab
- Assess for infusion-related reactions (fever, chills, urticaria, pruritus) during and for 2 hr after infusion
- Observe for development of new infcts
