Inflammatory Bowel Disease (IBD). Candice W. Laney Spring 2014. Inflammatory Bowel Disease (IBD). Crohn’s disease (regional enteritis) Ulcerative colitis See Table 38-4. Crohn’s Disease. Commonly diagnosed in young adults or adolescents (but can occur anytime on life).
Inflammatory Bowel Disease (IBD) Candice W. Laney Spring 2014
Inflammatory Bowel Disease (IBD) • Crohn’s disease (regional enteritis) • Ulcerative colitis • See Table 38-4
Crohn’s Disease • Commonly diagnosed in young adults or adolescents (but can occur anytime on life). • The disease begins with thickening of the mucosa, ulcers begin to appear in a cobblestone appearance. • Fistulas, fissures, and abscesses form. • As the disease advances, the bowel wall thickens and becomes fibrotic, and intestinal lumen narrows.
Symptoms • The onset of symptoms is usually insidious in Crohn’s disease with RLQ pain and discomfort • Abdominal tenderness, cramps, and spasms may occur. • In attempts to limit the symptoms patients decrease intake and loss weight and even become malnourished or anemic. • Disrupted absorption causes diarrhea and nutritional deficits. • Chronic symptoms: steatorrhea, abdominal pain, diarrhea, anorexia, weight loss, and nutritional deficiencies.
Assessment & Diagnostics • Proctosigmoidoscopy • Stool exam for occult blood and steatorrhea • Most conclusive diagnostic aid for Crohn’s Disease is a barium study of the upper GI tract • Barium Enema, CT,Endoscopy, colonoscopy and intestinal biopsies may also be used to confirm Crohn’s Disease. Lab Studies: • CBC; hgb& hct decreased, WBC elevation, ESR elevated & Albumin and protein are decreased indicating malnutrition
Ulcerative Colitits • A recurrent ulcerative and inflammatory disease od the mucosal and sub mucosal layer of the colon and rectum. • The disease usually begins in the rectum and progresses to the entire colon. • Eventually narrows and thickens because of muscular hypertrophy and fat deposits.
Symptoms • Diarrhea • With passage of mucus and pus in bowel movements • Left lower quadrant pain • Intermittent tenesmus, and rectal bleeding • Anemia • Anorexia &Weight loss • Fever, vomiting ,dehydration • Extraintestinal manifestations: skin lesions, eye lesion, joint abnormalities, liver disease.
Assessment & diagnostics • Common finding is rebound tenderness in RLQ • Assess for tachycardia, hypotension, tachypnea, fever, and pallor. • Assess for bowel sounds, distension, tenderness of abdomen. • Check stools positive for blood • Decreased HGB & HCT • Elevated WBC • Colonoscopy, Barium enema, CT, MRI, Abdominal X-ray
Question Is the following statement True or False? Abdominal pain and constipation are common clinical manifestations of Crohn’s disease.
Answer False Abdominal pain and diarrhea are common clinical manifestations of Crohn’s disease.
Nursing Process: The Care of the Patient with Inflammatory Bowel Disease—Assessment • Health history to identify onset, duration and characteristics of pain, diarrhea, urgency, tenesmus, nausea, anorexia, weight loss, bleeding, and family history • Discuss dietary patterns, alcohol, caffeine, and nicotine use • Assess bowel elimination patterns and stool • Abdominal assessment
Nursing Process: The Care of the Patient with Inflammatory Bowel Disease— Diagnoses • Diarrhea • Acute pain • Deficient fluid • Imbalanced nutrition • Activity intolerance • Anxiety • Ineffective coping • Risk for impaired skin integrity • Risk for ineffective therapeutic regimen management
Collaborative Problems/Potential Complications • Electrolyte imbalance • Cardiac dysrhythmias • GI bleeding with fluid loss • Perforation of the bowel
Nursing Process: The Care of the Patient with Inflammatory Bowel Disease— Planning • Major goals may include attainment of normal bowel elimination patterns, relief of abdominal pain and cramping, prevention of fluid deficit, maintenance of optimal nutrition and weight, avoidance of fatigue, reduction of anxiety, promotion of effective coping, absence of skin breakdown, increased knowledge of disease process and therapeutic regimen, and avoidance of complications.
Maintaining Normal Elimination Pattern • Identify relationship between diarrhea and food, activities, or emotional stressors. • Provide ready access to bathroom/commode. • Encourage bed rest to reduce peristalsis. • Administer medications as prescribed. • Record frequency, consistency, character, and amounts of stools.
Other Interventions • Assessment and treatment of pain/discomfort, anticholinergic medications prior to meals, analgesics, positioning, diversional activities, and prevention of fatigue • Fluid deficit, I&O, daily weight, assessment of symptoms of dehydration/fluid loss, encourage oral intake, measures to decrease diarrhea • Optimal nutrition; elemental feedings that are high in protein and low residue or PN may be needed • Reduce anxiety; calm manner, allow patient to express feelings, listening, patient teaching
Patient Teaching • See Chart 38-3 • Understanding of disease process • Nutrition/diet • Medications • Information sources: National Foundation for Ileitis and Colitis • Ileostomy care if applicable