Inflammatory Bowel Disease

NPN 200

Medical Surgical I

Inflammatory Bowel Disease

• Inflammation and ulceration of the lining of the intestines

• 2 types– Ulcerative colitis – begins in the rectum and extends upward

with remission and exaberations– Crohn’s disease or regional enteritis – can effect any area

but usually the terminal ilium. May involve regional lymph nodes and fistulas to the bladder, vagina, and perianal area.

• Treatment for both is similar, except for surgical approach

• Cause is unknown / more young Jew’s

Ulcerative Colitis

Patho

– Loose stools with blood and mucus

– Poor absorption of nutrients

– Thickening of colon wall and may form abscess’s

– Can have minor problems or may be serious

– Acute episodes may involve bleeding and ulcerations

– Chronic stage may have fibrosis, muscle atrophy, and narrow and shortened colon

Ulcerative Colitis

• Complications of Ulcerative colitis– Perforation and peritonitis with fistula

formation– Toxic megacolon– Hemorrhage– ^ risk of colon cancer– Malabsorption– Bowel obstruction

Ulcerative Colitis

• Subjective symptoms– Abd cramping and pain

– Nausea

– Loss of appetite

– Irritability

– Anxiety

– weakness

• Objective symptoms– Bloody diarrhea, with

pus and mucus (up to 10-20/d)

– Spastic rectum and anus

– Weight loss

– Vomiting

Ulcerative Colitis

• Diagnosis– H&P– CT– Stool exam– Sigmoidscopy– Colonoscopy– Barium enema– Lab studies

Ulcerative Colitis

• Medical treatment– Steriods

– Immunosuppressants

– Antidiarrheals

– Antibiotics

– Aminosalicylates (5-ASA)

– Iron and Vit B 12

– Low roughage diet

– No milk

– Sometimes TPN

– Surgery - total colectomy with ileostomy is the cure but not don until nothing else will work

Ulcerative Colitis

• Nursing care– Report S/S of problems

– Provide emotional support

– Skin care

– Record # of stools and type

– Monitor bowel sounds

– Vitals and I/O

– Watch for dehydration

– Monitor H & H, E-lytes

– Weigh daily

– Dietary consult

– Watch for complications

– If OR, follow routine

Crohn’s Disease

1. Both subjective and objective symptoms are relatively identical to colitis

2. Assessment are identical

3. Diagnostic tests are the same except:1. With Crohn’s will find string sign (segments of

stricture seperated by normal bowel)

2. With colonoscopy will find patchy areas of inflammations

3. Need biopsy for definitive diagnosis

Crohn’s Disease

• Nursing care– Identical to colitis– Watch for internal bleeding– Medications

• Sulfasalazine for antiinflammatory effects• Steriods• Antibiotics• Anticholinergics• RX for diarrhea

– Dietary changes• Restricted fiber diet with no raw fruit or vegetables and no nuts or

whole grains• Low fat diet to reduce fatty stools

Crohn’s Disease

• May need surgery for partial removal of diseased portion of bowel

• Follow routine care for client with bowel surgery

Inflammatory Bowel Disease

• Highly stressful, long term disease process

• Need support from health care and family

• Difficult to follow regimen of medication and diet

• Refer client to national organization for support

• Keep regular appointments with physician