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inflam bowel disease
pn 141 test 3 book burke 448
| Question | Answer |
|---|---|
| UC: what is it | a chronic inflammatory bowel disorderof the mucosa and submucosa of the colon and rectum |
| UC:who does it affect | the young, ppl between ages 50-70, whties |
| UC: is it autoimmune | yes |
| UC: what happens since | it is autoimmune and the pt own antibodies attack the colon |
| UC: what factors can contribute to the developmen of it | infection, diet, and environment, stress, and phsysiologic factors |
| UC: where in the body does it usually begin | in the rectal area |
| UC: where does it progress to | proximally along the colon, involving the bowel in a continuous pattern |
| UC: what happens to the mucosa | it becomes inflamed and edematous and it bleeds easily, it ulcerates, sloghs and it lost in the feces |
| UC:what happens as scar tissue forms | the bowel wall thickens and shortens |
| UC:where in the colon is it most effected in ppl | the rectum and sigmoid |
| UC:is the entire colon effected | sometimes, but it is less common |
| UC:what happens with the onset of BM | a gradula onset od diarrhea w/ intermittant rectal bleeding and mucus is common |
| UC:how long do acute attacks last; how often do acute attacks occur | 1-3 months; intervals of months to years |
| UC:what is the cheif s/s | diarrhea |
| UC:what are s/s with mild ulcerative colitis | fewer than 4 stools a day, with intermittent rectal bleeding and mucus, few systemic manifestations |
| UC:what are s/s with severe ulcerative colitis | 6-10 bloody stools per day, extensive colon involvement, dehydration, malnutrition |
| UC:rectal imflammation causes what | fecal urgency and tenesmus |
| UC:what is tenesmus | straining |
| UC:where is cramping common | left lower quadrant cramping |
| UC:left lower quadrant cramping is relieved by what | defecation |
| UC:what are systemic manifestations | fatigue, anorexia, weakness |
| UC:if a pt has a severe disease what may they develop | related arthritis |
| UC:what are the complications of it | toxic megacolon, colon perforation, hemmorhage, colon cancer |
| UC:what is the leading cause of death in these pt | colon perforation |
| UC:what is toxic megacolon | paralysis of the colon with significant distention, usually in the transverse segments of the large bowel |
| sUC:/s of toxic megacolon | fever, tachycardia, hypotension, dehydration, abdominal tenderness, cramping, an acute decrease in diarrhea |
| UC:these pt have a high risk for developing what | colon cancer |
| UC:how many stools can tehy have a day | 5-30 |
| UC:what is found in teh stool | blood an mucus |
| UC:what happens to their wt | they lose wt |
| UC: they have low serum ______ lvels | protein |
| crohns: is diarrhea common | yes |
| crohns:is diarrhea as severe as UC | no |
| crohns: is there blood and mucus in the stool | no |
| crohns: where is pain felt | TLQ or centrla abdominal pain |
| crohns: what happens to their wt | there is wt loss |
| crohns: do they have anemia | yes |
| crohns: what is their anemia due to | multiple nutrient deficets |
| crohns: what systemic s/s | fever, general malaise, fatigue |
| crohns: complications | obstruction, fistula or abscess formation, malabsorbtion, colon cancer |
| UC: do they have anemia; why | ye;s b/c of low serum protein |
| what are the two conditions in inflammatory bowel diseases | crohns, and ulcerative colitis |
| how is UC and crohns similar | cause unknown, autimmune, they affect young adults and older adults, chronic and reccurent, diarrhea is the predominent s/s, |
| UC: does it affect the large or small bowel | large |
| crohns:does it affect the large or small bowel | small |
| crohns: what is it | a chronic, relapsing inflammotory disorder of the GI tract |
| crohns: at what ages does it begin | usually between 10-30 |
| crohns: what contributes to its development | genetics, environmental factors, infectious diseases, autoimmunity |
| crohns: who is it common in | northern US, ashkenazi Jews, urban settings |
| crohns: where does it affect in the GI tract | any where from the mouth to anus; but it usually affects the distal portion of the small bowel and ascending colon |
| crohns: it causes inflammatory lesions where | of the bowel mucosa that may extend into all layers of the bowel wall |
| crohns: carecteristics of the inflammatory lesions | localized, surrounded by normal gut |
| crohns:what develops | ulcers and fissures |
| crohns: where do fistulas form | between the loops of bowel or between the bowel and other organs |
| crohns: what does inflammation and scarring do | cause the bowel to marrow and become partially or fully obstructed |
| crohns: what happens over time to the bowel wall | they thicken and lose flexibility and they look like a rubber hose |
| crohns: why many malabsorption and malnutrition develop | b/c inflammation and ulcers prevent absorbtion of nutrients |
| crohns: what nutrients are often not absrobed | vit B12, bile salts |
| crohns: what is the diarrhea liek | continuous episodic |
| crohns: what do the stools look like | they are liquid or semiform w/ no blood |
| crohns: where many a mass be palpable | in the right lower quadrant |
| crohns: what do many develop in the rectum and anus | lesions like fissures, ulcers, fistulas and abscesses |
| crohns: what are systemic s/s | fever, malaise, fatigue |
| crohns: s/s of intestinal obstruction | abdominal distention, cramping pain, borborygmi and N/V |
| crohns: s/s of an abscess | chills, fever, tender abdominal mass, leukocytosis |
| crohns: are fistuals symptomatic or asymptomatic | asymptomatic especially if they form between loops of the bowel |
| crohns: s/s of a fistula between the small bowel and colon | increased diarhea, wt loss, malnutrition |
| crohns: s/s of a fistula involving the bladder | recurrent UTI |
| crohns: what does it increase the risk for | colon cancer; by 5-6 times |
| tx: what is goal | supportive, managing s/s, and controlling the disease process |
| tx: what are supportive care measures | rest, stress reduction, drugs, and nutritional support |
| when is surgery needed | when the disease does not respond to Tx or complications develop |
| diagnostic tests: why is a stool specimen done | examined for blood and mucus and is sent for culture to rule out infectious causes |
| diagnostic tests: why is a CBC done | eval nutritional status |
| diagnostic tests: why is a sigmoid or colonoscopy done; what is avoided in prepping for this test and why | to visualize the bowel mucosa and collect tissue for biopsy; bowel prep b/c it may exacerbate the disease |
| meds: why are they prescibed | to terminate acute attacks of IBD and reduce the frequency of relapse |
| diet: why are supplements given | to promote wt gainand nutritional status |
| diet: what type of intolerance is common | lactose intolerance, so milk products are eliminated |
| diet: what may reduce diarrhea | an increase in dietary fiber |
| diet: what is the diet for obstruction or small bowel narrowing | low roughage diet |
| diet: what is a lowe roughage diet | no raw fruit and veggies, popcorn or nuts etc |
| diet: what is it in acute exacerbations; | NPO, TPN; reduce intestinal motility and allow the bowel to rest |
| surgery: surgical removal of _______ cures ulcerative colitis | colon |
| surgery: when is it the choice | when other treatments are ineffective or manifestations of the disease interfere with ADLs; chrohns, bowel obstruction, fistulas, abscess |
| surgery: UC- what will they undergo | a total colectomy |
| surgery: what is a colectomy | a surgical removal of the colon |
| surgery: when the colon is removed what is brought to the surface of the abdomen; what does this form | the terminal ileum; ostomy |
| surgery: what is an ostomy | an opeing that allows eleimination of fecal material |
| surgery: what is a stoma | the surface opening of the ostomy |
| surgery: what is an ileostomy | an ostomy made in the ileum of the small intestines |
| surgery: what does an internal puch from the terminal ileum allow the pt to do | it collects feces until the pt drains it with a catheter, a nipple valve prevents leagkge between caths |
| surgery: how is the pouch sutures to teh anal canal; what does this allow for | it is formed from the terminal ileum; it allows for more nromal bowel elemination and helps preserve body image (called a jpouch) |
| surgery: nursing care for bowel surgery | bowel prep, monitor bs and abd. distension, monitor drainage from ostomy (first bright red, then dark to clear or greenish yellow) |
| Nx Dx: deficient fluid volume: whatchanges in VS indicate low fluid volume | increased pulse and RR |
| UC: what layer of the GI is affected | only the inner layer |
| crohns: what layer of the GI is affected | all layers |
| the large intestines absorbes what | water |
| what one can be cured | UC |
| chrons: the scar tissue is like what | a hose |
| meds: what is used to help | aminosalicytes |
| meds: aminosalicytes- action | aspirin like compounds with antiinflammatory action the exert a topical anti inflammatory effect it inhibits prostaglandin production in the mucosa |
| meds: aminosalicytes- names for them | azulfidine (sulfasalazine), pentasa/asacol (mesalamine) |
| meds: aminosalicytes- common adverse reactions | abdominal pain, N, diarrhea |
| meds: aminosalicytes- how should they be administered | with a full glass of water, after meals to reduce GI effect |
| meds: aminosalicytes- what med is less effective with this drug | oral contraceptives |
| meds: aminosalicytes- what meds should be avoided | asa |
| meds: antibiotics (flagyl): why is it give n | with a fistula |
| meds: what are antidiarheals | lomotic, and immodium |
| meds: what meds increase the risk for toxic colon in UC | antidiarheals |
| surgery: why is it done with chrons | resection in obstruction, perforation, abcess |
| what is a proctocolectomy w/ ileostomy | the removal of the whole colon w/ the pouch in rectum |
| proctocolectomy w/ ileostomy: complications | pouchitis, diarrhea |
| surgery: when does anus have to be removed | when rectum is involved |
Created by:
jmkettel
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