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 • Objective symptoms
– Abd cramping and pain – Bloody diarrhea, with
– Nausea pus and mucus (up to
– Loss of appetite 10-20/d)
– Spastic rectum and
– Irritability
anus
– Anxiety
– Weight loss
– weakness
– Vomiting
 Ulcerative Colitis
• Diagnosis
– H&P
– CT
– Stool exam
– Sigmoidscopy
– Colonoscopy
– Barium enema
– Lab studies
 Ulcerative Colitis
• Medical treatment
– Steriods – Low roughage diet
– Immunosuppressants – No milk
– Antidiarrheals – Sometimes TPN
– Antibiotics – Surgery - total
– Aminosalicylates (5- colectomy with
ASA) ileostomy is the cure
but not don until
– Iron and Vit B 12
nothing else will work
 Ulcerative Colitis
• Nursing care
– Report S/S of problems – Watch for dehydration
– Provide emotional – Monitor H & H, E-
support lytes
– Skin care – Weigh daily
– Record # of stools and – Dietary consult
type – Watch for
– Monitor bowel sounds complications
– Vitals and I/O – 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