Notes week 3
Inflammatory bowel disease (IBD): chronic, recurrent
inflammation of intestinal tract. No cure, etiology unknown.
Classified as either ulcerative colitis or Crohn’s disease.
1. Ulcerative colitis: inflammation of the colon and rectum,
causing continuous lesions.
a. S/S: LLQ pain, fever, 15 -20 liquid stools/day,
abdominal distension and pain, rectal bleeding,
mucous/blood/pus in stools.
b. Risk factors: genetics, Caucasians, Jewish descent,
women.
c. Labs, medications, and nursing care same as Crohn’s.
2. Crohn’s Disease: inflammation and ulceration throughout
GI tract from mouth to anus, causing sporadic
(cobblestone) lesions. Fistulas are common.
Malabsorption and malnutrition.
a. S/S: RLQ pain, fever, 5 loose stools/day, mucus/pus
in stools, abdominal distension, pain, steatorrhea (fat
in stool).
b. Risk factors: smoking, genetics, Jewish decent,
usually starts in adolescence and young adults.
c. Labs: decreased Hgb / Hct, and albumin. Increased
ESR (test for inflammation), WBC, and C-Reactive
Protein (test for inflammation).
d. Medications:
i. 5-aminosalicylic acid (Anti-inflammatory):
Sulfasalazine
ii. Corticosteroids – prednisone
, iii. Immunosuppressants – cyclosporine
iv. Antidiarrheals – loperamide
e. Nursing care:
i. Monitor for fluid and electrolyte imbalance (risk
of hypokalemia), I&O, signs of dehydration.
ii. Increased risk for colon cancer (recommend
colonoscopy)
iii. NO caffeine or alcohol
iv. Encourage intake of multivitamin with iron
v. Small frequent meals with HIGH protein,
HIGH calories and LOW fiber. Remain NPO
during exacerbations.
vi. Emergency = bowel obstruction or perforation
( fever, severe ABD pain, vomiting).
3. Diverticulitis: inflammation of diverticula (small pouches
in the colon). Can perforate and cause peritonitis.
a. S/S: LLQ pain, N&V, fever, chills
b. Labs: decreased Hct, Hgb, increased WBC
c. Medications: antibiotics (metronidazole), and
analgesics
d. Nursing care:
i. Diet: NPO or clear liquid diet during
exacerbations, then progress to low- fiber diet.
Ongoing eat high-fiber diet. NO seeds, nuts,
popcorn.
ii. Monitor for s/s of peritonitis: N&V,
rigid/boradlike abdomen, rebound tenderness,
fever, tachycardia.
Inflammatory bowel disease (IBD): chronic, recurrent
inflammation of intestinal tract. No cure, etiology unknown.
Classified as either ulcerative colitis or Crohn’s disease.
1. Ulcerative colitis: inflammation of the colon and rectum,
causing continuous lesions.
a. S/S: LLQ pain, fever, 15 -20 liquid stools/day,
abdominal distension and pain, rectal bleeding,
mucous/blood/pus in stools.
b. Risk factors: genetics, Caucasians, Jewish descent,
women.
c. Labs, medications, and nursing care same as Crohn’s.
2. Crohn’s Disease: inflammation and ulceration throughout
GI tract from mouth to anus, causing sporadic
(cobblestone) lesions. Fistulas are common.
Malabsorption and malnutrition.
a. S/S: RLQ pain, fever, 5 loose stools/day, mucus/pus
in stools, abdominal distension, pain, steatorrhea (fat
in stool).
b. Risk factors: smoking, genetics, Jewish decent,
usually starts in adolescence and young adults.
c. Labs: decreased Hgb / Hct, and albumin. Increased
ESR (test for inflammation), WBC, and C-Reactive
Protein (test for inflammation).
d. Medications:
i. 5-aminosalicylic acid (Anti-inflammatory):
Sulfasalazine
ii. Corticosteroids – prednisone
, iii. Immunosuppressants – cyclosporine
iv. Antidiarrheals – loperamide
e. Nursing care:
i. Monitor for fluid and electrolyte imbalance (risk
of hypokalemia), I&O, signs of dehydration.
ii. Increased risk for colon cancer (recommend
colonoscopy)
iii. NO caffeine or alcohol
iv. Encourage intake of multivitamin with iron
v. Small frequent meals with HIGH protein,
HIGH calories and LOW fiber. Remain NPO
during exacerbations.
vi. Emergency = bowel obstruction or perforation
( fever, severe ABD pain, vomiting).
3. Diverticulitis: inflammation of diverticula (small pouches
in the colon). Can perforate and cause peritonitis.
a. S/S: LLQ pain, N&V, fever, chills
b. Labs: decreased Hct, Hgb, increased WBC
c. Medications: antibiotics (metronidazole), and
analgesics
d. Nursing care:
i. Diet: NPO or clear liquid diet during
exacerbations, then progress to low- fiber diet.
Ongoing eat high-fiber diet. NO seeds, nuts,
popcorn.
ii. Monitor for s/s of peritonitis: N&V,
rigid/boradlike abdomen, rebound tenderness,
fever, tachycardia.
