Kim Eastman RN,MSN, CNS

INFLAMMATORY BOWEL DISEASE  OVERVIEW  IMMUNOLOGIC DISEASE THAT RESULTS IN INTESTINAL INFLAMMATION  ULCERATIVE COLITIS  CROHN’S DISEASE

INFLAMMATORY BOWEL DISEASE  OVERVIEW TWO MILLION PEOPLE IN US HAVE IBD INCIDENCE OF ULCERATIVE COLITIS AND CROH’S IS SIMILAR AGE ANY AGE YEARS OF AGE GENDER/SEX MEN & WOMEN ARE AFFECTED EQUALLY MEN HAVE MORE ULCERATIVE COLITIS WOMEN HAVE MORE CROHN’S

INFLAMMATORY BOWEL DISEASE STRESSORS IDIOPATHIC DISEASE, UNKNOWN CAUSE UNKNOWN AGENT TRIGGERS THE BODY’S IMMUNE SYSTEM CAUSING A INFLAMMATORY REACTION GENETIC PREDISPOSITION FAMILIAL DISEASE INFECTIOUS AGENT IMMUNE RESPONSE TO AN ANTIGEN

ULCERATIVE COLITIS PATHOPHYSIOLOGY CAUSE IS UNKNOWN IMMUNE RESPONSE BOWL BECOMES INFLAMED AS IMMUNE SYSTEM FIGHTS OFF PATHOGENS POSSIBLE GENETIC LINK

ULCERATIVE COLITIS ASSESSMENT PATIENT HISTORY FAMILY HISTORY OF IBD SYMPTOMS ABDOMINAL CRAMPS & PAIN BLOODY DIARRHEA “TIED TO THE TOILET” FEVER WEIGHT LOSS DIET MAY CAUSE SYMPTOMS FATIGUE ARTHRITIS SYMPTOMS

ULCERATIVE COLITIS ASSESSMENT PHYSICAL ASSESSMENT USUALLY NON SPECIFIC VITAL SIGNS LOW GRADE FEVER ABDOMINAL DISTENTION

ULCERATIVE COLITIS ASSESSMENT LABORATORY ASSESSMENT CBC ↓ H & H ↑ WBC, ESR & C-REACTIVE PROTEIN CHEMISTRY ↓ NA, K, CL ↓ SE ALBUMIN

ULCERATIVE COLITIS ASSESSMENT IMAGING ASSESSMENT COLONOSCOPY DEFINITIVE TEST FOR DIAGNOSING ULCERATIVE COLITIS BARIUM ENEMA DIFFERENCE BETWEEN UC & CROHNS

ULCERATIVE COLITIS ANALYSIS/NURSING DIAGNOSIS DIARRHEA R/T INFLAMMATION OF THE BOWEL MUCOSA NUTRITION; ALTERED, LESS THAN BODY REQUIREMENTS R/T FEAR THAT EATING MAY CAUSE DIARRHEA BODY IMAGE DISTURBANCE R/T LOSS OF CONTROL OF BOWEL ELIMINATION, PRESENCE OF STOMA

ULCERATIVE COLITIS INTERVENTIONS PRIMARY INTERVENTIONS OBSERVE & RECORD STOOL CHARACTERISTICS FREQUENCY AMOUNT PRECIPITATING FACTORS FOODS FLUIDS NO SMOKING PHYSICAL AND EMOTIONAL REST

ULCERATIVE COLITIS INTERVENTIONS - DIARRHEA SECONDARY INTERVENTIONS MEDICATIONS ANATIDIARRHEALS LOMOTIL, IMODIUM ANTICHOLINERGICS BENTYL ANTI INFLAMMATORIES AMINOSALICYLATES - 5- ASA AZULFIDINE MESALAMINE (ROWADA) GLUCOCORTICOIDS PREDNISONE IMMUNOMODULATORS HUMIRA

ULCERATIVE COLITIS INTERVENTIONS- NUTRITION; ALTERED, LESS THAN BODY REQUIREMENTS SECONDARY INTERVENTIONS NPO TPN VIVONEX PLUS – ENTERAL FEEDINGS NO CAFFEINE, ALCOHOL, MILK PRODUCTS NO RAW VEGETABLES NO HIGH FIBER FOODS VITAMIN SUPPLEMENTS

ULCERATIVE COLITIS SURGICAL INTERVENTIONS - BODY IMAGE DISTURBANCE ILEOSTOMY PRE-OPERATIVE CARE CONSULTATION WITH A OSTOMY NURSE SPECIALIST EVALUATES THE BEST LOCATION ON THE ABDOMEN FOR THE STOMA VISIT BY ANOTHER OSTOMY PATIENT ROUTINE PRE-OPERATIVE CARE IV ANTIBIOTIC ONEHOUR PRIOR TO OR

ILEOSTOMY

ILEOANAL RESERVOIR SURGERY J POUCH

ULCERATIVE COLITIS TERTIARY INTERVENTIONS HOME CARE CARE OF OSTOMY DISCUSS THESE DURING THE LECTURE FOR COLON CANCER

CROHN’S DISEASE PATHOPHYSIOLOGY CAUSE IS UNKNOWN IMMUNE RESPONSE GENETICALLY INHERITED

Crohn’s Disease PATHOPHYSIOLOGY IMMUNE RESPONSE OCCURS ANYWHERE IN THE DIGESTIVE TRACT USUALLY FOUND IN THE ILEUM OR ILEOCECAL VALVE SKIP LESIONS FISTULA

CROHN’S DISEASE ASSESSMENT PATIENT & FAMILY HISTORY ABDOMINAL PAIN WEIGHT LOSS DIARRHEA FEVER PHYSICAL ASSESSMENT DISTENTION OF ABDOMEN GUARDING BOWEL SOUNDS ULCERATIONS OR FISTULAS IN THE PERIANAL AREA

CROHN’S DISEASE ASSESSMENT LABORATORY ASSESSMENT CBC ↓ H & H ↑ WBC, ESR & C-REACTIVE PROTEIN CHEMISTRY ↓ NA, K, CL ↓ SE ALBUMIN GENETIC TESTING ANTI-SACCHAAROMYCES CEREVISIAE ANTIBODIES (ASCA)

CROHN’S DISEASE ASSESSMENT IMAGING ASSESSMENT BARIUM SWALLOW OR ENEMA ULTRA SOUND CT MRI

CROHN’S DISEASE ANALYSIS/NURSING DIAGNOSIS DIARRHEA R/T INFLAMMATION OF THE BOWEL MUCOSA NUTRITION; ALTERED, LESS THAN BODY REQUIREMENTS R/T FEAR THAT EATING MAY CAUSE DIARRHEA RISK FOR IMPAIRED SKIN INTEGRITY R/T FISTULA FORMATION BODY IMAGE DISTURBANCE R/T LOSS OF CONTROL OF BOWEL ELIMINATION, PRESENCE OF STOMA

CROHN’S DISEASE INTERVENTIONS PRIMARY INTERVENTIONS SAME AS UC SECONDARY INTERVENTIONS – DIARRHEA MEDICATIONS SIMILAR TO THOSE USED IN UC SECONDARY INTERVENTIONS – NUTRITION SIMILAR TO THOSE USED IN UC

CROHN’S DISEASE INTERVENTIONS SECONDARY INTERVENTIONS – SKIN INTEGRITY SKIN BARRIERS DRAINS POUCHES ANTIBIOTIC THERAPY

CROHN’S DISEASE INTERVENTIONS SECONDARY INTERVENTIONS - BODY IMAGE DISTURBANCE SURGERY REMOVAL OF THE DISEASED PORTION OF THE BOWEL IMPROVE THE CONDITION, BUT DOES NOT CURE RECURRENCE OSTOMY