NUR 212 - Exam 2

UC - Only in 1st layer of colon - Bloody diarrhea - More frequent diarrhea Crohn's - Can occur anywhere in GI tract from mouth to anus - All layers of bowel are affected - Watery diarrhea - Perforation, pockets, fistulas, alteration can occur - Cobblestoning - Prone to infection Common S/S of UC & Crohn's - Fatigue - Fever - Diarrhea - Weight loss - Abdominal pain - Malnutrition - Dehydration - Electrolyte imbalance S/S of dehydration - Weak pulse - Low BP - High HR Primary purpose of TPN for UC or Crohn's Rest bowel TPN - Can be discontinued when pt is eating 60% of caloric needs - Start slowly & build up to dose to avoid causing refeeding syndrome - Discontinuation should not be based on labs because improves electrolytes - Never through a peripheral line - Interventions: I&O's, daily weightsIV therapy - Can cause FVO - Cath is based on fluid/med - Monitor I&O's, lung sounds - Pt should report if site becomes painful IV therapy infiltration - Pain - Swelling - Coolness IV therapy infection - Redness - Swelling - Warmth Tx of UC & Crohn's during exacerbation - NPO - TPN - Steroids - Advances to clear liquid diet Drug classes used for tx of IBD - Corticosteroids (decrease inflammation) - Immunosuppressants (suppress immune response) - Antimicrobials (prevent or tx of secondary infection) - Aminosalicylates (decrease inflammation) Indications that surgery may be needed for IDB - Fistulas - Intestinal obstructions - Inability to decrease corticosteroids What increases the risk for an exacerbation of IBD? - Stress - Illness - Infection Fluid/electrolyte complications w/ IBD?- Hypokalemia - Hypovolemia TX of UC & Crohn's - No cure - Steroids to get into remission - Immunosuppressants (Remicade) - Surgery - TPN - Biologics - Food diary - Lactose free, low residue diet, do not increase fiber, introduce food slowly UC cure - Remove entire colon - Ileostomy - J pouch Surgery for Crohn's - Remove diseased part of bowel but may occur in other parts of digestive tract - Could result in short bowel syndrome if too much is removed Glomerulonephritis Inflammation of the glomeruli that can be acute or chronic Acute glomerulonephritis is often caused by Strep throat S/S of glomerulonephritis - Fluid retention - Hypertension - Proteinuria - FVO - HA - Increased BP - Facial edema - Low grade fever - Weight gain