NSG 202 Inflammation Concept Summary

Inflammation Concept
Examples: Ulcerative Colitis, Crohn’s Disease, and IBS
Ulcerative Colitis (UC)
 Pathophysiology Review
o A disease that creates a widespread chronic inflammation of the colon
o It is a type of inflammatory bowel disease
o Common to have flare-ups (exacerbations)
 Intestinal infections can cause these flare ups.
o Older adults are at a high risk of F&E imbalances (dehydration and hypokalemia) as a
result of diarrhea.
o Characteristics
 Intestinal mucosa becomes hyperemic (increased blood flow)
 Edematous
 Reddened
 Bleed, erosion, and ulcers (more severe cases)
 Abscesses can result in tissue necrosis
 Narrowed colon which may increase the risk of partial bowel obstruction
 Blood and mucus are typically present in the stool
 Tenesmus (unpleasant and urgent feeling to defecate)
 Malaise
 Anorexia
 Anemia
 Dehydration
 Fever




o
 Causes
o The exact cause is unknown
o Genetic, immunologic, and environmental factors play a role
 Autoimmune dysfunction is likely the cause of the disease manifestation
 Most people are diagnosed between 15-35 years old

,  Most common in women

 Collaborative Care
o Assessment – History
 Family history of Inflammatory Bowel Disease
 Nutrition (food intolerance ex. Milk and spicy food)
 Usual bowel elimination
 Any antibiotics in the past 2-3 months (to rule out C-diff)
 Traveling
 NSAIDs (can cause flare-ups)
 Extraintestinal symptoms (arthritis, mouth sores, vision and skin problems)
o Assessment – physical (signs and symptoms)
 Vitals signs are usually normal (mild cases)
 Low-grade fever (severe cases)
 Look for abdominal distention along the colon
 Fever and tachycardia may be indicative of dehydration
 Assess for extraintestinal complications such as inflamed joints and mouth
lesions
 Eating can cause some abdominal pain and cramping
o Assessment – labs and other diagnostic assessments
 Hematocrit and hemoglobin - Low
 WBC, C-Protein, and ESR – High (consistent with inflammatory disease)
 Na, K, and CL – low (due to frequent diarrhea and malabsorption)
 Hypoalbuminemia (decreased serum albumin) – in severe cases from losing
protein in stool
 Magnetic Resonance Enterography (MRE) – visualize the bowel lumen and wall
 Fast 4-6 hours before the test
 Colonoscopies (bowel prep can be very uncomfortable for IBD patients)
 CT scan
 Barium enemas with air contrast can show differences between UC and Crohn’s
disease
o Interventions
 Managing Diarrhea
 Drug therapy
o Aminosalicylates also called 5-ASAs
 Treat mild-moderate UC and/or maintain remission
 Have anti-inflammatory effect on the linings of the
intestine
 Effective in 2-4 weeks
 Examples
 Sulfasalazine – take folic acid supplements
 Mesalamine – better tolerated than
sulfasalazine
o Glucocorticoids