University:
College
Course:
College Nursing
Academic year:

2023
Views:

67

Pages:

1
Author:

Ruby Ibarra

AUTO IMMUNE DISEASE Onset: usually teens & 30’s later UDYO NO EXACT CAUSE! Signs & Symptoms Liquid bloody stool (5-30 daily, mucus!) Colicky pain Tenesmus (urgent sensation to defecate) Malaise + Severe anxiety/depression Anorexia/unexplained weight loss (rare) Anemia (rt blood loss) Dehydration/Malnutrition (minimal?) Fever during acute attacks More rectal bleeding than Crohn’s Mild diarrhea: Stools daily (small amts of blood) Moderate diarrhea: up to 10 daily stools Severe diarrhea: 10-20 daily stools blood & mucus loss of more than 10% of total body weight Joint pain Eye inflammation Skin irritation Mild anemia, anorexia Pathophysiology Inflammation starts in rectum - cecum It affects inner layer of bowel wall Diarrhea w/ large amounts of blood & mucus Electrolyte losses (bc they aren’t absorbed through inflamed mucosa) Fistulas & abscesses are common but less than Crohn’s Pseudopolyps (tongue-like projections) Narrowed bowel lumen Diagnostics/Labs CBC iron-deficiency anemia (due to blood loss) WBC toxic granulations Electrolytes (from vomiting/diarrhea) CRP & ESR inflammation (inc) Na, K, Cl+, Bio-Chem, Liver Albumin/protein (low) w/ SEVERE disease (due to poor nutrient absorption) Double contrast barium enema Small bowel series Abdominal US CT MRI Endoscopy & biopsy for definitive dx Gold standard for colon cancer Vitamins & Iron (IVC) Due to poor absorption Treatment/Medication Amino salicylates (5-ASA) maintain remission & prevent flare-ups short-term use due to side effects Glucocorticoids (Prednisone) help achieve remission short-term use due to side effects Immunomodulator (Humira) (Adalimumab) last resort med subcut need TB skin test before therapy Antidiarrheal (Loperamide) mild diarrhea Nutritional Therapy Bowel rest - NPO IV fluids Elemental formula Dietary supplements for deficiencies Nursing Implications Monitor I&O, VS, weight Encourage fluid intake Prevent skin breakdown/perineal care Administer meds accurately Help pt select appropriate dietary choices to reduce inflammation Routine liver function tests & bone density scans (due to complications) Rest & diet management Refer pt to dietician Start pt on NPO low fiber/low residue diet Assist pt in accepting disease & coping mechanisms Patient Teaching Explain disease & treatment Cancer screening program Importance of medication adherence Dietary restrictions & supplements Stress management Importance of follow-up care Risk Factors Family history (especially first degree) Environmental factors - diet, smoking, stress (change in flora!) Higher intake of refined sugar, total fats, PUFA, omega-6 fatty acids NIDs, antibiotics, oral contraceptives (birth control) Priority Nursing Diagnoses Diarrhea Imbalanced nutrition Chronic pain Difficulty coping Ineffective individual coping Impaired skin integrity Additional Notes Avoid caffeine, high fiber/fat foods Routine liver function tests & bone density scans Referral to counseling/support/social worker Family support (especially emotional) NPO for acute flare-ups Abdominal gurgle assessment Rectal exam for occult blood Discontinue meds with severe bloody diarrhea, excessive cramping