Care of Patients with Inflammatory Intestinal Disorders

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Chapter 60

Care of Patients with Inflammatory

Intestinal Disorders


• Intestinal• Appendicitis• Peritonitis

• Bowel• Gastroenteritis (acute)• Crohn’s disease (chronic)• Ulcerative colitis (chronic)

Inflammatory Disorders


• Anal• Anorectal abscess• Anal fissure

• Parasitic infections• Food poisoning

• Salmonellosis• Staph• E. coli• Botulism

Inflammatory Disorders


1. Priority concern(s)2. Common manifestations3. Treatment options4. Include collaborative health care team5. Potential complications6. Implications for older adults

Group Activity for Inflammatory

Disorders


• Individualized questions• Appendicitis

• Signs/symptoms before and after rupture• Peritonitis

• Teaching plan for surgical patient• Gastroenteritis

• Medications used• Ulcerative colitis

• Profile of “typical” patient; dietary teaching plan• Crohn’s disease

• Teaching plan


Disorders


Diverticulosis vs. diverticulitis• Compare/contrast

Anorectal abscess, anal fissure, anal fistula• Key differentiations

Food poisoning• Teaching plan regarding organisms


Disorders


Diverticula


McBurney’s Point (Appendicitis)


Peritonitis


Crohn’s Disease


Ulcerative Colit is


Anorectal Fissure


Fistulas


Anal Fistula


Skin Barriers


The patient is a 21-year-old who has recently been diagnosed with ulcerative colitis. In the ED, she tells you that she has been having 7 to 8 bloody stools daily. Upon assessment, you find that her heart rate is 120/min, and she has abdominal pain upon palpation. Laboratory results show a hemoglobin level of 9 g/dL.

How is the severity of the patient’s ulcerative colitis categorized?A. MildB. ModerateC. SevereD. Fulminant

CASE STUDY


The patient is admitted to the acute medical unit.

Which ordered medication would the nurse question?A. Mesalamine (Asacol)B. Prednisone (Deltasone)C. Ibuprofen (Motrin)D. Loperamide (Imodium)

(cont’d)CASE STUDY


Later in the afternoon, the patient states that the abdominal pain is getting worse.

Which interventions would be implemented for her pain? (Select all that apply.)A. Administering analgesics as orderedB. Assisting with frequent positioningC. Providing sitz baths as neededD. Teaching music therapy or guided imageryE. Evaluating the diet for foods that cause painF. Providing antidiarrheal medications as needed



The patient states, “I am afraid I’ll never get to go out with my friends again because I can’t be away from the toilet.”

Which is the appropriate nursing response?A. “What makes you say that?”B. “Your friends will understand.”C. “I wouldn’t worry about it if I were you.”D. “It sounds like you are concerned about managing this

disorder when you are out.”



The patient is preparing for discharge. She asks what is the best way to keep her skin from breaking down.

What is the nurse’s best response?A. “Wash with mild soap and warm water after each bowel

movement.”B. “Apply a pectin-based skin barrier after each bowel

movement.”C. “Add high-fiber or high-cellulose foods to your diet.”D. “Take a laxative daily at bedtime to facilitate morning

bowel movements.”


Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 21

CHAPTER 60

AUDIENCE RESPONSE SYSTEM

QUESTIONS


An older patient diagnosed with bacterial gastroenteritis reports abdominal cramping, diarrhea, nausea and vomiting, and fatigue for the past 24 hours. The nurse should monitor the patient for what priority assessment? A. DehydrationB. HypokalemiaC. HypernatremiaD. Perineal skin breakdown

QUESTION 1


A patient has recently been placed on corticosteroids as treatment for ulcerative colitis. The nurse should monitor the patient’s laboratory results for evidence of which condition?

A. HypernatremiaB. HypercalcemiaC. HyperglycemiaD. Hyperkalemia

QUESTION 2


What priority laboratory analysis should the nurse review when caring for a patient with Crohn’s disease?

A. C-reactive proteinB. Serum albuminC. HemoglobinD. Potassium

QUESTION 3

Care of Patients with Inflammatory Intestinal Disorders

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