Post on 04-Apr-2018
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CROHNS DISEASE OUTLINE:
A.CROHNS DISEASE- A.k.a REGIONAL ENTERITIS, is the inflammationof the GI tract.
B.ETIOLOGY & PATHOPHYSIOLOGY:1. Autoimmune disease, genetic pre-disposition2. Effects all layers of mucosa and entire GI tract, but common in terminal
ileum
3. Key features: skip lesions, cobblestone appearance, thick walls4. Strictures & obstructions, after 15-40yrs cancer
C.SIGNS & SYMPTOMS1. Fever2. Increased WBC w/
decreased e-lytes
3. Diarrhea4. Steatorrhea5. loose stools6. Pre-umbilical pain before
and after BM
7. Colicy abdominal pain aftereating
8. Visible peristalsis
9. Palpable mass10. Decreased/absent bowels
sound w/ severe
inflammation
11. Weight loss12. Anorexia13. High pitched bowel sounds
over areas of narrowed
bowel loops
14. Anemia
D.DIAGNOSTICS & LABS:1. Barium enema2. Upper GI series Endoscopy3. WBC & elytes
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E.COLLABORATIVE INTERVENTIONS1. DIARRHEA MANAGEMENT:
i. Note vol, colour, consistence & # stoolsii. Assess perineal area & skiniii. Daily weight
2. DRUG THERAPYi. Anti-diarrheal- decrease intestinal motility
a.Diphenoxylate HCL (Lomotil)ii. Prostaglandin Inhibitors- inhibit synthesis prostaglandins in
intestinea.Sulfalazine (Azulfidine), Mesalamine (Azacol)
iii. Corticosteroids- to suppress inflammationa.Hydrocortisone
iv. Anti-infective- bowel antiseptic- inhibit bacterial proteinsynthesis
a.Neomycin (mycifradin)b.Metronidazole (Flagyl)
v. Infliximab (Remicide)- antitumor necrosis factor for thosewith active fistulas
3. MALNUTRITION MANAGEMENTi. High carb, protein, low fat, fibre dietii. Oral suppliments- ensure and vivonexiii. Record food intake w/ calorie countiv. TPN for those NPO
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4. FLUID & ELYTE REPLACEMENTi. Oral and/or IV fluidsii. Strict I/O
5. ASSESS SKINi. Apply pouch to fistula to prevent irretationii. Cover area around fistula w/ barrier ex. Duoderm, apply
wound drainage system
iii. Clean & keep dryiv. Observe for infection/sepsis: fever, abdominal pain, change
mental status6. SURGERY
i. Bowel resection & anastomosis w/or without colon resectionii. Strictoplasty for bowel strictures
a.Pre-op:1)Explain & reinforce surgeons teaching2)Instruct consume liquid diet +1 days3)Bowel prep: laxatives, enemas4)IV antibiotics
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b.Post-op1)Patency & placement tube2)Relief pain3)Colostomy management
i. Cover stoma & keep moist if no pouch inplace
ii. Monitor for:- necrotic tissue, stoma colour,bleeding
iii. Check & fit pouch & check leaksiv.
Assess fxn colostomy 2-4dys post-op
v. Empty pouch when full of gas or 1/3-1/2full stool
vi. Irrigate wound if indicatedvii. Change dressing as indicatedviii. Assess perineal woundix. Comfort measures for perineal itching-
antipyretics
x. Check s/s infectionF.COMPLICATIONS
1. Malabsorption2. Fistula3. Hemorrhage4. Abscess5. Bowel obstruction6. cancer