Term
INFLAMATORY BOWEL DISEASE (IBD)
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Definition
CHRONIC ILLNESS CHARACTERIZED BY EXACERBATIONS & REMISSIONS
INCLUDES: CROHN’S DISEASE, ULCERATIVE COLITIS |
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Term
CROHN’S DISEASE IS ALSO CALLED....
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Definition
| GRANULOMATOUS COLITIS, ILEITIS, REGIONAL ENTERITIS |
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Term
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Definition
CHRONIC INFLAMATORY DISEASE OF BOWEL
OCCURS ANYWHERE IN GI TRACT BUT USU. IN DISTAL ILEUM
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Term
PT'S WITH CROHN’S DISEASE
MAY ALSO HAVE ...... |
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Definition
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Term
CROHN’S DISEASE
HAS NO SYSTEMIC EFFECTS.
TRUE OR FALES?
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Definition
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Term
CROHN’S DISEASE HAS AN ________ ONSET
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Definition
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Term
CROHN’S DISEASE
COURSE VARIES, S/S MAY
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Definition
INCREASE OVER TIME
HAVE EXACERBATIONS & REMISSIONS
GO INTO SPONTANEOUS REMISSION
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Term
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Definition
ULCERS THAT EXTENDS THROUGH ALL LAYERS OF BOWEL WALL (TRANSMURAL)
SUBMUCOSAL LAYER IS MOST INVOLVED
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Term
CROHN’S DISEASE
PATHO
HYPEREMIA |
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Definition
INCREASED BLOOD FLOW TO A SIGHT
= EDEMA, ULCERATIONS IN AFFECTED AREAS GIVE ‘COBBLESTONE’ APPEARANCE ON ENDOSCOPY |
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Term
CROHN’S DISEASE
PATHO
‘SKIP LESIONS’ |
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Definition
| RANDOM INFLAMED AREAS ALTERNATING WITH NORMAL AREAS |
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Term
CROHN’S DISEAS
CHRONIC LESIONS CAUSE |
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Definition
| SCARRING WHICH LEADS TO BOWEL OBSTRUCTION |
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Term
CROHN’S DISEAS
WHAT CAUSES FISTULAS TO FORM? |
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Definition
| DAMAGE THROUGH THE INTESTINAL WALL |
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Term
CROHN’S DISEASE
TYPES OF FISTULAS
ENTEROCUTANEOUS |
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Definition
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Term
CROHN’S DISEASE
TYPES OF FISTULAS
PERIANAL, PERILABIAL
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Definition
ARE THE MOST COMMON TYPE.
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Term
CROHN’S DISEASE
TYPES OF FISTULAS
ENTEROVAGINAL |
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Definition
EXTENDS INTO THE VAGINAL RECTAL ARIES
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Term
CROHN’S DISEASE
CLINICAL MANIFESTATIONS
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Definition
ABD PAIN, TENDERNESS (ESP. RLQ) & DISTENTION
DISTENSION MAY BE ASSOCIATED WITH EATING
CHRONIC DIARRHEA WHICH MAY LEAD TO DEHYDRATION
FEVER, FATIGUE, ANOREXIA, WT. LOSS
POOR GROWTH IN CHILDREN & ADOLESCENTS
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Term
CROHN’S DISEASE
CLINICAL MANIFESTATIONS
SYSTEMIC EFFECTS _______ WITH GOOD CONTROL
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Definition
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Term
CROHN’S DISEASE
CLINICAL MANIFESTATIONS
SYSTEMIC EFFECTS
JOINTS
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Definition
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Term
CROHN’S DISEASE
CLINICAL MANIFESTATIONS
SYSTEMIC EFFECTS
SKIN
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Definition
ERTHYEMA NODOSUM
PYODERMA GANGRENOSUM
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Term
CROHN’S DISEASE
CLINICAL MANIFESTATIONS
SYSTEMIC EFFECTS
EYES |
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Definition
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Term
CROHN’S DISEASE
CLINICAL MANIFESTATIONS
SYSTEMIC EFFECTS
OTHER
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Definition
LIVER & GALLBLADDER DISORDERS
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Term
CROHN’S DISEASE
DIAGNOSTIC TESTS
STOOL |
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Definition
NEGATIVE C&S
POSITIVE FOR BLOOD & WBCs
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Term
CROHN’S DISEASE
DIAGNOSTIC TESTS
BLOOD |
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Definition
ANEMIA (R/T BLOOD LOSS & MALNUTRITION)
WBCs & SED RATE ELEVATED (R/T INFLAMATION)
PROTEIN & ALBUMIN DECREASED (R/T MALNUTRITION)
VITAMIN ADEK LEVELS DECREASED
ABNORMAL LYTES & ABGs (R/T DIARRHEA)
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Term
CROHN’S DISEASE
DIAGNOSTIC TESTS
NEW SERUM ANTIBODY TESTS |
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Definition
ADJUNCTIVE TEST R/T MAY OR MAY NOT BE ELEVATED & NORMAL PEOPLE MAY HAVE ELEVATED LEVELS
ASCA- ANTI-SACCAROMYCES ANTIBODY |
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Term
CROHN’S DISEASE
DIAGNOSTIC TESTS
X-RAYS
BARIUM ENEMA |
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Definition
| SHOWS INFLAMATION IN LARGE BOWEL |
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Term
CROHN’S DISEASE
DIAGNOSTIC TESTS
UPPER GI SERIES |
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Definition
WITH SMALL BOWEL FOLLOW THROUGH IF UPPER GI TRACT INVOLVEMENT SUSPECTED
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Term
CROHN’S DISEASE
DIAGNOSTIC TESTS
ENDOSCOPY |
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Definition
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Term
CROHN’S DISEASE
DIAGNOSTIC TESTS
COLONOSCOPY OR SIGMOIDOSCOPY
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Definition
SHOWS SKIP LESIONS & COBBLESTONES
ALLOWS BX. FOR CHRONIC INFLAMATION & GRANULOMA
– GRANULOMA = CROHN’S
– NO GRANULOMA DOES NOT R/O CROHN’S
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Term
CROHN’S DISEASE
DIAGNOSTIC TESTS
EGD DONE IF....
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Definition
| UPPER GI TRACT INVOLVEMENT SUSPECTED |
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Term
CROHN’S DISEASE
MEDICAL MANAGEMENT
DIET
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Definition
IV FLUIDS & LYTES & TRANSFUSIONS DURING ACUTE ATTACK
DIET: ADJUST FIBER ACCORDING TO STOOL CONSISTENCY AT THE TIME. HIGH CALORIE & PROTEIN R/T MALNUTRITION. AVOID LACTOSE (PRN) R/T SMALL BOWEL INVOLVEMENT CAN CAUSE LACTOSE INTOLERANCE
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Term
CROHN’S DISEASE
MEDICAL MANAGEMENT
NUTRITIONAL SUPPLEMENTS
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Definition
TPN TO REST & HEAL BOWEL
ELEMENTAL FORMULAS
ELEMENTAL FORMULAS TOLENEX, VIVONEX, PEPTAMEN
NUTRIENTS REDUCED TO EASILY ABSORBABLE FORM
NO REGULAR FOOD ALLOWED & TASTE BAD SO MOST PTS. CAN’T EAT THEM
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Term
CROHN’S DISEASE
MEDICAL MANAGEMENT
DRUGS – ANTIDIARRHEALS
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Definition
| LOMOTIL, IMMODIUM (IF INFECTION PESENT MAY CAUSE TOXIC MEGACOLON) |
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Term
CROHN’S DISEASE
MEDICAL MANAGEMENT
DRUGS – STEROIDS
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Definition
DURING ACUTE EXACERBATION
PREDNISONE PO
HYDROCORTISONE ENEMA OR SUPPOSITORY
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Term
CROHN’S DISEASE
MEDICAL MANAGEMENT
DRUGS – 5- ACETYLSALICYLIC ACID (5-ASA |
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Definition
EXAMPLES: SULFASALAZINE (AZULFADINE), OLSALAZINE (DIPENTUM), MESALAMINE (ASACOL, PENTASA, ROWASA [ENEMA OR SUPPOSITORY])
CONTRAINDICATED IF ASA ALLERGY, NEED HIGH FOLATE INTAKE, TAKE WITH FOOD TO DECREASE GI UPSET, REPORT S/S BONE MARROW SUPPRESSION, SUNSCREEN
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Term
CROHN’S DISEASE
MEDICAL MANAGEMENT
DRUGS – IMMUNE MODULATORS – IF 5-ASA & STEROIDS NOT EFFECTIVE IN MAINTAINING REMISSION
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Definition
EXAMPLES: MERCAPTOPURINE (6-MP), AZATHIOPRINE (IMURAN), CYCLOSPORINE (SANDIMMUNE), TACROLIMUS (PROGRAF), METHOTREXATE (MTX)
BONE MARROW SUPPRESSION, LIVER DAMAGE, INFECTION (S/S MAY NOT BE OBVIOUS), CATEGORY X
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Term
CROHN’S DISEASE
MEDICAL MANAGEMENT
DRUGS – BIOLOGIC AGENTS – NEW
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Definition
EXAMPLE: INFLIXIMAB (REMICADE)- ANTIBODY WHICH INTEREFERES WITH INFLAMATION – GIVEN IV
FOR SEVERE FISTULIZING CROHN’S
PRE-MED PT. WITH TYLENOL & BENADRYL TO DECREASE SIDE EFFECTS
PRE-MED PT. WITH PREDNISONE IF PREVIOUS REACTION
BONE MARROW SUPPRESSION, INFECTION (S/S MAY NOT BE OBVIOUS)
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Term
CROHN’S DISEASE
MEDICAL MANAGEMENT
DRUGS – ANTIBIOTICS
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Definition
METRONIDAZOLE (FLAGYL), CIPROFLOXAN (CIPRO)
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Term
CROHN’S DISEASE
SURGICAL TREATMENT (ILLEOSTOMY)
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Definition
NOT CURATIVE REOCCURS IN REMAINING BOWEL
DONE FOR COMPLICATIONS: INTESTINAL OBSTRUCTION/ PERFORATION, FISTULA FORMATION
MAY RESULT IN SHORT BOWEL SYNDROME & TPN FOR LIFE
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Term
CROHN’S DISEASE
NURSING
ASSESS
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Definition
DIET HX. & ALLERGIES, CLINICAL MANIFESTATIONS , BM PATTERN, MEDICATION SIDE EFFECTS, RESPONSE TO TREATMENT, COMPLICATIONS
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Term
CROHN’S DISEASE
NURSING
FOCUS OF CARE
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Definition
MANAGE F&E & ACID-BASE BALANCE
I&0, TURGOR, VS, WT.
EMOTIONAL SUPPORT
CAUTION WITH BOWEL PREPS DURING ACUTE ATTACK.
AVOID LAXATIVES FOR BOWEL PREP DURING ACUTE ATTACK R/T MAY CAUSE TOXIC MEGACOLON & PERFORATION.
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Term
CROHN’S DISEASE
NURSING- TEACH
REPORTABLE S/S
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Definition
INCREASED # BMs, VISIBLE BLOOD IN STOOL
SEVERE ABD PAIN
EXTREME FATIGUE, WT. LOSS
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Term
CROHN’S DISEASE
NURSING- TEACH
HOME HEALTH CONCERNS
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Definition
TPN/PICC LINE CARE – HAVE CAREGIVER RETURN DEMO BEFORE D/C
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