- First medications used to treat Crohn’s Disease areaminosaliclates• Ulcerative colitis:Edema and inflammation primarily in therectum and recto-sigmoid colon. In severe cases, it caninvolve the entire length of the colon. Mucosa andsubmucosabecome hyperemic (increase in blood flow) andthe colon will become edematous and reddened. It can lead toabscess formation.- Symptoms: bloody diarrhea- Complications: hemorrhage, toxic megacolon, markedincreased risk for developing colon cancer- Edema and thickened bowel mucosa can cause partialbowel obstruction. Intestinal mucosal cell changes canlead to colon cancer or insufficient production ofintrinsic factor, resulting in insufficient absorption ofvitamin B12 (pernicious anemia).- Classified as either mild, moderate, severe and fulminant
(refer to ATI)• Procedures:- Colonoscopy:prepped, maintain NPO, laxative, lightsedative ???, O2 given during procedure.Colonoscopies should begin by at least age 45 forindividuals who have a family history of cancer, andat age 50 for those who do not.Colonoscopies shouldbe done every 10 years if polyps are not found. Fecaloccult blood tests should be done annually starting at age50. However, fecal occult blood tests are not diagnosticof colon cancer, and a colonoscopy will need to be doneto confirm the diagnosis.- Ostomy:a surgical opening from the inside of the body tothe outside and can be located in various areas of thebody. Can be permanent or temporary.- Ostomy teaching: Filters, deodorizers, or a breath mintcan be placed in pouch to minimize odor while the pouchis open.Odor causingfoodsOdor decreasingodorsGas forming foodsGas decreasingfoodsFish, eggs,asparagus, garlic,beans and dark,green leafyvegetablesButtermilk,cranberry juice,parsley and yogurt.Dark, green leafy vegetables,beer, carbonated beverages,dairy products and corn.Also chewing gum, skippingmeals and smoking can causegas.Yogurt, crackersand toasto Colostomy: Surgical opening into the largeintestine to drain stool, with the ascending colonproducing more liquid stools, the transverse colonproducing more formed stools and the sigmoidcolon producing near-normal stool. When a portionof the bowel must be removed (cancer, ischemicinjury) or requires rest for healing (diverticulitis,trauma).o Ileostomy: Surgical opening into the ileum to drainstool, which is typically frequent and liquid sincelarge intestine is bypassed. When the entire colonmust be removed due to disease (Crohn’s disease orulcerative colitis).o Total colectomy with ileostomy: resect the boweland pull it through the outside the body where stoolcomes out. With ileostomy (liquidy stool), thepatient is losing a lot of water and is at risk forelectrolyte disturbances and fluid loss, especially
initially postoperatively. Must monitor for that andteach patient to intake adequate fluids.
- Fall '16
- Denise Cauble