
Clinical Manifestations:
- Lower right quadrant pain
- Diarrhea unrelieved by defecation
- Crampy abdominal pains AFTER MEALS
- Abdominal tenderness and spasm
- Weight loss
- Secondary anemia due to poor nutrient absorption
- Nutritional deficiencies
- Fever
- Leukocytosis
- Anoreixa
Complications:
- Intestinal obstruction
- Perianal disease
- Fluid and electrolyte imbalances
- Malnutrition secondary to malabsorption
- Fistula and abscess formation
- Stricture formation
Lab Findings (click here for normal lab values)
- Decreased hematocrit and hemoglobin levels
- Elevated white blood cell count
- Elevated sedimentation rate
- Low albumin and protein levels
- Positive for occult blood and steatorrhea (excess fat in the feces) in fecalysis
- Proctosigmoidoscopy
- X-Ray barium study of upper gastrointestinal tract
- Endoscopy and intestinal biopsy (Confirming diagnosis)
- Barium enema
- CT Scan
Barium enema shows ulcerations (cobblestone appearance)
Classic 'string sign' on X-Ray indicating constriction of a segment of a bowel (most conclusive diagnosis)
Medical Management:
- Nutritional therapy
- Antidiarrheal and antiperistaltic medications are given
- Sulfasalazine which is effective for mild or moderate inflammation, reduces recurrence
- Corticosteroids
Surgical Management:
- Total Colectomy with Ileostomy
- Total Colectomy with Continent Ileostomy
- Total Colectomy with Ileoanal Anastomosis
Nursing Management:
Assessment:
- Health history
- Dietart patterns (include intake of alcohol, nitcotine)
- Assess elimination patterns and stool consistency
- Nutrition status
- Assess abdomen for bowel sounds and characteristics
- Pain assessment
- Diarrhea R/T the inflammatory process
- Acute pain R/T increased peristalsis and GI inflammation
- Deficient fluid volume deficit R/T anorexia. nausea and diarrhea
- Imbalanced nutrition, less than body requirements
- Activity intolerance R/T fatigue
- Anxiety
- Ineffective coping
- Risk for impaired skin integrity
- Relieve pain by administering anticholinergic medications 30 mins. before meals
- Maintain fluid intake
- Maintain optimal nutrion through parenteral nutrition in severe cases
- Record intake and output
- Weigh daily
- High protein low fat and residue diet
- If food is tolerated give small frequent feedings
- Promote rest
- Establish rapport to reduce anxiety
- Provide perianal care and prevent skin breakdown for bed-ridden clients especially over bony prominences
- Elimination status
- Pain
- Fluid Balance
- Nutrition status
- Skin integrity
- Knowledge of disease process and management
- Potential complications must be reported
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