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56 Cards in this Set
- Front
- Back
What is Crohn's disease?
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an idiopathic (cause of disease uncertain) inflammatory disease of the small intestine (60%), the colon (20%), or both...
slowly progressive and recurrent disease with predominant involvement of multiple regions of intestine with normal sections between |
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What part of the body does Crohn's disease affect?
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all layers of the bowel but most commonly involves the terminal ileum
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How is Crohn's disease characterized?
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as chronic, nonspecific inflammation of entire intestinal tract, with terminal ileum most often affected...
eventually deep fissures and ulcerations develop and often extend through all bowel layers, predisposing the individual to the development of bowel fistulas...results in severe diarrhea and malabsorption of vital nutrients |
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What are the chronic pathologic changes of Crohn's disease?
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thickening of bowel wall, resulting in narrowing of bowel lumen and strictures
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What happens to the bowels in advanced stages of Crohn's disease?
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bowel mucosa has nodular swelling (granulomas) intermingled with deep ulcerations
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What is more common in UC, but can be seen in Crohn's as well?
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hemorrhaage
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What is more common in Crohn's disease than UC?
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severe malabsorption by small intestine
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What may develop in the small bowel and colon after 15 to 20 years?
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cancer
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_________ formation is a common complication of Crohn's disease.
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Fistula
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Where do fistulas occur with Crohn's disease?
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between segments of the intestine or manifest as cutaneous fistulas or perirectal abscesses; can also extend from bowel to other organs and body cavities, such as bladder or vagina
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Twenty to 30% of individuals with Crohn's will develop____________ obstruction. It initially results from ________ and ________ and becomes fibrotic, causing narrowing, then obstruction.
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intestinal
inflammation edema |
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___________ __________ may be a cause of Crohn's disease.
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Mycobacterium paratuberculosis
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The most widely accepted cause of Crohn's is a combination of reasons --
a defect in immunoregulation of inflammation in intestinal tract along with a _________ predisposition for disease. |
genetic....it's hereditary
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Peak ages for Crohn's is?
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15 and 40 years of age
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Exact cause unknown, what is Crohn's disease aggravated by?
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bacterial infection
inflammation smoking cessation |
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What history findings may be present when assessing patient?
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fever
abdominal pain loose stools possible unintentional loss of weight and frequency, consistency, and presence of blood in stool |
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When performing an abdominal assessment for Crohn's, look for symptoms that are the same as _______ ________.
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acute appendicitis
ex: tenderness guarded movement palpable mass in right lower quadrant |
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When INSPECTING abdomen, assess for _________ masses
or visible _________. |
distention
peristalsis |
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INSPECTION of perianal area may reveal _________ or ________.
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ulcerations
fissures |
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During AUSCULTATION, bowel sounds may be _______ or ________ if inflammation is severe or there is obstruction.
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decreased
absent |
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Upon AUSCULTATION, there may be an increase in _______-________ or rushing sounds over areas of narrowed bowel loops.
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high-pitched
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Upon PALPATION of abdomen, there may be?
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muscle guarding
masses rigidity tenderness |
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What do most clients report with presenting with Crohn's disease?
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diarrhea
abdominal pain low-grade fever (commonly present with fistulas and severe inflammation) |
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How often does diarrhea occur if disease is present only in the ileum?
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five or six times per day, often with a soft, loose stool..
steatorrhea (fatty diarrheal stools) is common rarely does stool contain bright red blood |
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Patients may experience _________ pain before and after bowel movements.
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periumbilical
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If lower colon is diseased, pain is often experienced in both _______ abdominal quadrants.
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lower
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_____ _____ is experienced in about 80% of Crohn's.
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Weight loss
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Patients often experience nutritional problems as a result of increased catabolism secondary to?
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chronic inflammation
anorexia malabsorption self-imposed dietary restrictions... results in fluid and electrolyte imbalances and protein, iron, vitamin, and mineral deficiencies |
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How does marked inflammatory bowel changes affect the small bowel's ability to absorb nutrients, which is worsened by surgery and fistulas
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decreases its ability to absorb nutrients.
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To minimize life-threatening complications, it is very important for the nurse to detect manifestations of?
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peritonitis
bowel obstruction nutritional and fluid imbalances |
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The psychosocial aspect of Crohn's is important to assess because?
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of numerous lifestyle changes that must be made...assess coping skills and support systems
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Are there disease-specific tests that can diagnose Crohn's?
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no
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Results of lab tests for Crohn's reflect extent and severity of ________ associated with disease.
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inflammation
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How might H & H be affected if bleeding is present?
How about serum levels of folic acid and cobalamin (vitamin B12 group) be affected? anemia Amino acid malabsorption may result in decrease of _______ level. presence of inflammation. WBCs in urine may indicate? ureteral obstruction or an enterovesical fistula which means? |
decreased levels
decreased...which further contributes to? albumin What does an elevated ESR (erythrocyte sedimentation rate) indicate? infection...and what might that be caused by? bowel to bladder fistula |
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If signficicant diarrhea is present, the client will experience what electrolyte losses?
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potassium
magnesium |
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More specific diagnostic information might be found with what studies?
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contrast barium enema
upper GI series |
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What can x-rays show with Crohn's disease?
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narrowing, ulcerations, strictures, fistulas
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If patient is in acute stage of Crohn's, which studies might be delayed to avoid perforation?
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contrast barium enema
upper GI series x-rays |
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Which test is used to diagnose when the others are not definitive for Crohn's?
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colonoscopy
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Because GI secretions are high in volume, electrolytes, and enzymes, what is the client at risk for? (3)
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malnutrition
dehydration hypokalemia |
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Antidiarrheals should be given with precaution, but due to the loss of fluid related to diarrhea, the patient may be rx'd?
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diphenoxylate hydrochloride or atropine sulfate (Lomotil)
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How many calories per day does the client need to promote healing of the fistula?
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3000 daily...probably given TPN if client can't take in appropriate amount
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What can the nurse do to assist a patient who has a fistula and is trying a TPN diet?
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monitor patient's tolerance
to diet help patient select high- calorie, high-protein, high-vitamin, low-fiber meals record food intake for accurate calorie count |
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For skin care of ostomies, refer to Medical 4-MS61-Ileostomy Care
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okay
be sure to measure effluent (drainage) |
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Patients with fistulas are at extremely high risk for?
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intra-abdominal abscesses and sepsis
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Subtle signs of infection or sepsis from fistula formation are? (3)
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fever
abdominal pain change in mental status |
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Alternative therapies for treating Crohn's are?
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naturopathy
herbs (ginger and peppermint oil) acupuncture hypnotherapy ayurveda (a combination of diet, herbs, yoga, breathing exercises) |
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Reasons for undergoing surgery for Crohn's includes?
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failure on medical
management fistula complications perforation massive hemorrhage intestinal obstruction (often caused by stricture) abscesses adenocarcinoma (rare) adeno means gland in Greek |
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What are the advantages of performing laparoscopy if this is the surgical method chosen over an open method?
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minimally invasive
smaller incisions less postop pain quicker recovery |
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What is resected in a laparoscopy procedure?
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small bowel (usually ileum)
ileocecal |
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What is stricturoplasty?
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performed for bowel strictures related to Crohn's disease
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What does stricturoplasty involve?
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incising along length of the stricture and suturing the incised area on the hz plane...preop and postop care similar to other abdominal surgeries
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Discharge care for Crohn's is similar to that of?
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ulcerative colitis
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What might the nurse teach the patient about home care?
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manage nutrition
supplies for wound and fistula care easy access to bathroom easy access to kitchen with readily prepared food |
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The teaching plan for Crohn's disease is similar to that of?
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UC
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Teaach client about?
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usual course of disease
symptoms of complications when to notify HCP medication teaching INCLUDE B12 vitamins as ileum can't absorb nutrients follow low-residue, high- calorie diet and avoid discomforting foods such as milk, gluten, and other foods that cause GI stimulation rest periods a must stress management required colonoscopies at regular intervals can detect changes in mucosa for possible development of cancer fistula (ostomy) care |