INFLAMMATORY

BOWEL
DISEASE
PREPARED BY:
EVANETH DACUT
CATHERINE THOMAS
JEROME GUERTA
CHLOE SELERIO
CARMELLI CALUGAY
MARIE A. PADINIT

CAUSES OF ULCERATIVE COLITIS AND CROHNS

DISEASE

The cause is unknown.

Abnormal response by the body's immune system to

normal intestinal bacteria.

STRESS

was once thought to be a cause.

increases the severity of an attack.
Genetic factors

ULCERATIVE COLITIS

PATHOPHYSIOLOGY

CROHNS DISEASE

begins @ terminal ileum & ascending

colon

begins @ rectum, progress proximally

crypt abcess form

small inflammatory aphthoid lesions & fissures

red & edematous mucosa d/t

vascular congestion, friable &
ulcerated

deeper ulcerations, granulomatous lesions &

fissures

bleeding

fibrotic changes thicken

hemorrhage

obstruction abcess & fistula

formations

chronic inflammation

malabsorption

atrophy & narrowing

malnutrition

LLQ cramps relieved by

defecation
skin & mucous membrane lesions
rectal inflammation
weakness
arthritis
uveitis
fever
diarrhea
5-30 stools/day

Fatigue
Anemia
Anorexia
Weight loss
High pitched bowel
sound
Abdominal pain &
cramping

relieved by
defecation

RLQ or periumbilical pain

abdominal pain & tenderness
malaise
steatorrhea

diarrhea
5 stools/day

SIGNS AND SYMPTOMS

ULCERATIVE COLITIS

The predominant symptoms of

ulcerative colitis include:
diarrhea
passage of mucus and pus
left lower quadrant abdominal pain,
intermittent tenesmus,
rectal bleeding
The bleeding may be mild or severe
and pallor, anemia, and fatigue
result.
anorexia,
weight loss
fever
vomiting
dehydration
feeling of an urgent need to
defecate, and the passage of 10 to
20 liquid stools each day.

CROHNS DISEASE
right lower quadrant abdominal

pain
diarrhea unrelieved by defecation
crampy abdominal pains
abdominal tenderness and spasm
Because eating stimulates
intestinal peristalsis,
the crampy pains occur after
meals.
weight loss
malnutrition
Chronic symptoms include
diarrhea, abdominal pain,
steatorrhea (ie, excessive fat in
the feces), Anorexia, weight loss,
and nutritional deficiencies

Inflammatory Bowel
Disease Diet
IF
YOU
HAVE
CROHN'S
DISEASE,
YOU
PROBABLY
HAVE FOUND THAT CERTAIN
FOODS
TRIGGER
YOUR
INTESTINAL
SYMPTOMS,
ESPECIALLY
WHEN
THE
DISEASE FLARES.

Learning to avoid these food

triggers may allow you to selfmanage your Crohn's disease,

reduce gastrointestinal
symptoms, and promote
intestinal healing.

What is a Crohn's disease diet plan?

There is no scientifically proven diet

for inflammatory bowel disease.

Most experts believe, though, that
some patients can identify specific
foods that trigger their
gastrointestinal symptoms,
particularly during disease flares.

By avoiding your "trigger foods," you may

find that your GI symptoms of gas, bloating,

abdominal pain, cramping, and diarrhea are
more manageable. At the same time, you will
give your inflamed intestines time to heal.

an effective Crohn's disease diet plan, based

on recommendations from experts, would

emphasize eating regular meals -- plus an
additional two or three snacks -- each day.
That will help ensure you get ample protein,
calories, and nutrients.

That will help ensure you get ample protein,

calories, and nutrients. In addition, you will

need to take your doctor-recommended
vitamin and mineral supplements. By doing
so, you will be able to replenish the necessary
nutrients in your body.

Which foods should I avoid with

a Crohn's disease diet plan?

of these listed foods will trigger

your symptoms:

alcohol (mixed drinks, beer, wine)

butter, mayonnaise, margarine, oils
carbonated beverages
coffee, tea, chocolate
corn husks

dairy products (if lactose intolerant)

fatty foods (fried foods)
foods high in fiber
gas-producing foods (lentils, beans, legumes,

cabbage, broccoli, onions)

nuts and seeds (peanut butter, other nut butters)

raw fruits
raw vegetables
red meat and pork
spicy foods
whole grains and bran

Crohn's Disease - Medications

Medicines usually are the treatment of choice for

Crohn's disease. They can control or prevent

inflammation in the intestines and help to:

Relieve symptoms.
Promote healing of damaged tissues.
Put the disease into remission and keep it from

flaring up again.
Postpone the need for surgery.

Medicine choices
Aminosalicylates (such as mesalamine or

sulfasalazine). These medicines help manage

symptoms.
Antibiotics (such as ciprofloxacin or
metronidazole). These may be tried if
aminosalicylates aren't helping. They are also
used to treat fistulas and abscesses.

Corticosteroids (such as budesonide or prednisone).

These may be given for a few weeks or months to

control swelling. These steroid medicines usually
stop symptoms and put the disease in remission. But
they are not used as long-term treatment to keep
symptoms from coming back.

Medicines that suppress the immune system (such

as azathioprine and methotrexate). You may take

these if the medicines listed above don't work, if your
symptoms come back when you stop taking steroid
medicines, or if your symptoms come back often,
even with treatment.

When Crohn's disease is

active, treatment has three

objectives:

relieve symptoms
control inflammation
help the person get proper

nutrition

Two-thirds to three-quarters

of people with Crohn's disease

will eventually need surgery to
treat their illness. There are
several reasons why surgery
might be needed

The medications are not working

to control symptoms or do not

work effectively enough.
The drug side effects are
unbearable.
The person has serious
complications that only surgery
can correct.

What are the

complications of Crohn's
disease that might require
surgery?

the formation of a stricture (a

scar), which is a narrowing in the

bowel that can cause
obstrucktions (blockages)
extensive bleeding in the intestine
a hole, or perforation, in the
bowel wall

the formation of a fistula,

which is a connection between

two parts of the body that do
not normally connect
the formation of an abscess,
which is a pocket of pus
caused by infection

a condition known as toxic

megacolon, in which the

colon, or large intestine, is
severely stretched out and
toxins spread through the
blood.

Types of Crohn's Surgery

Bowel resection. This removes a diseased part of

your intestine or corrects a fistula that doesn't

respond to drugs.
Stricturoplasty. This common surgery opens up
narrowed areas of the small intestine. Though it
doesn't remove any intestine, you may also need a
bowel resection.

Colectomy. If your Crohn's is

severe and affects your colon, it

may need to be removed. In some
cases, the surgeon can connect the
small intestine to your rectum, so
you can still pass stools in a normal
way.

Proctocolectomy. Sometimes both the colon and

rectum need to be removed. The surgeon also brings

the end of your small intestine through a hole in your
belly, called a stoma. Waste passes through it into a
bag, which you will need to wear and empty
throughout the day. The bag is hidden under
clothing, so no one sees it.

NURSING MANAGEMENT FOR

BOTH CROHNS AND
ULCERATIVE COLITIS

Reduce Inflammation
Suppressing inappropriate immune response.
Providing rest for a diseased bowel so that healing

may take place

Improving quality of life
Preventing or minimizing complications.

NUTRITIONAL THERAPHY
1. Oral fluids and a low residue
2. High protein
3. High calorie diet
4. Iron supplement

Risk for deficient fluid volume related to abnormal fluid loss with
diarrhea

Fluid management by providing fresh water and

other preferred fluids. Monitor fluid intake and

output. Provide antidiarrheals when appropriate
to help maintain adequate fluid volume.

Imbalanced Nutrition: less than body requirements related to

diarrhea and altered ability to digest and absorb food

Provide nutritional therapy, management, and in

some cases weight gain assistance. If anemia is

present suggest foods which are high in iron and
Vitamins B12, C, and folic acid. Provide comfort
from pain with medications in order to maintain an
adequate appetite. Offer frequent small quantities
of nutrient enriched foods.

Acute pain related to increased peristalsis

Maintain patients therapeutic comfort level with

appropriate medication. Educate and understand

importance of pain control related to appetite
management

NURSING
CARE PLAN

ASSESSMENT
SUBJECTIVES
sakit akong tiyan as verbalized by the patient
gakalibanga ko as verbalized by the patient

OBJECTIVES
Increased bowel sounds
Frequent watery stools

NURSING DIAGNOSIS
Diarrhea related to irritation of bowel
EXPECTED OUTCOME
At the end of 8 hours, the patient will identify/avoid contributing factors and report reduction in frequency
of stools/return to more normal stool consistency.
INTERVENTION
RATIONALE
Observe and record stool frequency,
characteristics, amount, and precipitating factors.

Helps differentiate individual disease and assesses

severity of episode.

Promote bedrest, provide bedside commode.

Rest decreases intestinal motility and reduces the

metabolic rate when infection or hemorrhage is a
complication. Urge to defecate may occur without
warning and be uncontrollable, increasing risk of
incontinence/falls if facilities are not close at hand.

Identify foods and fluids that precipitate diarrhea,

e.g., raw vegetables and fruits, whole-grain cereals, Avoiding intestinal irritants promotes intestinal rest.
condiments, carbonated drinks, milk products.

Restart oral fluid intake gradually. Offer clear

liquids hourly; avoid cold fluids.

Provides colon rest by omitting or decreasing the

stimulus of foods/fluids. Gradual resumption of
liquids may prevent cramping and recurrence of
diarrhea; however, cold fluids can increase
intestinal motility.

INTERVENTION

RATIONALE

Provide opportunity to vent

frustrations related to disease
process.

Presence of disease with unknown

cause that is difficult to cure and that
may require surgical intervention can
lead to stress reactions that may
aggravate condition.

Observe for fever, tachycardia,

lethargy, anxiety, and prostration.

May signify that toxic megacolon or

perforation and peritonitis are
imminent/have occurred, necessitating
immediate medical intervention.

EVALUATION
After 8 hours nursing intervention patient was able to avoid the foods that
precipitate diarrhea and verbalized reduction in frequency of stools.

ASSESSMENT
SUBJECTIVES
sakit akong tiyan as verbalized by the patient

OBJECTIVES
Pain scale: 6/10
Facial grimace
Show signs of irritability/restlessness

NURSING DIAGNOSIS
Acute pain related to abdominal discomfort
EXPECTED OUTCOME
At the end of 8 hours, patient will appear relaxed and able to sleep/rest appropriately, and verbalize
controlled pain.
INTERVENTION
RATIONALE
May try to tolerate pain rather than request
Encourage patient to report pain.
analgesics.
Assess reports of abdominal cramping or pain, noting
Colicky intermittent pain occurs with Crohns
location, duration, intensity (010 scale). Investigate
disease
and report changes in pain characteristics
Note nonverbal cues, e.g., restlessness, reluctance
to move, abdominal guarding, withdrawal, and
depression. Investigate discrepancies between verbal
and nonverbal cues.

Body language/nonverbal cues may be both

physiological and psychological and may be used in
conjunction with verbal cues to determine
extent/severity of the problem.

Review factors that aggravate or alleviate pain.

May pinpoint precipitating or aggravating factors

(such as stressful events, food intolerance) or
identify developing complications.

Encourage patient to assume position of comfort,

e.g., knees flexed.

Reduces abdominal tension and promotes sense of

control.

Provide comfort measures (e.g., back rub, reposition) Promotes relaxation, refocuses attention, and may
and diversional activities.
enhance coping abilities.

ASSESSMENT
SUBJECTIVES
halos tubig na akong ikalibang as verbalized
by the patient

OBJECTIVES
Hyperactive bowel sounds
Diarrhea
Weight loss

NURSING DIAGNOSIS
Risk for Deficiet Fluid Volume related to excessive losses through normal routes
EXPECTED OUTCOME
At the end of 16 hours, patient will maintain balanced I&O and will maintain adequate fluid volume as
evidenced by moist mucous membranes, good skin turgor, and capillary refill.
INTERVENTION
RATIONALE
Monitor I&O. Note number, character, and amount
Provides information about overall fluid balance,
of stools; estimate insensible fluid losses, e.g.,
renal function, and bowel disease control, as well as
diaphoresis. Measure urine specific gravity; observe
guidelines for fluid replacement.
for oliguria.
Assess vital signs (BP, pulse, temperature).

Hypotension (including postural), tachycardia, fever

can indicate response to and/or effect of fluid loss.

Observe for excessively dry skin and mucous

membranes, decreased skin turgor, slowed capillary Indicates excessive fluid loss/resultant dehydration.
refill.
Weigh daily.

Indicator of overall fluid and nutritional status.

Maintain oral restrictions, bedrest; avoid exertion.

Colon is placed at rest for healing and to decrease

intestinal fluid losses.

INTERVENTION

RATIONALE

Administer parenteral fluids, as indicated.

Maintenance of bowel rest requires alternative

fluid replacement to correct losses. Note: Fluids
containing sodium may be restricted in presence
of regional enteritis.

Monitor laboratory studies, e.g., electrolytes

Determines replacement needs and
(especially potassium, magnesium) and
effectiveness of therapy.
ABGs (acid-base balance).

EVALUATION
After 16 hours nursing intervention, patient was able to maintain balanced I&O, and
maintained adequate fluid volume.