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Transcript

Jessica Griffin, 2017

TOXIC

MEGA COLON

Overview

Toxic Megacolon is a potentially lethal complication of inflammatory bowel disesae (IBD) or infectious colitis that is characterized by total or segmental non obstructive colonic dilation plus systemic toxicity.

Toxic Megacolon is a potentially lethal complication ...

Key Assessment Findings

Clinical features

  • Severe bloody diarrhea*
  • Malaise
  • Abdominal pain and distention
  • Tachycardia
  • Fever
  • Postural hypotension

Clinical features

Clinical features that suggest IBD as a cause

  • Diarrhea
  • Bloody stools
  • Abdominal pain
  • Perineal disease
  • Extraintestinal manifestations such as:
  • arthritis
  • iritis
  • skin disease
  • liver disease

Labs and diagnostics

The diagnosis is based on the finding of the dilated colon on abd imaging

Initial Evaluation:

  • Establishing a diagnosis and determining the underling etiology to help institute specifc therapeutics measures

Criteria for the clinical diagnosis

  • Radiographic evidence of colonic distension
  • PLUS at least 3 of the following:
  • fever >38C/
  • HR >120 bpm
  • Neutrophilic leukocytosis >10,500/microL
  • Anemia
  • PLUS at least one of the following
  • Dehydration
  • ALtered sensorium
  • Electrolyte disturbances
  • Hypotension

Nursing Management

Nonsurgical interventions

  • Complete bowel rest and NGT to decompress GI tract
  • Monitor for deterioration (watch trends)
  • CBC, Electolytes, and serial abd plain films are reviewed Q12HR and then daily as pt improves
  • Enteral feeding
  • Intermittent rolling maneuvers or knee-elbow position on help promote decompression

Surgical Interventions:

  • Subtotal colectomy with end-ileostomy
  • Single stage proctocolectomy

Surgical Interventions:

Pharmacology

Pharmacological interventions for a pt with IBS

  • TPN found to be of limited benefit
  • Prophylaxis for stress ulcers and DVT
  • Broad spectrum antibx (ampicillin-gentamicin-metronidazole)
  • IV corticosteroids (not used in TMC due to C. Diff)

Pharmacological interventions for a pt with other disorders

  • if due to C. DIff, stop antibx followed by vancomycin and IV metronidazole.
  • Fecal microbial transplantation

Meditech Careplan/ Interventions

Inflammatory Bowel Disease

PROBLEM 1: Diarrhea

  • Interventions:
  • Evaluate causative factors of diarrhea
  • Teach fluid and dietary restrictions

PROBLEM 1: Diarrhea

PROBLEM 2: Pain

  • Invertentions:
  • Develop pain management program
  • Teach: Relaxation techniques

PROBLEM 2: Pain

Colectomy

PROBLEM 1: Altered bowel function

  • Interventions:
  • Colostomy care
  • Toileting schedule

Interventions

Interesting Facts

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