Inflammatory Bowel Disease (IBD)
A patient with ulcerative colitis has 15 bloody stools in 24 hrs. What is the priority complication to monitor?
Hypovolemia/anemia and risk for shock.
A cirrhosis patient has confusion, asterixis, and elevated ammonia. Which intervention takes priority?
Administer lactulose as ordered to reduce ammonia.
A pancreatitis patient’s calcium is 6.8 mg/dL. What complication should you anticipate?
Tetany/seizures (hypocalcemia)
A patient has RUQ pain radiating to shoulder after fatty meals. Which pathophysiology explains this?
Gallstones block bile flow, increasing pressure and irritation.
Patient has cola-colored urine. What does this finding indicate?
Hematuria from glomerular damage.
A dehydrated patient develops AKI. Which stage is this and why?
Prerenal is caused by low perfusion which reduces filtration.
Why does CKD cause anemia?
Low erythropoietin production resulting in fewer RBCs.
Crohn’s patient has anemia and neuropathy. Which nutrient deficiency should you suspect and why?
Vitamin B12 deficiency from ileal malabsorption.
Why does portal hypertension increase the risk of esophageal varices?
Increased venous pressure causes fragile veins to dilate/rupture.
Why does pancreatitis increase risk for hypovolemic shock?
Enzyme leakage causes systemic inflammation which fluid shifts into tissues
A post-laparoscopic cholecystectomy patient has shoulder pain. Which nursing intervention is most appropriate?
Encourage early ambulation and positioning (walking, left-side lying, Sims) to help absorb CO₂ gas.
Why does glomerulonephritis cause proteinuria?
Damaged filtration membrane leaks protein into urine.
A patient with AKI has peaked T waves. What is the cause?
Hyperkalemia.
Why are CKD patients advised to follow a special protein diet?
Protein intake may be restricted before dialysis to reduce waste buildup, but increased once on dialysis to prevent malnutrition.
Patient with Crohn’s is on steroids. Which complications do you monitor for long-term?
Osteoporosis, infection, hyperglycemia.
What laboratory findings would you anticipate in a patient with decompensated cirrhosis?
Increased AST/ALT, bilirubin, and PT/INR. Decreased albumin.
Patient reports pain relief when leaning forward. Explain the physiology.
Reduces pressure on inflamed pancreas and diaphragm.
Why does cholecystitis sometimes cause jaundice?
Stone blocks bile duct causing bilirubin to build up in blood.
How does glomerulonephritis cause hypertension?
Sodium/water retention and RAAS activation.
Why does AKI cause metabolic acidosis?
Kidneys cannot excrete H+ (acid) or make bicarbonate.
Which electrolyte imbalance in CKD is life-threatening and why?
Hyperkalemia causing fatal arrhythmias.
Why are low-fiber foods recommended during acute IBD flares?
Reduces mechanical irritation of inflamed bowel.
A cirrhosis patient has tense ascites and dyspnea. What intervention may be ordered and why?
Paracentesis relieves pressure and improves breathing.
Name 2 labs besides amylase/lipase that may be abnormal and why.
WBC ↑ (inflammation), calcium ↓ (fat necrosis), glucose ↑ (pancreatic beta-cell injury).
A gallbladder patient’s bilirubin and alkaline phosphatase are elevated. What does this indicate?
Obstructed bile flow (cholestasis).
Which assessment finding best indicates worsening renal function?
Rising serum creatinine with decreased urine output.
Which daily measurement is the most sensitive indicator of fluid status in AKI?
Daily weights.
Explain how dialysis corrects both electrolyte and acid-base imbalances.
Removes potassium, phosphate, excess fluid, hydrogen ions, and restores bicarbonate.
A UC patient is scheduled for colectomy with ileostomy. What is the greatest immediate post-op risk?
Fluid/electrolyte imbalance due to high-output stoma losses.
Explain why cirrhosis leads to peripheral edema and ascites even if total body fluid is elevated.
Low albumin means there is low oncotic pressure and portal HTN which fluid shifts into interstitial/abdominal spaces.
A patient with acute pancreatitis has a nasogastric tube (NGT) to low intermittent suction. Which finding indicates that the treatment is effective?
Decreased abdominal pain and distention.
After open cholecystectomy, a patient has bile-colored drainage from JP drain. What does this mean?
Possible bile leak so notify provider immediately
Patient has pulmonary edema, oliguria, and high BUN/Cr. Which treatment may be required?
Dialysis.
Why is oliguria dangerous in AKI?
Waste and electrolytes accumulate causing increased risk for uremia, hyperkalemia, acidosis.
Why are CKD patients prone to bone disease?
Phosphate retention and low calcium can lead to secondary hyperparathyroidism.