Treatments & Complications — the companion to NG-030 (Patho, Signs, Causes)
NG-111GIADHD-friendly visual edition
Both are Inflammatory Bowel Disease (IBD). This page picks up where NG-030 left off: what goes wrong when it's not controlled, the drugs that control it, and the nursing care that keeps a flare from becoming an emergency.
🔪 Surgery cures UC onlyColectomy = cure for UC. Crohn's can recur anywhere.
💊 Step up the ladder5-ASA → steroids → immunomodulators → biologics → surgery.
🚨
COMPLICATIONS
STEP 1 · WHAT GOES WRONG
Crohn's digs tunnels through the wall. UC balloons the colon out. Both roads can end in peritonitis.
⚖️ Crohn's vs UC — the complication & cure table
👑 Crohn's
🩸 UC
Location 📍
Mouth to anus, skip lesions, mainly small intestine
Colon & rectum only, continuous
Depth 🔬
Transmural — through every layer
Mucosal — surface layer only
Signature complication
Fistulas, strictures, abscesses, obstruction
Toxic megacolon, severe bleeding
Cancer risk
Increased, but lower than UC
Higher colon cancer risk with long-standing disease
Surgical cure? 🔪
NOT curative — disease can recur anywhere in the GI tract
Colectomy IS curative — removing the colon removes the disease
🧠 "You can cut UC out — you can't cut Crohn's out." UC lives only in the colon, so removing the colon removes the disease. Crohn's can pop up anywhere from mouth to anus, so surgery only treats the current complication, not the disease itself.
🕳️ Crohn's: tunnels through the wall
Deep, transmural inflammation burrows all the way through the bowel wall, creating:
🕳️ Fistulas — abnormal tunnels connecting bowel to bladder, vagina, skin, or other bowel loops
🧠 Deep = damage that lasts. Transmural inflammation means Crohn's leaves permanent structural changes — strictures and fistulas don't heal shut on their own.
🎈 UC: the colon balloons — toxic megacolon
Toxic megacolon — severe inflammation paralyzes colon motility, the colon distends massively, and the wall can rupture, spilling bowel contents and causing peritonitis — a deadly infection of the peritoneal cavity.
🧠 Toxic megacolon = UC's emergency. Fistulas/strictures are Crohn's signature; toxic megacolon → rupture → peritonitis is UC's.
🚨 Peritonitis red flags — Report to HCP
🌡️Feverover 100.3°F
🤲Rebound tenderness
🪵Rigid abdomen"board-like"
📈Increasing pain& tenderness
😰Restless
💓Fast HR & RRtachycardia/tachypnea
🧠 Same 6 red flags, every abdominal-emergency page in this course (appendicitis, diverticulitis, IBD) — memorize this list once, apply it everywhere.
💊
PHARMACOLOGY
STEP 2 · CLIMB THE LADDER
Treatment steps up in intensity as disease gets harder to control — cheapest/safest drugs first.
🪜 The treatment ladder
1
🧴 Aminosalicylates (5-ASA):Sulfasalazine — "STOPS the body attacking itself" — first-line, especially for UC
2
🔥 Corticosteroids:Prednisone — "soothes the swelling" — induces remission fast, not for long-term use
🎯 Biologics (anti-TNF): infliximab, adalimumab — for moderate–severe disease; screen for TB/infection first
5
🔪 Surgery — for complications or disease that won't respond
🧠 "Soothe, then Stop, then Suppress, then Surgery." Steroids soothe symptoms short-term, 5-ASA/immunomodulators stop the ongoing attack, biologics suppress the immune trigger, surgery is the last step.
💊 Symptom-control drugs
Drug
Memory clue
Loperamide (Imodium)
"LOW bowel movements"
Dicyclomine
"Dry Cycle" — antispasmodic, dries up cramping/spasm
🧠 Caution: antidiarrheals can be risky during a severe flare — slowing the bowel can contribute to toxic megacolon. Give as prescribed and monitor closely.
🔪 Surgery — resection with ostomy
Most clients get a colostomy or ileostomy after a bowel resection, where the diseased segment of bowel is removed.
🧠 Surgery in Crohn's treats the complication in front of you (a stricture, fistula, abscess) — it does not remove the disease.
🩺
CARE
STEP 3 · SUPPORT THE WHOLE PERSON
Fluid & electrolytes, nutrition, and psychosocial support — the day-to-day nursing that keeps a flare from becoming an emergency.
💧 Fluid & electrolyte monitoring
📋 Strict I&O monitoring — closely, every shift
💧 Encourage fluids — roughly 2 L/day, more with diarrhea to prevent dehydration
🧪 Hypokalemia — K⁺ 3.5 mEq/L or less — from ongoing diarrhea, monitor for weakness & dysrhythmias
🧠 Diarrhea drains potassium. Any IBD client with active diarrhea is a hypokalemia risk until proven otherwise — check the K⁺.
🍽️ Diet
🥩 High protein & high calorie — healing & malabsorption needs
🥣 Low fiber during flares — rest the irritated bowel
🍽️ Small, frequent meals
📓 Keep a food journal to spot personal triggers
❌ Avoid alcohol; reduce caffeine (coffee, tea) — both irritate the gut
🧠 "High protein, low fiber, small & often." Feed the healing, rest the lining.
💊 Comfort & psychosocial care
💊 Give analgesics as prescribed for pain
🧠 Encourage clients to discuss feelings — chronic disease, body image with an ostomy
😌 Stress reduction — stress is a known flare trigger (see NG-030)
🧠 IBD is chronic and relapsing — psychosocial support is not optional extra care, it's core to preventing the next flare.
📝 NCLEX SATA practice — client with UC, select all interventions
Which of the following belong in the plan of care? (Select all that apply.)
✅ Discuss plans to decrease stress
✅ Encourage fluids, roughly 2 L/day, more with diarrhea
✅ Monitor for K⁺ 3.5 mEq/L or less (hypokalemia)
✅ Administer analgesics for pain
✅ Avoid alcohol; reduce caffeine
🧠 SATA questions on IBD almost always bundle: stress reduction + fluids + K⁺ monitoring + analgesics + avoid alcohol/caffeine — learn this cluster as one unit.
⚡
QUICK RECALL
SAY IT OUT LOUD
🕳️ Crohn'sFistulas, strictures, abscesses — surgery NOT curative.
🎈 UCToxic megacolon → rupture. Colectomy IS curative.
🚨 Fever + rigid + rebound= peritonitis, report to HCP.
🎯 Cover & check — 4 rapid-fire questions
Q1: Which disease is cured by a colectomy, and why?
Ulcerative colitis — disease is confined to the colon, so removing the colon removes the disease. Crohn's can recur anywhere in the GI tract, so surgery is not curative.
Q2: Name Crohn's signature complications versus UC's signature complication.