Page 198 - Critical Care Notes

4223_Tab06_175-198 29/08/14 8:27 AM Page 192

GI
■ UGI series or endoscopy and barium enema
■ Abdominal x-rays and CT, MRI, or ultrasound of the abdomen
■ CBC, ESR, and C-reactive protein
■ Serum chemistries, including albumin, protein, and calcium, and liver func-
tion tests
Management
■ Assess vital signs for ↑ HR, ↓ BP, ↑ RR, and fever, and assess for pallor.
■ Assess skin in the perianal area for redness and skin breakdown.
■ Assess bowel sounds, and examine abdomen for distention and tenderness.
■ Assess number and frequency of stools, and test stool for occult blood and
parasites.
■ Administer IV fluids to correct fluid and electrolyte imbalance.
■ Maintain NPO with TPN, or provide diet high in protein and calories with
vitamins and iron.
■ Administer bulk hydrophilic agents.
■ Administer antibiotics, such as metronidazole (Flagyl).
■ Administer aminosalicylates:
■ Sulfasalazine (Azulfidine)
■ Mesalamine or mesalazine (5-ASA, Asacol, Pentasa)
■ Balsalazide (Colazal)
■ Olsalazine (Dipentum)
■ Administer corticosteroids:
■ Prednisone or hydrocortisone
■ Prednisolone or methylprednisolone
■ Beclomethasone or budesonide
■ Administer GI anti-inflammatory drugs/monoclonal antibodies:
■ Infliximab (Remicade)
■ Visilizumab (Nuvion)
■ Administer immunosuppressants:
■ Mercaptopurine (6-MP)
■ Azathioprine (Imuran, Azasan)
■ Methotrexate (Amethopterin)
■ Tacrolimus (Prograf)
■ Administer analgesics, sedatives, and antidiarrheals as needed.
■ Prepare patient for surgery as needed (total colectomy with ileostomy,
continent ileostomy, or bowel resection).
Complications
■ Toxic megacolon → colonic distention → fever, abdominal pain and disten-
tion, vomiting, and fatigue (does not respond to medical management
within 24–72 hr); total colectomy possibly indicated
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