ORLANDO, Fla. — Nurses specializing in inflammatory bowel disease care should take note of these 10 pieces of advice from a nurse at Advances in IBD 2017.
“These are just some tips I’ve learned along the way,” Ashley Bochenek Perkovic, APN, FNP, from the University of Chicago, said during her presentation.
1. Nutritional deficits in IBD: “Nutritional intake and increased losses occur as a result of many factors. ... You want to make sure you’re checking for these vitamin and mineral deficiencies routinely.”
2. Steroids: “The benefits of steroids are that they work really well and quickly in patients that are really sick and they induce remission. ... However, they have many, many drawbacks so that’s why we only use them to induce remission and not maintain remission.”
3. Role of metronidazole in IBD: “Peripheral neuropathy is associated with long-term use so if your patient is one of those that requires chronic antibiotics ... we actually try not to use metronidazole long-term because it causes peripheral neuropathy.”
4. IBD flare vs. infectious colitis: “You want to make sure you’re asking the right questions. ... We don’t admit anyone for an IBD flare unless we rule out infection first.”
5. Therapeutic drug monitoring in thiopurines: “We would check this before starting any of those medications to see how the patient would metabolize the medication.”
6. Therapeutic drug monitoring in thiopurines – metabolites: “It’s also helpful to see if your patient is actually taking the medicine, ... but this is not a substitute for your regular labs.”
7. Methotrexate in IBD: “This is commonly used in the pediatric population due to the lymphoma risk associated with thiopurines and it’s a good choice for patients with concomitant arthritis.”
8. Surgery in IBD: “You want to make sure you’re addressing the surgery option with your patients and you’re not leaving it as a last resort. It should be talked about early on so patients can make a better informed decision about what is right for them. ... Often surgery can offer an improved quality of life.”
9. Pain medicine in IBD: “It should not be used routinely in inflammatory bowel disease, [but] there are appropriate uses. ... If you do have to give narcotics, make sure you limit and monitor their use. ... Refer to a pain specialist when necessary.”
10. Flare prevention in IBD: “Educate your patient on things that can cause flares ... and address these issues before they happen, if possible. ... Have them be proactive by tracking flare symptoms.” – by Katrina Altersitz
Reference: Perkovic AB. Session IVB: Interprofessional IBD Patient Management. Presented at: Advances in IBD; Nov. 9-11, 2017; Orlando, Fla.
Disclosures: Bochenek Perkovic reports she is on the speaker’s bureau for AbbVie and Janssen.