NLE Gastrointestinal Nursing — Lower GI & Bowel DisordersMemory Anchors

Memory aid

Remember 'CROHN'S SKIPS': C = Can occur anywhere (mouth to anus), R = Recurs after surgery, O = Often terminal ileum, H = Holes (fistulas) and strictures, N = Not curable by surgery, S = Skip lesions (patchy), K = Kobblestone mucosa, I = Inflammation is FULL-thickness (transmural), P = Pain + malabsorption, S = Surgery is NOT curative. Picture a little boy named Crohn who SKIPS rope from his mouth all the way down to his bottom — jumping over patches of rope (skip lesions), going deep underground at each hop (transmural), and despite jumping everywhere, he never gets tired of skipping (it RECURS).

Why it works

The acronym anchors each clinical feature to a letter, and the silly image of a boy skipping from mouth to anus embeds the 'skip lesion + full extent' concept visually and emotionally.

Example usage

NLE question: 'Which IBD type features skip lesions and transmural inflammation?' — You mentally see the skipping boy and answer: Crohn's Disease.

Recall trigger

Think: 'CROHN'S SKIPS' — picture the skipping boy

Memory aid

UC is like a PAINT ROLLER that starts at the RECTUM and rolls continuously upward through the colon — it never skips a spot, always leaving a uniform red (bloody) coat on the mucosal surface only. Unlike Crohn who skips, UC is relentless and continuous. Best part: if you REMOVE the canvas (total colectomy), the painting stops forever — UC IS CURED by surgery! Also remember: UC = U Can be Cured (by colectomy).

Why it works

The paint roller image physically shows the continuous, bottom-up, mucosal-only nature of UC. The 'U Can be Cured' play on the initials creates a direct word-memory link to surgery being curative.

Example usage

Asked which IBD is curable by surgery — recall the paint roller image and 'U Can be Cured' → Ulcerative Colitis / total colectomy.

Recall trigger

Paint roller starting at the rectum + 'U Can be Cured'

Memory aid

Use the phrase: 'CROHN GOES DEEP AND SKIPS; UC BLEEDS AND STICKS.' Crohn = DEEP (transmural) + SKIPS (discontinuous) + GOES anywhere (mouth to anus) + NO cure by surgery. UC = BLEEDS (bloody diarrhea) + STICKS (continuous, no skip) + stays in COLON/RECTUM + SURGERY cures. Repeat it as a rhythm: 'Crohn goes DEEP and SKIPS — UC BLEEDS and STICKS!'

Why it works

Rhyme and rhythm improve phonological memory. Each keyword maps to a clinically testable feature, making the contrast impossible to mix up under exam pressure.

Example usage

Any question contrasting Crohn's and UC — recite the phrase mentally first, then match clinical features to the correct diagnosis.

Recall trigger

Say aloud: 'Crohn goes deep and skips — UC bleeds and sticks!'

Memory aid

Imagine a nurse named Nurse HLE (pronounced 'haley') who almost KILLED her patient with appendicitis by applying Heat to the abdomen, giving a Laxative, and administering an Enema — all in one shift. HLE = Heat, Laxatives, Enemas. Her patient's appendix ruptured and she was called before the PRC Board of Nursing. The story is sad and unforgettable: 'Never be a Nurse HLE!' Every time you see appendicitis on the exam, think of Nurse HLE and say NEVER do H-L-E.

Why it works

Negative emotional stories (fear, consequence) are encoded more strongly in memory. The nurse's name 'HLE' is both an acronym and a character, creating dual encoding.

Example usage

NLE question: 'Which intervention is contraindicated in suspected appendicitis?' — Think of Nurse HLE, recall H-L-E, and identify heat application, laxatives, or enemas as wrong answers.

Recall trigger

Think: 'Never be Nurse HLE!' → Heat, Laxatives, Enemas = NEVER in appendicitis

Memory aid

Picture a MAP of a person's abdomen. Draw a straight line from the UMBILICUS (belly button) to the RIGHT Anterior Superior Iliac Spine (RASIS — the bony bump on the right side of your hip). The midpoint of that line is McBurney's Point. Memory image: 'MC BURNEY burned himself exactly in the MIDDLE of the path from his belly button to his right hip bone.' His name has a BURN in it — and the pain of appendicitis BURNS at that exact midpoint. Right side, midway — McBurney's Point.

Why it works

Spatial visualization combined with a narrative about the name (BURNEY = burn) creates a multi-sensory memory trace that links anatomy to the clinical sign.

Example usage

Question: 'The nurse palpates maximum tenderness at what landmark in appendicitis?' — Picture McBurney burning at the midpoint → answer: McBurney's point (RLQ, midpoint between umbilicus and RASIS).

Recall trigger

Visualize the BURN midway between belly button and right hip bone

Memory aid

Think of a water balloon (the appendix) being squeezed. The pressure builds and hurts terribly. Then — POP! For a split second, the pain is GONE. But now the water (infected contents) has spilled everywhere inside the belly — and moments later, the agony of PERITONITIS begins. The 'moment of relief' is the most DANGEROUS moment because it means RUPTURE. Tell yourself: 'When the patient says AHHH (relief), the nurse says OH NO (rupture).' The apparent relief is a red flag, not a good sign.

Why it works

The water balloon metaphor makes the pathophysiology tangible. The contrast 'AHHH = OH NO' creates a memorable emotional reversal that combats the intuitive but wrong assumption that pain relief means improvement.

Example usage

Scenario: Client with suspected appendicitis reports sudden reduction in pain. The correct response is to recognize this as a sign of rupture/perforation and notify the physician immediately — not reassure the client.

Recall trigger

Water balloon popping → 'When patient says AHHH, nurse says OH NO'

Memory aid

Remember the '4 Fs of Sulfasalazine': Food (take with food), Fluids (drink plenty), Folate (supplement folic acid — drug blocks folate absorption), and False color urine (orange-yellow urine is NORMAL and harmless). Imagine a traffic light that is orange — STOP and remember: Folic acid, Food, Fluids, False color. The orange urine is also a great memory hook: 'Sulfasalazine turns your pee like a traffic light — ORANGE. That's your reminder to take your 4 Fs.'

Why it works

The 4-F acronym reduces four separate teaching points to one letter. The orange traffic light image is visually distinctive and connects the color of urine to the drug's name and teaching points.

Example usage

NLE question: 'A client on sulfasalazine reports orange-yellow urine. What is the nurse's best response?' — Recall the 4 Fs: orange urine is NORMAL (False color) — reassure the patient. Also ensure they take with food, drink fluids, and take folic acid.

Recall trigger

Orange traffic light → 4 Fs of Sulfasalazine: Food, Fluids, Folate, False-color urine

Memory aid

Biologics (anti-TNF drugs) are like IMMIGRATION OFFICERS — before they let anyone in (suppress the immune system), they must SCREEN EVERYONE at the border for dangerous stowaways: TUBERCULOSIS and HEPATITIS B. If TB or Hep B is hiding (latent/dormant), the biologic will 'open the border' (suppress immunity) and let these infections EXPLODE into active disease. So before every biologic: SCREEN FIRST, THEN TREAT. Think: 'BI-ologics need a BI-ometric screen — TB and Hep B.'

Why it works

The immigration/border control analogy maps directly to the immunosuppression mechanism. The wordplay 'BI-ologic = BI-ometric' creates a phonological hook linking the drug class to the two required screenings.

Example usage

Question: 'Before initiating infliximab for Crohn's disease, the nurse should ensure the patient has been screened for:' — Recall the immigration officer: TB and Hepatitis B.

Recall trigger

Immigration officer checking for TB and Hep B at the border → Biologics need screening FIRST

Memory aid

IBS = 'I'm BS-ing You' — meaning IBS is all symptoms and no real structural damage. It has NO blood, NO weight loss, NO nocturnal symptoms, NO inflammation — it's like the bowel is throwing a tantrum without any real injury. The KEY feature: pain is RELIEVED by defecation (the tantrum stops when the bowel empties). Red flags that say 'this is NOT IBS': Blood, Weight loss, nocturnal Awakening, Fever = BWAF. If you see BWAF, it's organic disease, NOT IBS.

Why it works

The playful phrase 'I'm BS-ing you' captures the functional (no organic pathology) nature of IBS in a way that's impossible to forget. BWAF provides a quick red-flag checklist.

Example usage

NLE question: 'Which finding would indicate a diagnosis other than IBS?' — Recall BWAF: Blood in stool, Weight loss, nocturnal Awakening, Fever → these point to organic disease (IBD, cancer), NOT IBS.

Recall trigger

'I'm BS-ing You' = IBS is functional; BWAF = red flags ruling out IBS

Memory aid

Picture a TRAFFIC LIGHT for diverticular diet: GREEN light (WELL/maintenance) = HIGH FIBER (protect the colon, prevent new diverticula from forming). RED light (ACUTE attack/diverticulitis) = STOP high fiber, go LOW fiber/liquids (rest the colon, prevent more pressure and perforation). The traffic light switches based on the patient's current status. A simple phrase: 'HIGH fiber PREVENTS diverticulosis, LOW fiber TREATS acute diverticulitis.' Never mix them up — the acute attack flips the light to RED.

Why it works

The traffic light (red/green) creates a binary visual anchor that maps to the two opposite dietary recommendations. The conditional rule (acute vs. well) is embedded in the color choice.

Example usage

NLE question: 'What diet should be taught to a client recovering from acute diverticulitis discharge planning?' — The traffic light turns GREEN (recovery/maintenance) → HIGH-fiber diet with adequate fluids.

Recall trigger

Traffic light: GREEN = high fiber (prevention); RED = low fiber (acute attack)

Memory aid

Dr. Diverto has pain on his LEFT side (sigmoid colon = LLQ). His nurse wanted to do a colonoscopy but Dr. Diverto shouted 'NO! That camera could POKE a hole in my inflamed pouch!' So they did a CT SCAN instead — safe and accurate. After he recovered, the nurse finally did the colonoscopy. Remember: 'Diverto hurts LEFT, fears the SCOPE, loves the CT.' And antibiotics (metronidazole + ciprofloxacin) are his friends during the acute phase.

Why it works

The character Dr. Diverto personalizes the condition and his fear of the colonoscope gives a logical reason for the contraindication, making it memorable rather than an arbitrary rule.

Example usage

Question: 'The appropriate diagnostic test for suspected acute diverticulitis is:' → Dr. Diverto loves CT (not colonoscopy). Answer: CT scan of the abdomen.

Recall trigger

'Diverto hurts LEFT, fears the SCOPE, loves the CT'

Memory aid

A small bowel obstruction is like a TRAFFIC JAM right after the EXIT RAMP on a highway. Cars (gastric contents with ACID/HCl) get stuck and back up — then they pour out the wrong way as VOMITING. Since so much ACID is lost in the vomit, the blood becomes too BASIC (alkaline) — METABOLIC ALKALOSIS. Think: 'Small bowel blocks early, vomits acid, goes ALKALINE.' Contrast with large bowel obstruction: the jam is far down the highway — less vomiting, more DISTENSION and acidosis (because bicarbonate builds up in the colon).

Why it works

The highway traffic jam maps to the anatomical location of obstruction and shows why vomiting (and acid loss) is an early, prominent feature. The alkalosis-from-acid-loss connection is embedded in the analogy.

Example usage

NLE question: 'A patient with small bowel obstruction is most likely to develop which acid-base imbalance?' → Recall traffic jam + acid vomit going out → metabolic alkalosis.

Recall trigger

Traffic jam near the exit ramp → small bowel → early vomiting → alkalosis

Memory aid

Rhyme it: 'Large bowel blocked — the belly BLOWS, no stool/gas GOES, acidosis GROWS.' Large bowel obstruction causes: massive ABDOMINAL DISTENSION (belly blows up), OBSTIPATION (no stool or gas passes — nothing goes), and METABOLIC ACIDOSIS (bicarbonate is lost from the colon, acid accumulates). Vomiting comes LATE if at all. The belly becomes a distended drum — you can tap it and hear a hollow sound (tympany).

Why it works

The rhyme creates phonological encoding for three separate clinical features. The drum analogy adds an auditory-tactile layer to the distension concept.

Example usage

Question contrasting small vs large bowel obstruction: Recall the rhyme — large bowel = distension + obstipation + metabolic acidosis (vs small bowel = early vomiting + alkalosis).

Recall trigger

'Belly BLOWS, nothing GOES, acidosis GROWS' → large bowel obstruction

Memory aid

Use the TRAFFIC LIGHT for stoma color: PINK = PERFECT (healthy, well-perfused). DARK RED or DUSKY = DANGER (call the surgeon). BLACK = DEAD TISSUE (ischemia — emergency). Think of raw meat: fresh meat is PINK and moist; bad/rotten meat turns DARK and BLACK. A stoma should always look like FRESH MEAT (pink and moist). Never confuse a dark, dusky stoma for normal bruising — this is a surgical emergency. The phrase: 'Pink is PRIME, Black is a CRIME (against the stoma).'

Why it works

The fresh meat analogy is viscerally memorable (pun intended) and culturally familiar to Filipino students who shop in wet markets (palengke). The traffic light and rhyme add two additional encoding layers.

Example usage

NLE question: 'A client's stoma appears dark purple and dusky 12 hours post-op. The nurse should:' → Recall the traffic light: dark = danger → notify the surgeon immediately (possible ischemia).

Recall trigger

'Pink is PRIME, Black is a CRIME' → assess stoma color every shift

Memory aid

An ileostomy is like a BROKEN FAUCET at the very top of the plumbing system — the water (liquid stool) flows CONTINUOUSLY, never has time to thicken, and contains ENZYMES (like dish soap that eats through your skin). Because it never stops dripping, the patient constantly LOSES FLUIDS and ELECTROLYTES. The skin around it gets 'melted' by the enzymes if not protected. Key teaching: empty the pouch when 1/3–1/2 full (not full — it will leak), protect the skin, drink extra fluids and salt. Memory: 'Ileo = Incessant Liquid Enzyme Output — ILEO!'

Why it works

The broken faucet makes the continuous, liquid, enzyme-rich output tangible. The skin-melting image creates urgency around peristomal skin protection. The acronym ILEO reinforces the drug name itself.

Example usage

Question: 'Which complication is the priority concern in a patient with a new ileostomy?' → Broken faucet → continuous enzyme-rich liquid loss → priority: fluid/electrolyte imbalance AND skin integrity.

Recall trigger

Broken faucet = ileostomy = continuous liquid + enzymes + skin breakdown risk

Memory aid

Imagine a hot air balloon (the colon in UC) that gets INFLATED (massively distended), HEATED (fever), and the engine RACES (tachycardia). When a hot air balloon overinflates in the heat with a racing engine — it EXPLODES (perforation and sepsis). This is TOXIC MEGACOLON — a life-threatening complication of UC. Signs = DFT: Distension, Fever, Tachycardia. The nurse must act like a balloon handler: DON'T give laxatives or antidiarrheals (they worsen distension), call the surgeon STAT.

Why it works

The hot air balloon metaphor makes the three cardinal signs (distension, fever, tachycardia) visually memorable and the explosion = perforation/sepsis captures the urgency. DFT is an easy acronym to recall.

Example usage

NLE question: 'A client with UC develops sudden abdominal distension, fever of 39.5°C, and HR of 118. The nurse should recognize this as:' → Hot air balloon = Toxic Megacolon → surgical emergency.

Recall trigger

Hot air balloon overinflating and racing → DFT = Distension, Fever, Tachycardia = TOXIC MEGACOLON

Memory aid

Peritonitis makes the abdomen feel like a WOODEN PLANK (rigid, board-like) — no movement, no sound (absent bowel sounds), and touching it then RELEASING causes sharp pain (rebound tenderness). Picture a SILENT WOODEN BOARD that PUNCHES you when you let go. Nursing position: SEMI-FOWLER'S — to let fluid drain into the pelvis (away from the diaphragm) and ease breathing. NPO + NGT + IV antibiotics + urgent surgery. The SILENCE (no bowel sounds) is the alarm that paralytic ileus has developed.

Why it works

The wooden plank gives a tactile-kinesthetic anchor for the classic board-like rigidity. The punching sensation encodes rebound tenderness. Silence as an alarm is an auditory-paradoxical memory anchor.

Example usage

Clinical scenario: Patient post-appendectomy develops absent bowel sounds, rigid abdomen, fever, and rebound tenderness → Recall the wooden board → peritonitis → NPO, NGT, antibiotics, semi-Fowler's position, notify MD.

Recall trigger

Silent wooden board that punches when you let go → peritonitis

Memory aid

An NGT on LOW INTERMITTENT SUCTION is like a sump pump in a flooded basement: it doesn't suck all the time (intermittent), it doesn't suck too hard (low), but it steadily removes the backed-up fluid. If you suck too hard or continuously, you'll damage the delicate gastric mucosa (like suctioning too hard on a drinking straw pressed against your cheek — ouch). Always: NPO + NGT on LOW INTERMITTENT + strict I&O + IV fluids. The pump phrase: 'Slow and easy clears the belly.'

Why it works

The sump pump analogy makes a clinical-technical procedure concrete and memorable. The straw-against-cheek sensation creates a self-referential physical memory for why the suction must be low and intermittent.

Example usage

NLE question: 'What is the correct suction setting for a nasogastric tube inserted for intestinal obstruction decompression?' → Sump pump → LOW INTERMITTENT suction.

Recall trigger

Sump pump = NGT on low intermittent suction = slow and easy clears the belly

Memory aid

Imagine Prednisone is a POWERFUL BOSS who takes over the adrenal gland's job during a flare. When the boss is around, the adrenal gland relaxes and stops producing cortisol (adrenal suppression). If the boss SUDDENLY QUITS (abrupt discontinuation), the adrenal gland is unprepared and can't produce cortisol on its own — leading to ADRENAL CRISIS (hypotension, weakness, shock). The boss must TAPER out slowly, giving the adrenal gland time to wake up and take over again. Rule: 'Never fire the steroid boss without a 2-week notice (taper).'

Why it works

The boss-worker analogy explains the physiological mechanism of HPA axis suppression and rebound in a memorable narrative format. The '2-week notice' metaphor maps to the clinical tapering principle.

Example usage

NLE question: 'A client on prednisone for UC feels well and wants to stop taking it. The nurse should advise:' → Boss needs notice → NEVER stop abruptly, must taper under physician guidance.

Recall trigger

'Never fire the steroid boss without a taper notice' → never stop corticosteroids abruptly

Memory aid

Post-hemorrhoidectomy care rhyme: 'Sit in warm water (sitz bath), soften your stool, the first trip to the toilet may hurt — that's the rule.' Three key teachings: SITZ BATHS (warm water promotes healing and comfort), STOOL SOFTENERS (prevent straining), and WARN the patient the FIRST BOWEL MOVEMENT WILL BE PAINFUL (so they don't panic or refuse to defecate, which worsens constipation). A client who is not warned may hold back stool — causing more straining and reopening the wound.

Why it works

Rhyme encodes three separate post-op teachings in a single memorable phrase. The warning about painful first BM is often tested because it requires anticipatory guidance — and the rhyme flags it explicitly.

Example usage

Question: 'Which teaching is most important for a client one day after hemorrhoidectomy?' → Recite the rhyme → warn about the painful first BM, use stool softeners, sitz baths.

Recall trigger

'Sit, soften, and expect the hurt' → hemorrhoidectomy post-op teaching

Answer

Crohn's Disease

Memory link

A1 — CROHN'S SKIPS: skip lesions, mouth-to-anus, transmural, NOT curative by surgery

Answer

Heat, Laxatives, Enemas (HLE — the tools of Nurse HLE)

Memory link

A4 — Never be Nurse HLE: Heat, Laxatives, Enemas are NEVER given in appendicitis

Answer

Irritable Bowel Syndrome (IBS)

Memory link

A9 — 'I'm BS-ing You' — IBS is functional, pain relieved by defecation, NO blood/weight loss/fever (BWAF are red flags against IBS)

Answer

No — dark/dusky stoma = ischemia (blood supply compromised) → notify surgeon IMMEDIATELY. It is a surgical emergency.

Memory link

A14 — 'Pink is PRIME, Black is a CRIME' — dark/dusky/black stoma = emergency

Answer

Sulfasalazine. Four Fs: Food (take with food), Fluids (drink plenty), Folic acid (supplement), False color urine (orange is normal)

Memory link

A7 — The 4 Fs of Sulfasalazine; orange traffic light reminder

Answer

Toxic Megacolon. DFT = Distension, Fever, Tachycardia. It is a life-threatening surgical emergency.

Memory link

A16 — Hot air balloon overinflating: DFT = Distension, Fever, Tachycardia = Toxic Megacolon

Answer

NO — sudden pain relief = possible perforation/rupture. Notify the physician STAT. Monitor for peritonitis (pain and rigidity will return).

Memory link

A6 — Water balloon popping: 'When patient says AHHH, nurse says OH NO' — sudden relief = rupture

Answer

Small bowel obstruction → early vomiting → loss of stomach acid (HCl) → Metabolic ALKALOSIS

Memory link

A12 — Traffic jam near exit ramp: small bowel → early vomiting → acid loss → metabolic alkalosis

Mnemonic

'MC BURNEY burned himself MIDWAY between his BELLY BUTTON and his RIGHT HIP BONE.' His name has BURN in it — pain of appendicitis BURNS at exactly that midpoint.

When to use

When assessing a patient for appendicitis: palpate at McBurney's point for maximum tenderness. Also used to answer NLE questions about appendicitis physical examination findings.

What each part means

Umbilicus = belly button (center reference point); RASIS = bony prominence felt on the right side of the anterior hip; Midpoint = exactly halfway between the two — this is where maximum tenderness in appendicitis is expected.

Mnemonic

DFT = 'Don't Forget the Toxicity!' or 'Dangerous Flare Triad' — Distension, Fever, Tachycardia. This triad in a UC patient = surgical emergency.

When to use

Any NLE question or clinical scenario involving a UC patient who develops sudden worsening of symptoms — check for DFT to identify toxic megacolon.

What each part means

D = Distension (massive colonic dilation > 6 cm); F = Fever (systemic infection/inflammation); T = Tachycardia (early sepsis sign); Together these signal impending perforation and septic shock.

Mnemonic

'One-third to half is the SAFE HALF' — empty the pouch before it gets heavy enough to pull away from the skin and leak. Think of a jeepney that must be emptied before it becomes overloaded and breaks down.

When to use

Teaching ostomy self-care to patients; answering NLE questions about ostomy pouch management.

What each part means

1/3 to 1/2 full = optimal emptying point. Too empty = frequent disruption. Too full = weight causes seal to break, pouch leaks, skin breakdown, embarrassment for patient.

Mnemonic

CROHN = C for Choppy/CUTS (skip lesions like cuts with healthy tissue between them); UC = U for Uniform/Unbroken (no breaks, starts at rectum, goes continuously upward). Think: C = Choppy, U = Uniform.

When to use

Any NLE question asking about the pattern of intestinal inflammation in IBD — Choppy (C = Crohn's) vs Uniform/Unbroken (U = UC).

What each part means

Skip lesions = inflamed patches with normal mucosa between them (Crohn's); Continuous = no normal tissue between lesions, unbroken inflammation from rectum upward (UC). This single distinction correctly classifies the majority of IBD NLE questions.

Recall test

Without looking: What 3 things must NEVER be done in appendicitis? What position is used for comfort? What does sudden pain relief mean?

Memory chain

Follow 'APPER' — Assess the APPLE (periumbilical to RLQ pain migration), Press for REBOUND (Blumberg's), Pop alert (sudden relief = rupture), Execute NEVER HLE (Heat-Laxative-Enema), Rest in semi-Fowler's, Surgery STAT. The acronym APPER helps: A=Assess migration, P=Press rebound, P=Pop = rupture alert, E=Eliminate HLE, R=Rest in semi-Fowler's, STAT for surgery.

Items to remember

• Assess: periumbilical pain migrating to RLQ at McBurney's point
• Assess: rebound tenderness (Blumberg's sign), guarding, low-grade fever
• DANGER: sudden pain relief = possible rupture
• NEVER: apply heat to abdomen
• NEVER: give laxatives or enemas
• Position: semi-Fowler's or right-side flexed for comfort
• Action: NPO and prepare for appendectomy

Recall test

Without looking: Which IBD is curable by surgery? Which causes fistulas? Which causes bloody diarrhea? Which has skip lesions? Which is transmural?

Memory chain

Use 'CROHN GOES DEEP AND SKIPS; UC BLEEDS AND STICKS': C=Can go anywhere, deep (transmural), skips, fistulas, NOT cured by surgery. U=Uniform/continuous, colon only, bloody diarrhea, toxic megacolon, IS cured by colectomy. Visualize a boy named Crohn skipping deep holes across a full field vs a paint roller smoothly coating just the lower colon in blood red.

Items to remember

• Location: Crohn's = anywhere mouth to anus; UC = colon/rectum only
• Pattern: Crohn's = skip lesions; UC = continuous
• Depth: Crohn's = transmural; UC = mucosal/submucosal only
• Stool: Crohn's = soft/semi-liquid, less blood; UC = bloody, mucoid 10-20x/day
• Complications: Crohn's = fistulas, strictures; UC = toxic megacolon, higher cancer risk
• Surgery: Crohn's = NOT curative; UC = colectomy IS curative

Recall test

Without looking: What suction setting is used for the NGT? What signs indicate strangulation? What electrolyte imbalance occurs in small bowel obstruction vs large bowel obstruction?

Memory chain

Story: 'I NiGhTly IV-ly Strictly Monitor Surgery' — NPO, NGT low-intermittent suction, IV fluids, Strict I&O, Monitor strangulation signs, Surgery consult. Think of setting up a hospital room at NIGHT: NPO sign on door, NGT tube hanging, IV drip running, I&O chart on wall, monitor beeping for danger signs, surgeon's number taped to wall.

Items to remember

• 1. NPO immediately
• 2. Insert nasogastric tube (NGT) for decompression
• 3. Set NGT to low intermittent suction
• 4. IV fluids and electrolyte replacement
• 5. Strict intake and output (I&O) monitoring
• 6. Monitor for strangulation: fever + tachycardia + rigid abdomen
• 7. Surgical consult if no resolution or signs of strangulation

Recall test

Without looking: Name all 4 teaching points for sulfasalazine. What is the orange urine due to? What vitamin must be supplemented? Why is fluid intake important?

Memory chain

'The 4 Fs of Sulfasalazine turn your pee ORANGE' — Food + Fluids + Folic acid + False color urine. Picture a glass of orange juice on a dining table (food), beside a large pitcher of water (fluids), with a bottle of folic acid vitamins and an orange color chart to show the normal urine color. The orange juice = the orange urine = the 4 Fs.

Items to remember

• Food: take with food to reduce GI upset
• Fluids: drink plenty of water to prevent crystalluria
• Folic acid: supplement because drug impairs folate absorption
• False color: orange-yellow urine is NORMAL, not blood

Recall test

Without looking: What stoma color is an emergency? When do you empty the pouch? Why does an ileostomy patient need more fluids and salt? What is different about ileostomy vs colostomy output?

Memory chain

The STOMA CARE chain: Spot the color (pink=good, dark=emergency), Time to empty at 1/3-1/2, Over-protect skin around ileostomy, Measure opening to fit stoma, Add extra fluids and salt (ileostomy), Cut out gas-forming foods, Encourage body image. Acronym STOMACEL: Spot, Time, Over-protect, Measure, Add fluids, Cut gas foods, Encourage body image.

Items to remember

• Assess stoma: pink/moist = normal; dark/dusky/black = ischemia (emergency)
• Empty pouch when 1/3 to 1/2 full
• Protect peristomal skin (especially ileostomy — enzyme-rich liquid output)
• Ensure appliance opening is only slightly larger than stoma
• Ileostomy: extra fluids and salt (continuous liquid loss)
• Avoid gas-forming and odor-causing foods as tolerated
• Support body image and psychosocial adaptation