Crohns DiseaseElizabeth Alvarez, Andrea Reyna, Kent Schmidt,
Melinda Torres, Dale V. Trinidad, & Ken Westra
A Description of Crohns DiseaseCrohns disease is a
classification of inflammatory bowel disease (IBD). Times of
remission are mixed among times of exacerbation. Research has yet
to identify a definitive cause for Crohns disease, and a multitude
of factors may contribute to this autoimmune reaction. No cure
exist at this time.
Clinical Manifestationsdiarrheabloody stoolsweight lossabdominal
feverfatiguerectal bleeding (in some cases)
Potential Complicationsperineal abscessfistulasfat
malabsorptionanemiacancer of the small intestineperipheral
arthritisankylosing spondylitissacroiliitisfinger clubbingerythema
stonesprimary sclerosing cholangitisosteoporosisthromboembolism
Diagnosticshistory & physical examinationCBC, ESRserum
chemistriesoccult blood stoolstool infectioncapsule endoscopy
double-contrast barium enemasmall bowel seriestransabdominal
ultrasoundCTMRIsigmoidoscopy/colonoscopy with biopsyBarium enema is
not employed in acute exacerbations.
Collaborative Therapyhigh-calorie, high-vitamin, high-protein,
diet or parenteral nutritionphysical & emotional restcounseling
or support groupsurgery**The goals of care are to rest the bowel,
control the inflammation, fight infection, reestablish proper
nutrition, relieve stress, address symptoms, and improve the
quality of living for the client.*The use of sulfasalazine to
cytokine inflammatory processes may discolor the skin and urine
yellowish orange. This medication may also alter photosensitivity.
Use caution in sun exposure and UV radiation. **Surgery is
typically relegated to removing strictures, obstructions, arresting
bleeding, and managing fistulas.
DiagnosesDiarrhea related to bowel inflammation and intestinal
hyperactivityImbalanced nutrition: less than body requirements
related to decreased absorption and increased nutrient loss through
diarrheaIneffective coping related to chronic disease, lifestyle
changes, inadequate confidence in ability to cope
Acute phase implementationhemodynamic stabilitypain controlfluid
& electrolyte balancenutritional support
Implementation continuing into recovery &
dischargeI&Onumber & appearance of stoolencourage client to
talk about self-care strategiesteach strategies for managing
stressencourage the client to quit smokingassist the client in
accepting the chronicity of Crohns disease
Education regarding goalsimportance of rest and diet
managementperianal caredrug action & side effectssymptoms of
recurrencewhen to seek medical careuse of diversional activities to
Expected outcomesThe client will:experience a decrease in the
number of diarrhea episodesmaintain body weight within a normal
rangebe free from pain & discomfortdemonstrate the use of
effective coping strategies
For further information contact the Crohns and Colitis
Foundation of America, www.ccfa.org.
ReferenceSchmelzer, M. (2014). Lower gastrointestinal problems.
In S. L. Lewis, S. R. Dirksen, M. M. Heitkemper, L. Bucher, and M.
M. Harding (Eds.), Medical-Surgical Nursing, (pp. 961-1005). St.
Louis, MO: Elsevier.