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Crohn’s Disease ELIZABETH ALVAREZ, ANDREA REYNA, KENT SCHMIDT, MELINDA TORRES, DALE V. TRINIDAD, & KEN WESTRA

Crohn’s disease dvt

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Page 1: Crohn’s disease dvt

Crohn’s DiseaseELIZABETH ALVAREZ, ANDREA REYNA, KENT SCHMIDT, MELINDA TORRES, DALE V. TRINIDAD, & KEN WESTRA

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A Description of Crohn’s DiseaseCROHN’S 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 CROHN’S DISEASE, AND A MULTITUDE OF FACTORS MAY CONTRIBUTE TO THIS AUTOIMMUNE REACTION. NO CURE EXIST AT THIS TIME.

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Clinical ManifestationsDIARRHEABLOODY STOOLSWEIGHT LOSSABDOMINAL PAIN

FEVERFATIGUERECTAL BLEEDING (IN SOME CASES)

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Potential ComplicationsPERINEAL ABSCESSFISTULASFAT MALABSORPTIONANEMIACANCER OF THE SMALL INTESTINEPERIPHERAL ARTHRITISANKYLOSING SPONDYLITISSACROILIITISFINGER CLUBBINGERYTHEMA NODOSUM

PYODERMA GANGRENOSUMAPHTHOUS ULCERSCONJUNCTIVITISUVEITISEPISCLERITISGALLSTONESKIDNEY STONESPRIMARY SCLEROSING CHOLANGITISOSTEOPOROSISTHROMBOEMBOLISM

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DiagnosticsHISTORY & PHYSICAL EXAMINATIONCBC, ESRSERUM CHEMISTRIESOCCULT BLOOD STOOLSTOOL INFECTIONCAPSULE ENDOSCOPY

DOUBLE-CONTRAST BARIUM ENEMASMALL BOWEL SERIESTRANSABDOMINAL ULTRASOUNDCTMRISIGMOIDOSCOPY/COLONOSCOPY WITH BIOPSY

Barium enema is not employed in acute exacerbations.

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Collaborative TherapyHIGH-CALORIE, HIGH-VITAMIN, HIGH-PROTEIN, LOW-RESIDUE, LACTOSE-FREE DIETAMINOSALICYLATES*ANTIMICROBIALSCORTICOSTEROIDSIMMUNOSUPPRESSANTSIMMUNOMODULATORSELEMENTAL 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.

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Diagnoses• DIARRHEA RELATED TO BOWEL INFLAMMATION AND

INTESTINAL HYPERACTIVITY• IMBALANCED NUTRITION: LESS THAN BODY

REQUIREMENTS RELATED TO DECREASED ABSORPTION AND INCREASED NUTRIENT LOSS THROUGH DIARRHEA

• INEFFECTIVE COPING RELATED TO CHRONIC DISEASE, LIFESTYLE CHANGES, INADEQUATE CONFIDENCE IN ABILITY TO COPE

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Acute phase implementation HEMODYNAMIC STABILITY PAIN CONTROL FLUID & ELECTROLYTE BALANCE NUTRITIONAL SUPPORT

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Implementation continuing into recovery & discharge I&O NUMBER & APPEARANCE OF STOOL ENCOURAGE CLIENT TO TALK ABOUT SELF-CARE STRATEGIES TEACH STRATEGIES FOR MANAGING STRESS ENCOURAGE THE CLIENT TO QUIT SMOKING ASSIST THE CLIENT IN ACCEPTING THE CHRONICITY OF

CROHN’S DISEASE

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Education regarding goals1. IMPORTANCE OF REST AND DIET MANAGEMENT2. PERIANAL CARE3. DRUG ACTION & SIDE EFFECTS4. SYMPTOMS OF RECURRENCE5. WHEN TO SEEK MEDICAL CARE6. USE OF DIVERSIONAL ACTIVITIES TO REDUCE STRESS

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Expected outcomesThe client will: EXPERIENCE A DECREASE IN THE NUMBER OF DIARRHEA

EPISODES MAINTAIN BODY WEIGHT WITHIN A NORMAL RANGE BE FREE FROM PAIN & DISCOMFORT DEMONSTRATE THE USE OF EFFECTIVE COPING

STRATEGIES

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For further information contact the Crohn’s and Colitis Foundation of America, www.ccfa.org.

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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.