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

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.

Clinical ManifestationsDIARRHEABLOODY STOOLSWEIGHT LOSSABDOMINAL PAIN

FEVERFATIGUERECTAL BLEEDING (IN SOME CASES)

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

PYODERMA GANGRENOSUMAPHTHOUS ULCERSCONJUNCTIVITISUVEITISEPISCLERITISGALLSTONESKIDNEY STONESPRIMARY SCLEROSING CHOLANGITISOSTEOPOROSISTHROMBOEMBOLISM

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.

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.

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

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

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

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

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

For further information contact the Crohn’s 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.