Crohn’s Disease Pathophysiology, Podcast, & Nursing Care Plan

intestines

Crohn’s Disease

Crohn’s Disease is classified as an inflammatory bowel disease (IBD). The inflammation caused by Crohn’s disease can cause the patient to have abdominal pain, malnutrition, weight loss, severe diarrhea and even fatigue. Crohn’s can lead to scarring, abscesses, fistulas, and ulcerations in the intestine. It is also characterized by remissions and exacerbation’s.

Sign and symptoms of Crohn’s disease:

  • abdominal pain
  • blood and mucus in stools
  • fatigue
  • Chronic diarrhea which can become bloody
  • Fever
  • Feeling of a mass or fullness in the abdomen
  • Rectal bleeding
  • Weight loss

 

Causes of Crohn’s disease:

Smoking: Smoking is thought to be a  primary risk factor in the development  of Crohn’s disease. Smokers, who are suffering from Crohn’s disease are at more risk of having severe symptoms than non-smokers.

The immune system: Various bacteria or viruses can trigger Crohn’s.  When the patients immune system attempts to fight the bacteria or virus that is triggering Crohn’s disease, the good bacteria of digestive tract get attacked too.

Environmental factors: Crohn’s disease is a common western countries such as the UK, and uncommon in isolated parts of the world such as Africa.

Genetics: Crohn’s is common in patients with a family member with the same disease.

Age: Crohn’s disease can occur at any age, but the chances are higher when you’re young. Many patients who have Crohn’s disease are diagnosed before age 30.

Use of NSAIDS such as Ibuprofen, naproxen sodium can lead to inflammation that makes the disease process of Crohn’s worse.

Diet: a high fat diet or a diet high in refined foods can have larger risk of developing Crohn’s disease.

 

 

Complications of Crohn’s disease:

Ulcers: The chronic inflammation can lead to ulcers. Ulcers can develop anywhere in your digestive tract, including your mouth down to the rectum, and even in the genital area.

Bowel obstruction: Crohn’s disease can affect the thickness of the intestinal wall. After parts of the bowel become thicker and narrow, it may impede the flow of digestive contents. The patient may require surgery to remove the affected portion of bowel.

Inflammation: Inflammation may develop in the bowel wall, leading to stenosis of the bowel.

Colon cancer: If the patient has had Crohn’s disease, then it can increase the risk of developing into colon cancer.

Fistula formation: If the patient develops an ulcer, it can extend through the intestinal wall, this can create a fistula. This causes an abnormal connection between two different body parts.

Diagnostic tests

Diagnosis is made by exclusion, meaning that the healthcare provider needs to rule out other possible causes of signs and symptoms:

  • Laboratory tests to check for infection, anemias, etc.
  • Occult blood – stool to check for the presence of blood in stool, this can be done at the bedside on most floors.
  • Stool cultures
  • Colonoscopy/ sigmoidoscopy
  • CT Scans
  • Endoscopy
  • MRI

 

 

Treatments for Crohn’s disease:

  • Anti-inflammatory drugs – reduce inflammation
  • Immune system suppressors – also reduce inflammation but to targeted areas
  • Antibiotics
  • Bowel rest
  • NG tube placement to provide bowel rest
  • Low residue/Low fiber diet if not on bowel rest. Low residue is designed to lower the size and number of stools.
  • Surgery: to remove damaged part of GI tract

Nursing Care Plan

Nursing Diagnosis

1. Acute pain related to inflammatory process of the Crohn’s Disease as evidenced by patient rates pain at 8/10 on pain scale and states abdominal cramping and tenderness in abdomen.

Desired outcomes:

Patient will report a decrease in pain from 8 to 0 on the pain scale by discharge.

InterventionsRationals
InterventionsRationals
Assess level of pain using appropriate pain scale. Assess pain 30 minutes before and after pain medication is given.Using an appropriate age pain rating scale will help the healthcare providers monitor the level of pain and adjust pain medications as needed.
Administer pain medications as prescribed and indicated.Analgesics are helpful in relieving pain and helping in the recovery process.
Have patient maintain limited bedrest and activityThis will help to minimize pancreatic secretions and pain.
Incorporate nonpharmacologic measures to assist with control of pain.Ideally, the use of comfort measures will distract the patient from pain and may increase the effectiveness of pharmacological measures.

2. Risk for Infection related to development of inflammatory process or worsening Crohn’s Disease.

Desired outcomes:

By discharge, the patient will remain free signs and symptoms of infection.

InterventionsRationals
InterventionsRationals
Assess vital signs including temperature every 4 hours and as needed. Report any abnormal findings to the healthcare provider.Fever is often one of the first signs of infection.
Assess mental status and level of consciousnesses every 4-6 hours.Mental status changes, confusion, or any deterioration from baseline can signify infection.
Report and note any abnormal laboratory values (i.e. elevated WBC count) to the healthcare provider.Certain abnormal laboratory results could be an indicator of infection.

Other possible nursing diagnosis:

Risk for imbalanced fluid volume

Impaired gas exchange

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

 

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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

One comment

  • MAKOKO DICKSON

    The given information was very clear and helped me to get what I was searching.
    thanks.

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