Crohn’s Disease NCLEX Review Care Plans
Nursing Study Guide on Crohn’s Disease
Crohn’s disease is an inflammatory bowel disease, is characterized by the inflammation of the digestive tract causing gastrointestinal problems and discomfort.
The inflammation may involve even the deeper layers of the gastrointestinal tract.
This condition can be overwhelming and debilitating to the affected individuals.
Crohn’s disease affects almost everyone but it is commonly seen in individuals between the age of 20 and 30.
Crohn’s disease may also lead to serious complications, if not promptly treated. Although, there is no definitive treatment for Crohn’s disease, its management focuses on reducing symptoms and long-term remission.
It may involve the use of therapies that aim to alleviate symptoms and improve the quality of life of the patients.
Signs and Symptoms of Crohn’s Disease
The signs and symptoms of Crohn’s disease may vary from mild to severe.
They may depend on the affected area of the digestive tract, most commonly the colon.
The onset of symptoms can be progressive or abrupt and without any warning.
There are also periods of remission where the patient does not experience any signs and symptoms.
However, if the condition is active, it can develop symptoms such as:
- Abdominal pain
- Abdominal cramps
- Blood in stool
- Mouth sores
- Loss of appetite
- Weight loss
- Rectal Bleeding
- Pain or drainage near or around the anus
Severe cases of Crohn’s disease may develop:
- Inflammation of skin, eyes, joints, liver, or bile ducts
- Kidney stones
- Iron deficiency (anemia)
- Delayed growth or sexual development, in children
Causes and Risk Factors of Crohn’s Disease
When there is a bacterial or a viral infection, the immune system normally responds by attacking the foreign body.
However, it may also cause damage to the cells located in the digestive tract.
The presence of bacteria or viruses may trigger the development of Crohn’s disease, but this notion still needs further research.
The inflammation can affect any part of the gastrointestinal tract from the mouth to anus, with ileum, the end of the small bowel, being the most common affected area.
It can also spread deeper into the lining of the GI tract, affecting the entire bowel wall and all its layers.
Crohn’s disease can be incohesive in nature, which means that the inflammation may leave some of the areas normal.
Although the cause of Crohn’s disease is unknown, there are risk factors that may aggravate the disease, such as diet and stress.
Some of the causative factors considered are genetics and dysfunction of the immune system.
Hereditary factors may increase a person’s susceptibility to the disease, so Crohn’s disease is likely to occur among individuals that have a family history of this condition.
The risk factors of Crohn’s disease may include:
- Age. It is likely to develop before the age of 30. Crohn’s disease may affect any age, but it is most likely to develop during this time.
- Family history. Research shows that 1 in 5 people diagnosed with Crohn’s disease has a family member with the same condition. This means that family history increases the likelihood of developing the disease.
- Ethnicity. It may affect any ethnicity but, it is mostly seen on people of Eastern European Jewish descent. There is also an increasing incidence of Crohn’s disease among Black people living in United Kingdom and North America.
- NSAIDs. Non-steroidal anti-inflammatory medications can increase bowel inflammation which can worsen Crohn’s disease.
- Cigarette smoking. According to several studies, smokers are more prone to developing the disease than non-smokers. Smoking also increases the severity of Crohn’s disease.
Complications of Crohn’s Disease
- Bowel Obstruction. When the entire depth of the intestinal wall is affected, it can cause narrowing on some parts of the bowel, leading to obstruction in the flow of gastric contents.
- Fistulas. Crohn’s disease may cause open sores or ulcers in the GI tract in the long run. If the ulcers extend all the way through the intestinal wall, it can create an abnormal connection or tunnel, also called as fistula. This can develop between the skin and the intestine or between the intestine and another organ.
- Anal fissure. A small tear in the tissue lining of the anus or its surrounding skin may develop.
- Malnutrition. Chronic diarrhea and abdominal pain may cause deficiency in nutrition.
- Other health conditions including colon cancer, clotting disorders, anemia, osteoporosis, arthritis and certain diseases of the skin, gallbladder, and liver
Diagnosis of Crohn’s Disease
- Blood test to check for anemia and infection
- Stool studies to check for blood, parasites and other organisms
- Colonoscopy – used for visualization of the gastrointestinal tract and its affected areas
- Computerized tomography (CT) Scan
- Magnetic resonance imaging (MRI)
- Capsule endoscopy
- Balloon-assisted enteroscopy
Treatment of Crohn’s Disease
- Medications often used to manage the symptoms of Crohn’s disease include:
- Anti-inflammatory drugs, including corticosteroids and oral 5-aminosalicylates – initially used to reduce the inflammation
- Immunosuppressant and biologic drugs – decrease inflammation by targeting the immune system
- Antibiotics – used to fight off harmful bacteria found in the intestines and to decrease pus formation and drainage from fistula and abscess
- Anti-diarrhea medications
- Vitamins and supplements
A special diet may be prescribed to treat malnutrition and reduce inflammation by allowing the bowel to rest.
It can be given through the mouth or via feeding tube which helps promote nutritional buildup.
This form of therapy is also used as nutritional support prior to having surgery.
A low fiber and low residue diet may also be recommended to reduce blockage of the intestines and the quantity of stools.
This is usually recommended when the medication, nutrition therapy, and lifestyle modification fail to alleviate or improve symptoms.
Surgery does not cure the disease, but it helps to save the unaffected portions of the intestines.
Surgery often involves the removal of the diseased portion of the intestines and establishing a connection between the healthy ones.
It may also include the closure of fistula and drainage of abscess.
The surgical benefits may be temporary, but this intervention helps improve the quality of life especially if it is followed by an appropriate medication regimen.
Nursing Care Plans for Crohn’s Disease
Nursing Care Plan 1
Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to altered absorption of nutrients secondary to Crohn’s disease, as evidenced by diarrhea, abdominal pain and cramping, weight loss, nausea and vomiting, and loss of appetite
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
|Explore the patient’s daily nutritional intake and food habits (e.g. meal times, duration of each meal session, snacking, etc.)||To create a baseline of the patient’s nutritional status and preferences.|
|Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term nutrition and weight goals related to Crohn’s disease.||To effectively monitory the patient’s daily nutritional intake and progress in weight goals.|
|Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and high fiber, high fat foods.||To relieve abdominal pain and cramping, alleviate diarrhea, and healthy food habits. Caffeine is a stimulant of gastric acid production, which can worsen the condition.|
|Refer the patient to the dietitian.||To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed Crohn’s disease.|
|Start the patient on a nothing by mouth status, and gradually progress to clear liquids, followed by bland diet, and the low residue diet. The patient can then have a low fat, low fiber diet on a long-term basis.||Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. Gradual progression from NBM up to a low fat and low fiber diet can help manage the symptoms of Crohn’s disease.|
Nursing Care Plan 2
Nursing Diagnosis: Acute Pain related to abdominal muscle spasms secondary to Crohn’s disease as evidenced by pain score of 10 out of 10, verbalization of abdominal pain and cramping, guarding sign on the abdomen
Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.
|Administer prescribed medications that alleviate the symptoms of stomach pain.||Anti-inflammatory drugs, including corticosteroids and oral 5-aminosalicylates – initially used to reduce the inflammation. Immunosuppressant and biologic drugs – decrease inflammation by targeting the immune system.|
Antibiotics – used to fight off harmful bacteria found in the intestines and to decrease pus formation and drainage from fistula and abscess.
Vitamins and supplements
|Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.||To monitor effectiveness of medical treatment for the relief of heartburn and stomach pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.|
|Teach the patient on how to perform non-pharmacological pain relief methods such as deep breathing, massage, acupressure, biofeedback, distraction, music therapy, and guided imagery.||To reduce stress levels, thereby relieving the symptoms of Crohn’s disease, especially stomach pain and heartburn.|
|Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and high fiber, high fat foods.||To relieve abdominal pain and cramping, alleviate diarrhea, and healthy food habits.|
Other Nursing Diagnoses:
- Ineffective Coping
- Deficient Knowledge
- Risk for Deficient Fluid Volume
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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