Crohn’s Disease is a chronic inflammatory bowel disease that requires comprehensive nursing care and management. This guide provides detailed nursing diagnoses, interventions, and care plans to help nurses deliver optimal care for patients with Crohn’s disease.
Understanding Crohn’s Disease
Crohn’s disease is a chronic inflammatory condition that can affect any part of the gastrointestinal tract, from the mouth to the anus. The disease typically involves severe inflammation of the intestinal wall, leading to various complications, including malnutrition, bowel obstruction, and fistulas.
Key Characteristics:
- Chronic inflammation of the digestive tract
- Periods of active disease (flares) and remission
- It can affect any part of the GI tract
- Associated with various extraintestinal manifestations
- There is no known cure, but it is manageable with proper treatment
Nursing Assessment
Subjective Data Collection
Patient History:
- Duration and severity of symptoms
- The pattern of bowel movements
- Dietary habits and food intolerances
- Family history
- Previous treatments and their effectiveness
- Impact on daily activities
Current Symptoms:
- Abdominal pain characteristics
- Diarrhea frequency and consistency
- Presence of blood in stool
- Weight changes
- Fatigue levels
- Joint pain or skin problems
Objective Data Collection
Physical Assessment:
- Vital signs
- Weight and BMI
- Abdominal examination
- Skin assessment
- Oral mucosa examination
Laboratory Values:
- Complete blood count
- C-reactive protein
- Erythrocyte sedimentation rate
- Comprehensive metabolic panel
- Stool tests
Nursing Care Plans for Crohn’s Disease
1. Risk for Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for impaired skin integrity related to frequent diarrhea, malnutrition, and perianal complications.
Related Factors/Causes:
- Frequent loose stools
- Anal fissures
- Perianal fistulas
- Poor nutritional status
- Medication side effects
Nursing Interventions and Rationales:
Assess skin integrity daily
- Rationale: Early detection of skin breakdown allows prompt intervention
Implement proper perineal care after each bowel movement
- Rationale: Maintains skin integrity and prevents infection
Apply barrier cream as needed
- Rationale: Protects skin from moisture and irritation
Teach proper skin care techniques
- Rationale: Empowers patient for self-care and prevention
Monitor nutritional status
- Rationale: Adequate nutrition supports skin health
Desired Outcomes:
- The patient maintains intact skin integrity
- Patient demonstrates proper skin care techniques
- The patient reports decreased skin irritation
2. Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis Statement:
Imbalanced nutrition: less than body requirements related to malabsorption, decreased intake, and inflammatory process.
Related Factors/Causes:
- Malabsorption
- Decreased appetite
- Nausea and vomiting
- Fear of eating due to pain
- Medication side effects
Nursing Interventions and Rationales:
Monitor weight daily
- Rationale: Tracks nutritional status and effectiveness of interventions
Assess dietary intake
- Rationale: Identifies nutritional deficiencies and preferences
Collaborate with dietitian
- Rationale: Ensures comprehensive nutritional planning
Administer prescribed supplements
- Rationale: Addresses specific nutritional deficiencies
Provide small, frequent meals
- Rationale: Improves nutrient absorption and reduces GI symptoms
Desired Outcomes:
- The patient maintains a stable weight
- The patient demonstrates improved nutritional intake
- The patient shows normal laboratory values
3. Acute Pain
Nursing Diagnosis Statement:
Acute pain related to inflammation of the gastrointestinal tract and disease complications.
Related Factors/Causes:
- Intestinal inflammation
- Bowel obstruction
- Fistulas
- Abscesses
- Joint inflammation
Nursing Interventions and Rationales:
Assess pain characteristics regularly
- Rationale: Guides pain management strategies
Administer prescribed medications
- Rationale: Provides timely pain relief
Position patient comfortably
- Rationale: Minimizes discomfort
Apply heat/cold therapy as appropriate
- Rationale: Provides non-pharmacological pain relief
Teach relaxation techniques
- Rationale: Helps manage stress-related pain
Desired Outcomes:
- The patient reports decreased pain levels
- Patient demonstrates effective pain management techniques
- The patient maintains normal activity levels
4. Risk for Deficient Fluid Volume
Nursing Diagnosis Statement:
Risk for deficient fluid volume related to frequent diarrhea and decreased oral intake.
Related Factors/Causes:
- Frequent diarrhea
- Decreased fluid intake
- Nausea and vomiting
- Fever
- Malabsorption
Nursing Interventions and Rationales:
Monitor fluid intake and output
- Rationale: Ensures adequate hydration
Assess for signs of dehydration
- Rationale: Enables early intervention
Administer IV fluids as ordered
- Rationale: Maintains fluid balance
Encourage oral fluid intake
- Rationale: Prevents dehydration
Monitor electrolyte levels
- Rationale: Identifies imbalances requiring correction
Desired Outcomes:
- The patient maintains adequate hydration
- The patient demonstrates normal vital signs
- The patient shows balanced intake and output
5. Anxiety
Nursing Diagnosis Statement:
Anxiety related to chronic illness and lifestyle changes.
Related Factors/Causes:
- Unpredictable disease course
- Fear of complications
- Social isolation
- Changes in body image
- Treatment concerns
Nursing Interventions and Rationales:
Assess anxiety levels
- Rationale: Guides intervention strategies
Provide emotional support
- Rationale: Helps patient cope with diagnosis
Teach stress management techniques
- Rationale: Provides tools for anxiety management
Refer to support groups
- Rationale: Connects patient with others sharing similar experiences
Encourage the expression of feelings
- Rationale: Promotes emotional well-being
Desired Outcomes:
- The patient demonstrates reduced anxiety levels
- The patient uses effective coping strategies
- Patient verbalizes understanding of disease management
Patient Education
Key Education Points:
- Disease process and management
- Medication administration and side effects
- Dietary modifications
- Stress management techniques
- Recognition of complications
- When to seek medical attention
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Andersson P, Olaison G, Bendtsen P, Myrelid P, Sjödahl R. Health related quality of life in Crohn’s proctocolitis does not differ from a general population when in remission. Colorectal Dis. 2003 Jan;5(1):56-62. doi: 10.1046/j.1463-1318.2003.00407.x. PMID: 12780929.
- Cohen RD. The quality of life in patients with Crohn’s disease. Aliment Pharmacol Ther. 2002 Sep;16(9):1603-9. doi: 10.1046/j.1365-2036.2002.01323.x. PMID: 12197839.
- Cushing K, Higgins PDR. Management of Crohn Disease: A Review. JAMA. 2021 Jan 5;325(1):69-80. doi: 10.1001/jama.2020.18936. PMID: 33399844; PMCID: PMC9183209.
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