Crohn’s Disease Nursing Diagnosis and Nursing Care Plan

Crohn’s Disease Nursing Care Plans Diagnosis and Interventions

Crohn’s Disease NCLEX Review and Nursing Care Plans

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:

  1. Diarrhea
  2. Fever
  3. Fatigue
  4. Abdominal pain
  5. Abdominal cramps
  6. Blood in stool
  7. Mouth sores
  8. Loss of appetite
  9. Weight loss
  10. Rectal Bleeding
  11. Pain or drainage near or around the anus

Severe cases of Crohn’s disease may develop:

  1. Inflammation of skin, eyes, joints, liver, or bile ducts
  2. Kidney stones
  3. Iron deficiency (anemia)
  4. 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:

  1. 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.
  2. 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.
  3. 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.
  4. NSAIDs. Non-steroidal anti-inflammatory medications can increase bowel inflammation which can worsen Crohn’s disease.
  5. 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

  1. 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.
  2. 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.
  3. Anal fissure. A small tear in the tissue lining of the anus or its surrounding skin may develop.
  4. Malnutrition. Chronic diarrhea and abdominal pain may cause deficiency in nutrition.
  5. 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

  1. Blood test to check for anemia and infection
  2. Stool studies to check for blood, parasites and other organisms
  3. Colonoscopy – used for visualization of the gastrointestinal tract and its affected areas
  4. Computerized tomography (CT) Scan
  5. Magnetic resonance imaging (MRI)
  6. Capsule endoscopy
  7. Balloon-assisted enteroscopy

Treatment of Crohn’s Disease

  1. Medications often used to manage the symptoms of Crohn’s disease include:
  2. Anti-inflammatory drugs, including corticosteroids and oral 5-aminosalicylates – initially used to reduce the inflammation
  3. Immunosuppressant and biologic drugs – decrease inflammation by targeting the immune system
  4. Antibiotics – used to fight off harmful bacteria found in the intestines and to decrease pus formation and drainage from fistula and abscess
  5. Anti-diarrhea medications
  6. Analgesics
  7. Vitamins and supplements

Nutrition therapy

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.

Surgery

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.

Nursing Stat Facts
Nursing Stat Facts

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 Diagnosis for Crohn’s Disease

Nursing Care Plan for Crohn’s Disease 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.

Nursing Interventions for Crohn’s DiseaseRationale
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 for Crohn’s Disease 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.

Nursing Interventions for Crohn’s DiseaseRationale
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.
Anti-diarrhea medications
Analgesics
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.

Nursing Care Plan for Crohn’s Disease 3

Diarrhea

Nursing Diagnosis: Diarrhea related to inflammation of the small bowels secondary to Crohn’s disease as evidenced by abdominal cramps and frequent watery stool.

Desired Outcomes:

  • The patient will verbalize relief of abdominal cramps and urgency to defecate.
  • The patient will report a reduced frequency of stools with a more formed stool consistency.
  • The patient will be able to identify contributing and relieving factors of Crohn’s disease for extended periods of remission.
Nursing Interventions for Crohn’s DiseaseRationale
Assess and monitor the patient’s stool characteristics using the Bristol stool chart. Note the frequency and precipitating factor.These will help the nurse identify the patient’s pattern of elimination and monitor improvements from the interventions given.
Encourage complete bed rest and provide a bedside commode for the patient.A complete bed rest facilitates relaxation and reduction of peristaltic movements. A bedside commode can aid the patient with a sudden urge to defecate, thus, preventing accidents and incontinence.
Assess for any diarrhea-related signs and symptoms of Crohn’s disease.Signs and symptoms can be localized or systemic, ranging from mild to severe, with periods of remission and exacerbations. These include: abdominal pain/crampsHematochezia or blood in the stoolLoss of appetite and weight lossFatiguePain and inflammation in the skin, eyes, joints, bile ducts, anus, etc.Anemia from internal bleedingDelayed growth or development in children  
Educate the patient about a gradual introduction of clear fluids. Avoid foods and drinks that may precipitate diarrhea such as cold fluids, milk products, caffeinated beverages, etc.Avoid oral intake during the acute phase of diarrhea, and gradually introduce clear fluids until up to 2 liters per day to prevent dehydration. Avoiding those mentioned intestinal irritants prevent cramping and decreases intestinal motility.
Educate the patient about the low fiber and low residue diet given through the mouth or via tube feeding as tolerated.Low fiber and low-residue diet decrease the frequency of defecation. Tube feeding is used as nutritional support during acute exacerbations or before a procedure.
Administer medications such as antidiarrheals, analgesics, anti-inflammatories, antibiotics, or vitamins and supplements as ordered.These medications help manage symptoms associated with Crohn’s disease, prevent exacerbations, and improve the quality of life.
Refer the patient to a dietitian upon consent.Patients with Crohn’s disease have a special diet for long-term nutritional support.
Educate the patient about the disease process and provide emotional support.Although there are no definitive treatments for Crohn’s disease, adequate knowledge about the disease and symptom management can improve the patient’s life.

Nursing Care Plan for Crohn’s Disease 4

Anxiety

Nursing Diagnosis: Anxiety related to change in health status secondary to Crohn’s disease as evidenced by restlessness and verbalization of concern regarding current changes in the patient’s life.

Desired Outcomes:

  • The patient will express awareness of the anxiety and ways to cope and deal with it.
  • The patient will present calm and verbalize reduced anxiety level.
Nursing Interventions for Crohn’s DiseaseRationale
Provide a quiet, calm, and safe environment for the patient.Establishing a trusting environment between the patient and the nurse creates an open and harmonious relationship.
Explain the risk factors and other important information regarding Crohn’s disease. Allow the client to have enough time to think and ask questions.Providing a good explanation of the information about Crohn’s disease can help alleviate anxiety. Also, providing an opportunity for the client to ask questions can help reduce anxiety levels.
Teach the patient to perform deep breathing by standing in front of the patient and doing it simultaneously.Restless patients may not follow directions easily, deep breathing can help the patient calm down during acute anxiety attacks.
Assess the patient’s anxiety level and perspective of the situation by asking open-ended questions in a calm and non-threatening manner.These can help the nurse explore the patient’s thoughts and feelings. The patient can honestly communicate if they feel comfortable and secure.
Educate the patient about the disease process, management of symptoms, resources available, and how to avoid exacerbations. Explain this briefly while evaluating the patient’s understanding and concerns.Giving adequate information about the disease process can help the patient understand that the condition can be managed, lessening anxiety. Simple discussion can help the patient cope with the situation.
Encourage the patient to share fears and concerns regarding the condition. Acknowledge the patient’s feelings and discuss options that might help.The nurse can offer specific options for the patient when the nurse knows the exact concern of the patient.
Educate the patient about relaxation techniques and diversional activities such as guided imagery, meditation, exercise, etc.These can help the patient cope with the condition providing relief during anxiety attacks.
Make a treatment plan with the patient involving them in the decision-making.Involving the patient in the treatment planning will help the patient gain control over their condition, increasing compliance.
Refer the patient to a support group or psychotherapy upon consent.The patient can gain a sense of belongingness to individuals with the same problems and teach them effective coping strategies.

Nursing Care Plan for Crohn’s Disease 5

Ineffective Coping

Nursing Diagnosis: Ineffective Coping related to lack of support system secondary to Crohn’s disease as evidenced by reports of being alone for years.

Desired Outcomes:

  • The patient will recognize ineffective coping behaviors and disruptive behaviors.
  • The patient will be able to recognize the support system available to help them cope with the condition.
Nursing Interventions for Crohn’s DiseaseRationale
Assess the patient’s stressors, disruptive behaviors, and non-verbal signs of stress.These will help the nurse understand the patient’s disruptive behaviors and identify the problems that should be addressed.
Assess the patient’s available resources and support system, if available.The patient may not recognize that friends, colleagues, or people in the community can also be their support system.
Assess the patient’s perception of their condition using therapeutic communication.These will foster a trusting relationship, helping the nurse identify barriers and issues the patient might have.
Assess the patient’s activities of daily living and coping strategies such as exercise, hobbies, work, music, spiritual belief, interaction, or relationship with others.Knowing these things will help the nurse identify daily stressors and activities that might help the patient cope with these stressors.
Discuss and help the patient identify effective and ineffective coping mechanisms and how they affect their relationship with others.The patient is going through something new in their life, they might be unaware of how their response affects others which might cause conflict. Helping the patient recognize this will help regain a support system and effective coping skills.
Encourage adequate rest and sleep. Educate the patient about relaxation techniques and stress management skills.This promotes relaxation and peace and helps the patients cope.
Provide emotional support and positive reinforcement.The patient can feel a sense of accomplishment and boost their confidence with continued supervision until recovery is achieved.
Educate the patient about available support groups and community organizations.The patient can feel a sense of belongingness with individuals with the same problems and teach them effective ways to cope with the condition.
Refer the patient for counseling upon consent.Professional counseling can help the patient with problem-solving and effective coping skills.

More Crohn’s Disease Nursing Diagnosis

Nursing References

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. (2022). 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. (2020). 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

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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