Outline of Crohn's Disease

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

2. A Description of Crohn’s
Disease
CROHN’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.

3. Clinical Manifestations
DIARRHEA
BLOODY STOOLS
WEIGHT LOSS
ABDOMINAL PAIN
FEVER
FATIGUE
RECTAL BLEEDING (IN SOME CASES)

4. Potential Complications
PERINEAL ABSCESS
FISTULAS
FAT MALABSORPTION
ANEMIA
CANCER OF THE SMALL INTESTINE
PERIPHERAL ARTHRITIS
ANKYLOSING SPONDYLITIS
SACROILIITIS
FINGER CLUBBING
ERYTHEMA NODOSUM
PYODERMA GANGRENOSUM
APHTHOUS ULCERS
CONJUNCTIVITIS
UVEITIS
EPISCLERITIS
GALLSTONES
KIDNEY STONES
PRIMARY SCLEROSING CHOLANGITIS
OSTEOPOROSIS
THROMBOEMBOLISM

5. Diagnostics
HISTORY & PHYSICAL EXAMINATION
CBC, ESR
SERUM CHEMISTRIES
OCCULT BLOOD STOOL
STOOL INFECTION
CAPSULE ENDOSCOPY
DOUBLE-CONTRAST BARIUM ENEMA
SMALL BOWEL SERIES
TRANSABDOMINAL ULTRASOUND
CT
MRI
SIGMOIDOSCOPY/COLONOSCOPY WITH
BIOPSY
Barium enema is not employed in acute exacerbations.

6. Collaborative Therapy
HIGH-CALORIE, HIGH-VITAMIN, HIGH-PROTEIN,
LOW-RESIDUE, LACTOSE-FREE DIET
AMINOSALICYLATES*
ANTIMICROBIALS
CORTICOSTEROIDS
IMMUNOSUPPRESSANTS
IMMUNOMODULATORS
ELEMENTAL DIET OR PARENTERAL NUTRITION
PHYSICAL & EMOTIONAL REST
COUNSELING OR SUPPORT GROUP
SURGERY**
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.

7. 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

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

9. 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

10. Education regarding goals
1. IMPORTANCE OF REST AND DIET MANAGEMENT
2. PERIANAL CARE
3. DRUG ACTION & SIDE EFFECTS
4. SYMPTOMS OF RECURRENCE
5. WHEN TO SEEK MEDICAL CARE
6. USE OF DIVERSIONAL ACTIVITIES TO REDUCE STRESS

11. Expected outcomes
The 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

12. For further information contact the
Crohn’s and Colitis Foundation of
America, www.ccfa.org.

13. Reference
Schmelzer, 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.