NCLEX: Crohn's Disease

Crohn's interventions (ACUTE):

- NPO - administer fluids/electrolytes/parenteral nutrition IV

A string sign is:

- a narrowing of the lumen of the intestine - as shown on the barium x-ray

Diagnosis of Crohns:

- barium studies (reveals a string sign)

Tx of Crohn's disease:

- diet - vitamins - meds - surgery

Diet for Crohn's disease:

- low residue - high protein diet - vitamins - iron supplements may be perscribed - avoid gas forming foods - caffeine containing products

Diet for Crohns disease:

- low residue diet - low fiber - vitamin and iron suplements

Crohn's disease and ulcerative colitis are triggered by;

- pesticides - food additives - radiation - possibly allergies/immune system

Crohn's disease leads to:

- swelling - thickening/scarring - abscess formation - fistulas - ulcerations

Gas forming foods:

- whole grains - nuts - raw fruits and vegetables - pepper - alcohol - caffeine-containing products

2 major inflammatory bowel disorders:

1. Crohn's disease 2. Ulcerative colitis

Symptoms of Crohn's disease:

1. abdominal pain (right lower quadrant) - that does not resolve with defecation (bowel movement) and pain is aggravated (worse) by eating. 2. Low-grade fever 3. Diarrhea/Steatorrhea (excess fat in feces) 4. weight loss (may become emaciated) (abnormally thin or weak because of illness) 5. Formation of fistulas (abnormal tracts between bowel and skin/bladder or vagina) 6. Usually there is no bleeding (which helps to differentiate from ulcerative colitis) 7. Leukocytosis (increase of white cells in the blood from infection) 8. May be accompanied by arthritis, skin lesions, conjunctivitis and /or oral ulcers. 9. "String sign" on x-ray: indicates constriction in a segment of the terminal ileum 10. Decreased hematocrit and hemoglobin 11. Elevated ESR (Erythrocyte Sedimentation Rate)

Meds for Crohn's include:

1. sedatives 2. antidiarrheals 3. steroids 4. anti rheumatics 5. immunosuppressives

Therapeutic measures for Crohn's

Bowel resection (possible ileostomy) Stricturoplasty profiles: Hct, hemoglobin Laboratory: C-reactive protein, WBC, ESR Abdominal x-ray

Treatment

Corticosteroids Azathioprine Antibiotics Ciprofloxacin Metronidazole infliximab Adalimumab Natalizumab (Tysabri)

signs and symptoms

Diarrhea - 5 to 6 per day Cramping/Abdominal pain Fever Weight Loss Malabsorption Anemia

Crohn's disease contributing factors

Family history Jewish ancestry Bacterial infection Smoking Adolescents or younger adults (ages 15 to 40) Living in an urban area

Complications

Obstruction Fistulas (abnormal openings between two adjacent hollow organs)

Crohn's interventions:

Promote adequate rest periods Record color, volume, frequency, and consistency of stools Monitor and prevent fluid deficit Nutrition therapy: includes high-calorie, protein, low-fiber, no dairy Provide supportive care Monitor for complications: 1.) Intestinal obstruction 2.) Perianal disease 3.) Fluid electrolyte imbalances 4.) Malnutrition 5.) Fistula, abscess If the above measures are not effective, prepare for surgery: Bowel resection with possible ileostomy or stricturoplasty Refer to support group

Client education for Crohn's

Refer to support group Dietary Health promotion and relaxation

Crohn's disease is AKA;

Regional enteritis

meds for crohns disease

Steroids Anti-infective: Metronidazole Aminosalicylates (5-ASAs) Immune modulators: infliximab, adalimumab, certolizumab, and natalizumab TPN (Total parenteral nutrition)

Following the acute phase, diet progresses to:

clear liquids to low residue as tolerated

Crohn's disease is an:

inflammatory bowel disease (autoimmune disorder)

Crohn's disease is an

inflammatory bowel disorder that can involve any segment of the GI tract from the mouth to the anus but preferentially is found in the terminal ileum. It can occur anywhere in the intestinal tract, but most commonly occurs in the distal (terminal) ileum. It is characterized by the "cobblestone" appearance of ulcers that are separated by normal tissue.

Who is at higher risk for developing Crohns disease and ulcerative colitis:

people 15-40 yrs of age

Surgery for Crohns disease is reserved for:

severe cases

Crohn's disease most often affects the:

terminal ileum