Crohn’s disease (CD) is a type of inflammatory bowel disease that can affect any portion of the gastrointestinal (GI) tract but most commonly affects the small bowel. It causes thickening and scarring, leading to obstruction, fistulas, ulcerations, and abscesses. Remissions and exacerbations characterize Crohn’s disease.
Crohn’s disease originates from an inappropriate autoimmune response in the colon to environmental factors brought on by substances, toxins, infections, or intestinal bacteria.
An intestinal crypt is the site of the first lesion’s infiltration. Ulceration then progresses, starting in the uppermost mucosa layer and spreading to deeper layers. Granulomas develop in all layers of the intestinal lining as the inflammation worsens. The inflamed portions of the intestines are replaced by scarring when the Crohn’s flare subsides.
Currently, there is no known cure nor a single medication that is effective for patients with Crohn’s disease. Reduced inflammation is one of the objectives of medical treatment. Crohn’s disease may be mild, moderate, or severe and treated with a combination of immunomodulators and biologics. By reducing complications, the long-term prognosis improves.
In this article:
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- Diarrhea
- Dysfunctional Gastrointestinal Motility
- Imbalanced Nutrition: Less Than Body Requirements
- Ineffective Tissue Perfusion
Nursing Process
Symptom management and early detection are key to managing and preventing complications. The nurse can advise of the following:
- Encourage patients to get screenings to check for cancers due to increased risks
- Monitor the patient’s mental health for anxiety and depression, common with Crohn’s disease
- Educate and develop a meal plan with the patient
- Instruct the patient on skincare and stool evacuation to prevent skin breakdown and infection
Although medications are useful, complications may require surgical procedures to manage the symptoms. Remissions and exacerbations are expected; therefore, patients may require lifelong monitoring and routine consultation from a gastroenterologist.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section, we will cover subjective and objective data related to Crohn’s disease.
Review of Health History
1. Ask about the patient’s general symptoms.
Symptoms of Crohn’s disease include the following:
- Abdominal pain and cramping
- Diarrhea (semisolid), which may be bloody or include pus or mucus
- Abdominal distension
- Vomiting, nausea, and anorexia
- Significant weight loss
2. Investigate the changes in bowel habits.
- Cramp-like and colicky abdominal pain following meals
- Frequent loose stools
- Nausea and vomiting
- Watery stools lasting more than two weeks
3. Determine the risk factors.
- Non-modifiable risk factors:
- Race: Crohn’s disease is most prevalent in North America, northern Europe, and New Zealand. There is a high incidence among Northern Europeans and people of Jewish origin.
- Age: Onset occurs most frequently between the ages of 15 and 30 and 40 and 60.
- Family history: A first-degree family member (such as a parent, sibling, or child) increases the risk of CD by 15%.
- Modifiable risk factors:
- Smoking: Control Crohn’s disease by quitting smoking. It is as successful in treating Crohn’s symptoms and putting CD into remission as immunotherapy medications. Smoking can make CD flare-ups more severe and cause other intestinal complications.
4. Review the use of NSAIDs.
Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) as much as possible because they may result in symptom flare-ups and stomach or intestinal ulcers.
Physical Assessment
1. Monitor the temperature.
The inflamed intestines can cause a fever of 38.0 C (100.0 F) or more.
2. Weigh the patient.
Crohn’s disease-related inflammation can cause nausea, diarrhea, abdominal cramping, and decreased appetite. As a result, patients eat less, making it more challenging to maintain adequate weight.
3. Auscultate the bowel sounds.
Intestinal gurgling and splashing may be audible in people with Crohn’s disease. Other symptoms like cramps and bloating may also accompany these sounds.
4. Perform a rectal examination.
Rectal examinations can assist in identifying sphincter tone, the existence of hematochezia, and gross abnormalities of the rectal mucosa. Inspect the perianal area for skin tags, fistula, abscesses, and hemorrhoids.
5. Record the physical assessment findings.
Crohn’s disease can display extraintestinal manifestations:
- HEENT: episcleritis (inflammation of thin layer between conjunctiva and sclera), uveitis (inflammation of the eye’s middle layer), dry eyes
- Musculoskeletal: arthritis and arthralgia in the large joints (such as hips, knees, and ankles), osteoporosis
- Integumentary: erythema nodosum (red nodules to the shins, ankles, and arms), pallor, jaundice, rashes, skin lesions
Diagnostic Procedures
1. Expect no definitive diagnostic test for Crohn’s disease.
No specific test can diagnose Crohn’s disease. It is diagnosed after ruling out other conditions.
2. Send stool samples for testing.
Stool tests assess for infections, culture and sensitivities, ovum and parasites, Clostridium difficile toxins, and leukocyte count. Calprotectin can detect active Crohn’s disease and is used for monitoring the disease.
3. Review serum lab results.
Blood tests include:
- Complete blood count with a metabolic panel to check for anemia (B12 or iron deficiency) or liver disease. Common abnormalities in micronutrients like folic acid and electrolytes like calcium and magnesium are frequently observed.
- Special serology (anti-neutrophil cytoplasmic antibodies (ANCA) and anti-saccharomyces cerevisiae antibodies (ASCA)) are antibodies common in people with inflammatory bowel diseases and may distinguish CD from UC.
- C-reactive protein (CRP) or erythrocyte sedimentary rate (ESR) monitors the severity of the inflammation.
4. Assist with imaging scans.
Imaging scans visualize the bowel regions to monitor inflammation.
- Computed tomography (CT) scan/magnetic resonance enterography (MRE) is the preferred imaging modality for initial diagnosis and the evaluation of an acute flare.
- Video capsule endoscopy (VCE) can visualize the small bowel when regular endoscopy or colonoscopy cannot reach some areas of the GI tract. VCE can only detect mucosal changes.
- Plain X-rays are used when bowel obstruction is suspected.
- Small bowel follow-through assesses the involvement of the terminal ileum and detects fistulas.
5. Visualize the entire colon.
A colonoscopy confirms the diagnosis by revealing the sites of inflammation in the entire colon. Biopsy samples may be taken during the procedure. Granulomas, or collections of inflammatory cells, indicate Crohn’s diagnosis.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you’ll learn more about possible nursing interventions for a patient with Crohn’s disease.
Manage the Inflammation
1. Aim to reduce inflammation.
There is no cure for Crohn’s disease, and effective treatment requires individualization. Reducing the inflammation that causes flares is the primary goal of medical treatment. Limiting inflammation can avoid complications to enhance long-term prognosis.
2. Provide anti-inflammatory drugs as prescribed.
Anti-inflammatory medications are the initial step in treating inflammatory bowel diseases like Crohn’s. Corticosteroids are administered to improve symptoms for a brief period (three to four months) and to bring on remission. Corticosteroids may also be used with an immune system suppressor to maximize the effects of other drugs. Eventually, they are tapered off and discontinued.
3. Target the immune system.
Crohn’s is an autoimmune disease, so medications that suppress the overactive immune response are useful. Some people respond better to these medications in combination with other anti-inflammatory drugs. Biologics are a class of medications that target immune mediators. Common biologics used in the treatment of CD include infliximab (Remicade), adalimumab (Humira), vedolizumab (Entyvio), and ustekinumab (Stelara).
4. Initiate antibiotic therapy.
Antibiotics can lessen leakage from fistulas and abscesses and reduce bacteria contributing to intestinal inflammation. Antibiotics ciprofloxacin (Cipro) and metronidazole (Flagyl) are frequently administered.
5. Relieve the signs and symptoms.
Certain drugs may alleviate the signs and symptoms in addition to reducing inflammation. However, before taking any over-the-counter drugs, advise the patient to consult their healthcare provider. They may advise one or more of the following medications, depending on the severity of Crohn’s disease:
- Anti-diarrheals: By giving the stool more bulk, a fiber supplement like psyllium powder (Metamucil) or methylcellulose (Citrucel) can treat mild to moderate diarrhea. Loperamide (Imodium A-D) may be helpful in cases of severe diarrhea.
- Pain relievers: Acetaminophen (Tylenol, among others) can be given for mild pain. Do not give ibuprofen or naproxen sodium, as these medications can worsen symptoms.
- Vitamins and supplements: The healthcare provider can recommend vitamins and dietary supplements if patients lack nutrients due to bowel inflammation.
Treatment for Severe Cases
1. Remove the affected area.
The healthcare provider may recommend surgery if medications are ineffective. Half of patients with Crohn’s disease will need at least one surgery. However, it will not cure Crohn’s disease. In surgery, a diseased segment of the digestive tract is removed, and the healthy sections are reconnected. Fistulas and abscesses are also drained through surgery.
2. Prevent the recurrence after surgery.
Surgery for Crohn’s disease is typically temporary. Crohn’s disease frequently returns close to the rejoined tissue. To reduce the chance of recurrence, advise the patient to adhere to their medication regimen and lifestyle modifications.
3. Prevent malnutrition.
CD often affects the small intestine, where nutrients are absorbed. Severe cases of CD may lead to malnutrition from frequent diarrhea, pain, poor intake, and malabsorption. Frequently assess the patient’s electrolyte levels, weight, bone mineral density, protein, albumin, and more.
4. Rest the bowel.
Allowing the bowel to rest by consuming a bland diet, or in severe cases, receiving parenteral or enteral nutrition can relieve intestinal inflammation. As the patient begins to tolerate oral intake, instruct on a low-fiber diet.
Coping and Education
1. Assist the patient in coping.
Emotional well-being is also negatively impacted by Crohn’s disease in addition to the physical symptoms. A patient’s life can revolve around the continual need to use the restroom, interrupting social activities, work, and school.
2. Impart knowledge about Crohn’s disease.
Learning about Crohn’s disease is one of the best ways to help the patient feel more in control. Remind the patient that finding the best treatment for them may take time and trial and error. A combination of medications is usually necessary.
3. Refer to a support group.
Coping with a chronic autoimmune disease can be isolating. Refer the patient to support groups for inflammatory bowel disease to learn from others and what has worked for them.
4. Refer to an IBD specialist.
Gastroenterologists specializing in inflammatory bowel disease provide knowledgeable guidance about the treatment and symptom management of Crohn’s disease.
5. Recognize triggers and flare symptoms.
Help the patient take control of their disease by keeping a diary of triggers and flare symptoms. Triggers can include food, smoking, medications, and stress. Symptom trackers and smartphone apps are available to monitor symptom severity which can be especially useful for the provider in evaluating treatment effectiveness.
6. Educate on lifestyle modifications.
Educate the patient on the following Crohn’s disease flare triggers:
- Nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen and naproxen
- Smoking
- Stress
- Dairy products, greasy food, raw vegetables, and whole grains
- Caffeine
- Alcohol
Nursing Care Plans
Once the nurse identifies nursing diagnoses for Crohn’s disease, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for Crohn’s disease.
Deficient Knowledge
Deficient knowledge associated with Crohn’s disease can result in a misconception of triggers, symptoms, prevention, and management.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Inadequate knowledge about Crohn’s disease
- Lack of understanding of signs and symptoms of Crohn’s disease
- Misinformation about remission and exacerbation of Crohn’s disease
- Misunderstanding of triggers causing exacerbation of Crohn’s disease
- Unfamiliarity with the treatment plan
As evidenced by:
- Expressed concerns about Crohn’s disease
- Questions about Crohn’s disease
- Ineffective meal plan
- Worsening symptoms leading to exacerbations
- Nonadherence with prevention and management recommendations
Expected outcomes:
- Patient will be able to verbalize knowledge about Crohn’s disease and its signs and symptoms.
- Patient will list three trigger factors that can exacerbate Crohn’s disease.
- Patient will not experience an exacerbation of Crohn’s disease symptoms.
Assessment:
1. Assess the patient’s knowledge of Crohn’s disease.
The nurse must first assess the patient’s understanding of Crohn’s disease and the expectations of treatment before creating a health teaching plan. This will help the nurse to determine what should be focused on during teaching.
2. Assess the factors affecting learning.
The nurse must assess the patient’s perspective of Crohn’s disease and barriers to learning. The nurse can assess the patient’s motivation, support system, socioeconomic status, culture, and other factors that may influence how they learn.
3. Distinguish between myths and facts.
The nurse must assess the patient’s knowledge to determine the patient’s beliefs and distinguish between facts and myths.
4. Review the patient’s meal plans, eating habits, and food preferences.
Review the patient’s current meal plans, eating habits, and food choices. The nurse can then intervene if misunderstandings are apparent.
Interventions:
1. Involve the patient in the development of the care plan.
Patient engagement in the care plan will promote independence, commitment, and adherence to the prevention of exacerbations and management of symptoms of Crohn’s disease.
2. Welcome clarifications and questions.
Patients with Crohn’s disease experience anxiety, embarrassment, fear, and powerlessness. Clarification and questions from patients should be encouraged and welcomed. An approachable manner will create a trusting environment between the nurse and patients.
3. Appreciate the patient’s efforts.
Express appreciation for the patient’s efforts and commitment to their care plan. Adhering to the management of Crohn’s disease requires a lifetime commitment. When patients achieve their health goals, exacerbations and complications can be prevented.
4. Ask the patient to list the preventive measures for Crohn’s disease.
Avoiding triggering factors is the best way to manage symptoms and prevent flare-ups. Evaluate the patient’s understanding by having them list factors that trigger their symptoms.
5. Refer to an IBD specialist.
Inflammatory bowel disease (IBD) specialists deliver professional advice and expertise. They can answer inquiries and guide the patient about Crohn’s disease care.
Diarrhea
Diarrhea associated with Crohn’s disease occurs during flares when the intestinal mucosa becomes inflamed.
Nursing Diagnosis: Diarrhea
Related to:
- Inflammation of the GI tract
- Irritation in the bowel
- Trigger foods that aggravate symptoms
As evidenced by:
- Increased bowel sounds
- Increased peristalsis
- Abdominal cramping
- Increased urgency to defecate
- Loose or watery stools
- Defecation more than three times a day
- Blood or pus in the stool
Expected outcomes:
- Patient will be able to manifest decreased urgency and frequency of stools less than 3 per day.
- Patient will report a more formed and solid stool consistency without the presence of blood.
- Patient will be able to express the alleviation of abdominal cramps.
Assessment:
1. Assess the patient’s bowel movements.
Bowel movement frequency and characteristics may be affected by inflammation. Irritated intestinal mucosa cannot absorb fluids and causes intestinal muscle spasms leading to diarrhea.
2. Inspect the stool color.
Malabsorption is a potential symptom of Crohn’s disease. Therefore, colorful foods like bright green leafy vegetables may only be partially digested and maintain the color in the stool.
3. Check if the stool is bloody or mucoid in appearance.
Blood or mucus in the stool is common during a flare-up due to inflammation or fissures in the colon. The stool may become red or black in color due to the presence of blood. Mucus can have a yellow or white color and a stringy or gel-like appearance.
4. Observe for bowel signs and symptoms.
After using the toilet, people with Crohn’s disease sometimes feel as though they still haven’t completed their bowel movements. Additionally, they could have abdominal cramps and pain during bowel movements. Changes in bowel habits may indicate a flare-up of Crohn’s disease.
Interventions:
1. Maintain hydration.
There is a risk of dehydration in Crohn’s disease due to diarrhea. It is essential to maintain proper hydration. Water, broth, soup, and rehydration solutions can be given orally. If severe, the patient may require inpatient admission with IV fluids.
2. Promote complete bed rest.
Complete bed rest promotes the relaxation of gastric muscles and lowers peristaltic movements.
3. Encourage a clear liquid diet.
To avoid dehydration during the acute phase of diarrhea, avoid oral intake that may trigger peristalsis and gradually increase clear fluid consumption.
4. Encourage a low-fiber and low-residue diet.
Low-fiber and low-residue diets decrease bowel movements, urgency, and frequency of defecation.
5. Control the inflammation.
Administer the following medications as prescribed to control inflammation:
- Aminosalicylates are used for mild inflammation in the gastrointestinal tract.
- Biologic therapies help the immune system to tame the inflammation of the intestines.
- Corticosteroids manage the swelling caused by moderate to severe Crohn’s disease.
- Immunomodulators stop inflammation by controlling the immune system. These may take effect weeks or months after the initial dose.
6. Manage the symptoms.
The following medications can be given as ordered to manage the symptoms:
- Acetaminophen relieves the pain in Crohn’s disease.
- Antibiotics target infections in the GI tract that could result in abscesses or fistulas.
- Loperamide is a short-term anti-diarrheal treatment.
7. Avoid the triggers.
Avoid triggering factors such as food (dairy products, fatty and greasy foods), smoking, and medications (ibuprofen, naproxen, and aspirin) that can aggravate the symptoms.
8. Prepare for possible surgery.
Most patients with Crohn’s disease eventually require surgery. Surgery can remove the scarred portion of the intestine and preserve the healthy sections.
Dysfunctional Gastrointestinal Motility
Crohn’s disease frequently causes alterations in GI motility, usually linked to inflammation.
Nursing Diagnosis: Dysfunctional Gastrointestinal Motility
Related to:
- Disease process
- Intestinal obstruction
- Inflammatory process
As evidenced by:
- Abdominal cramping
- Abdominal distension
- Abdominal pain
- Altered bowel sounds
- Chronic diarrhea
Expected outcomes:
- Patient will remain free from abdominal distention and discomfort.
- Patient will display formed, brown stools no more than twice per day.
Assessment:
1. Assess diagnostic studies.
Diagnostic tests like colonoscopy, sigmoidoscopy, and endoscopy are the most accurate methods to visualize inflammation in the intestines. It will also help rule out other gastrointestinal conditions like ulcerative colitis, cancer, or diverticular disease.
2. Assess the patient’s bowel sounds.
Crohn’s Disease can cause hyperactive bowel sounds like audible gurgling in the intestines upon auscultation. These distinct bowel sounds are often accompanied by abdominal cramping, tenderness, and bloating.
3. Assess the patient’s fluid and electrolyte levels.
Crohn’s Disease is associated with severe malabsorption, resulting in malnutrition and electrolyte imbalances caused by dysfunctional motility.
Interventions:
1. Administer prescribed medications as ordered.
Depending on the severity of Crohn’s disease, 5-aminosalicylate (5-ASA) therapy is often indicated. These medications help control the symptoms and inhibit the production of substances that cause inflammation, allowing the gastrointestinal tract to heal and improve its function and motility.
2. Administer total parenteral nutrition as indicated.
Nutritional deficits are common in patients with Crohn’s disease, further affecting normal gastrointestinal function and motility. During exacerbations, bowel rest is initiated by keeping the patient NPO and starting total parenteral nutrition (TPN).
3. Encourage the patient to avoid irritating foods and fluids.
Once the patient is allowed to eat, encourage the patient to avoid foods and beverages that can further irritate the intestines as this can cause further issues with motility and aggravate symptoms of Crohn’s disease like diarrhea, abdominal pain, and abdominal bloating.
4. Prepare the patient for surgery.
Surgery in patients with Crohn’s disease is often indicated for those with complications like bleeding, fistula, obstructions, and strictures. Resolving these complications improves gastrointestinal function and motility.
5. Encourage alternative therapies for gut health.
Patients with Crohn’s disease may benefit from alternative therapies like naturopathy, acupuncture, functional nutrition, hypnotherapy, and Ayurveda to relax and soothe the gastrointestinal tract.
Imbalanced Nutrition: Less Than Body Requirements
Imbalanced nutrition: less than body requirements associated with Crohn’s disease can be caused by malabsorption of nutrients, restricted intake, anxiety/fear that eating may result in diarrhea, and increased metabolism.
Nursing Diagnosis: Imbalanced Nutrition: Less than body requirements
Related to:
- Malabsorption of nutrients
- Restricted intake as prescribed or recommended
- Anxiety/fear that eating may result in diarrhea
- Increased metabolism
As evidenced by:
- Significant weight loss
- Diminished subcutaneous fat or muscle mass
- Muscle tone loss
- Hyperactive bowel sounds
- Pale oral mucosa
- Food aversion
Expected outcomes:
- Patient will maintain weight within the normal BMI range for height and weight.
- Patient will be able to list at least five preferred food choices.
- Patient will be able to create a meal plan following the recommended diet.
Assessment:
1. Evaluate the patient’s diet, eating habits, and choices.
Identify the patient’s daily dietary consumption, eating patterns (such as the frequency of meals and snacks), and food preferences as a baseline.
2. Weigh the patient.
Patients with Crohn’s disease typically have low body weight and struggle to maintain an ideal body mass index (BMI). The nurse should take the patient’s muscle tone into consideration.
3. Monitor the patient’s intake and output.
The monitoring of intake is used to ensure the patient is getting the right amount of fluid. Monitoring output determines whether stool and urine output balances the patient’s intake.
4. Assess for any signs and symptoms affecting nutrition.
Nausea, vomiting, abdominal pain, and diarrhea can cause an aversion to eating. Monitor for symptoms as well as the emotional effects that prevent proper nutrition.
Interventions:
1. Assist the patient in developing nutritional and weight goals.
Develop a daily food, fluid, and weight chart to track the patient’s dietary intake and progress toward weight-related goals. Talk with the patient about their short and long-term nutritional and weight goals.
2. Offer dietary selections applicable to the patient.
It’s crucial to continue eating a balanced and nutrient-rich diet even during remission. Introduce new foods gradually.
3. Advise the patient to keep a meal diary.
A meal diary can identify trigger foods by listing all food consumed by the patient each day. Once trigger foods are known, the patient can feel more in control by avoiding foods that cause symptoms.
4. Remind foods to avoid during flares.
When the patient experiences a flare-up, high-fiber fruits and vegetables, whole grains, nuts and seeds, fatty and spicy foods, caffeine, and alcohol can worsen symptoms.
5. Emphasize a high-calorie and high-protein diet.
Maintaining a high-calorie and high-protein diet is crucial, especially if loss of appetite and malabsorption are present due to Crohn’s disease. This will help the patient get the necessary nutrition to maintain their weight and energy.
6. Encourage snacks in between meals.
Emphasize eating three meals per day along with an additional two or three snacks. Snacks in between meals will help sustain enough protein, calories, and nutrients for the patient within the day.
7. Administer supplements as prescribed.
Supplements can help replenish the body’s essential vitamins and nutrients since the patient is at risk for malnutrition and malabsorption.
8. Consult with a nutritionist or dietitian.
A dietician can assist the patient in creating a customized diet by providing information on the foods that are recommended or should be avoided.
Ineffective Tissue Perfusion
Crohn’s disease, with its frequent flares, can lead to tissue perfusion complications like bowel obstruction, scarring, strictures, ulcers, anal fissures, intestinal fistulas, malnutrition, bowel perforation, and peritonitis.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Disease process
- Inflammatory process
- Abdominal compartment syndrome
- Frequent flares
- Intestinal scarring
As evidenced by:
- Chronic diarrhea
- Abdominal discomfort
- Loss of appetite
- Altered bowel sounds
- Nausea and vomiting
- Weight loss
Expected outcomes:
- Patient will remain free from gastrointestinal tissue perfusion problems like intestinal obstruction, bowel perforation, scarring, and fistulas.
- Patient will experience a significant reduction in symptoms and reduced incidence of flare-ups.
Assessment:
1. Assess the patient’s vital signs.
Alterations in the patient’s vital signs will vary with the acute onset and severity of the condition. In severe cases of Crohn’s disease, the patient will have fever and tachycardia, which can indicate complications in perfusion like peritonitis and bowel perforation, along with dehydration.
2. Assess the patient’s nutritional status.
Patients with Crohn’s disease often experience nutritional deficits due to chronic diarrhea. If the small intestines are involved, the patient may also experience weight loss due to malabsorption and gastrointestinal tissue perfusion problems from the inflammation of the small intestines.
3. Evaluate and assess endoscopy results.
Crohn’s disease is diagnosed and managed based on clinical manifestations, laboratory tests, and diagnostic imaging tests. Colonoscopy is considered the gold standard in evaluating Crohn’s disease. This test allows examination of the intestinal mucosa for ulcerations, inflammation, and scarring. Repeated flares that cause inflammation eventually cause scarring that leads to narrowing and perfusion complications like obstructions and strictures.
Interventions:
1. Administer medications as indicated.
While there is no cure for Crohn’s disease, drug therapy, including steroids, antibiotics, antidiarrheals, and analgesics, are indicated to help reduce inflammation, improve perfusion, prevent infection, prevent flare-ups, and relieve associated signs and symptoms of Crohn’s disease.
2. Keep the patient on NPO and provide parenteral nutrition as indicated.
Keeping the patient NPO allows the bowel to rest and improves inflammation of the intestinal mucosa. While the patient is NPO, parenteral nutrition may be provided to address nutrient malabsorption complications arising from Crohn’s disease.
3. Encourage the patient to refrain from smoking.
Smoking increases the risk of developing Crohn’s disease and can aggravate symptoms if the patient already has the condition. Smoking triggers an immunologic response to vascular injury, which results in severe symptoms and the development of intestinal perfusion complications like strictures and obstructions.
4. Prepare the patient for possible blood transfusions.
Patients with Crohn’s disease are at risk of developing bloody stools, intestinal bleeding, and anemia and may need a blood transfusion to support perfusion and hemodynamic stability.
5. Educate on possible triggers.
Preventing flares is a primary goal in managing Crohn’s disease. Flare triggers can differ for each patient and may be difficult to identify. Help the patient recognize possible triggers using a journal or app to track symptoms and related causes such as foods, alcohol, stress, or poor medication adherence.
6. Encourage the patient to refrain from taking certain NSAIDs.
Patients with Crohn’s disease should avoid NSAIDs like ibuprofen or naproxen, as these medications can aggravate intestinal inflammation and bleeding and cause symptom flare-ups and intestinal ulcers.
References
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