IBD-Crohn's Disease

PATHOPHYSIOLOGY
1. (Mazal, 2014)
  1. unknown cause
  2. progressive, systemic autoimmune disorder
  3. abnormal inflammation of any parts of GI tract
  4. Discontinuous, “skip” lesions
2. (Hart & Ng, 2015)
  1. varied mucosal ulcerations
    1. burrow gut wall
      1. fistula
    2. narrowed lumen
      1. obstruction
    3. cobble stone apperance
DIAGNOTIC TESTS
1. (Gajendran et al., 2018)
  1. Laboratories studies
    1. Serology
      1. CBC (anemia), C-reactive protein (CRP)
      2. erythrocyte sedimentation rate (ESR)
        monitor response to treatment
    2. Stool studies
  2. Imaging
    1. confirm disease location and intestinal complications.
      1. endoscopy
        obtain tissue ->pathological evaluation
      2. CT, MRI, contrast radiography
COLLABORATIVE CARE
1. Nutritional therapy
  1. (Crohn’s and Colitis Canada, 2016, 2017)
    1. No special diet →customized to fit pt.
    2. a well-balanced diet
    3. Enteral feeding
      1. insert NG tube or stomach tube
        primary therapy
        secondary treatment: malnutrition
    4. Total parenteral nutrition (TPN)
      1. when oral & enteral feeding is inadequate
    5. supplements
      1. Calcium citrate, Iron, Vitamins D, and B12, Folic acid,
  2. (Karakashian & Schub, 2018)
    1. eliminate certain foods (e.g., bulky grains, hot spices, alcohol, milk products)
      1. prevent worsening diarrhea, cramping
NURSING INTERVENTIONS
1. Total parenteral nutrition (TPN)
  1. ( General Surgery North York General Hospital, 2013)
    1. extended bowel rest
      1. during exacerbation; pre-operation.
    2. NOT compatible with any other solutions
      1. be administered by itself
    3. NOT obtain blood samples from same port as TPN infusions.
    4. Do not abruptly discontinue
      1. HYPOGLYCEMIA RISK
  2. (Robertson, 2014; General Surgery North York General Hospital, 2013)
    1. RISKS
      1. Administration-related
        Pneumothorax; Fluid excess/ pulmonary edema.
        Monitor VS closely
        sepsis, embolism, catheter occlusion
      2. Formulation-related
        nutritional imbalance; electrolyte imbalance
        hypoglycemia, hyperglycemia
        monitor blood glucose
2. Patient teaching
  1. Ostomy care
    1. (Crohn’s and Colitis Canada, 2017)
      1. examine stoma daily
        healthy stoma
        moist, dark pink to red
        skin around stoma
        no redness or sores
      2. Empty pouch when 1/3 full
      3. Change pouch & skin barrier
        if irritated->change skin barrier right away
        regularly: at least 1-2X/week
      4. not limited to sport and work
        if physician says "all clear"
      5. normal to experience diarrhea or constipation
        Diarrhea → avoid foods make feces more watery
        Constipated→ drinking fruit juices
  2. Diet
    1. (Crohn’s and Colitis Canada, 2017)
      1. In remission
        eating a well-balanced diet
        no need to avoid any particular kind of food
      2. During flare-up
        modify diet, avoid aggravating gut
        avoid trigger foods
        Avoid Alcohol, Sugar, Fructose, Caffeine, Greasy food
        Eat smaller meals, q2-3h
        Avoid drinking a lot of fluid during a meal
        Reduce fat intake
3. Overall goals (Cope, 2015)
  1. induce & maintain remission
  2. prevent complications

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IBD-Crohn's Disease

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