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Medical 4-MS61-Crohn's Disease


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What is Crohn's disease?
an idiopathic (cause of disease uncertain) inflammatory disease of the small intestine (60%), the colon (20%), or both...
slowly progressive and recurrent disease with predominant involvement of multiple regions of intestine with normal sections between
What part of the body does Crohn's disease affect?
all layers of the bowel but most commonly involves the terminal ileum
How is Crohn's disease characterized?
as chronic, nonspecific inflammation of entire intestinal tract, with terminal ileum most often affected...
eventually deep fissures and ulcerations develop and often extend through all bowel layers, predisposing the individual to the development of bowel fistulas...results in severe diarrhea and malabsorption of vital nutrients
What are the chronic pathologic changes of Crohn's disease?
thickening of bowel wall, resulting in narrowing of bowel lumen and strictures
What happens to the bowels in advanced stages of Crohn's disease?
bowel mucosa has nodular swelling (granulomas) intermingled with deep ulcerations
What is more common in UC, but can be seen in Crohn's as well?
What is more common in Crohn's disease than UC?
severe malabsorption by small intestine
What may develop in the small bowel and colon after 15 to 20 years?
_________ formation is a common complication of Crohn's disease.
Where do fistulas occur with Crohn's disease?
between segments of the intestine or manifest as cutaneous fistulas or perirectal abscesses; can also extend from bowel to other organs and body cavities, such as bladder or vagina
Twenty to 30% of individuals with Crohn's will develop____________ obstruction. It initially results from ________ and ________ and becomes fibrotic, causing narrowing, then obstruction.

___________ __________ may be a cause of Crohn's disease.
Mycobacterium paratuberculosis
The most widely accepted cause of Crohn's is a combination of reasons --
a defect in immunoregulation of inflammation in intestinal tract along with a _________ predisposition for disease.'s hereditary
Peak ages for Crohn's is?
15 and 40 years of age
Exact cause unknown, what is Crohn's disease aggravated by?
bacterial infection
smoking cessation
What history findings may be present when assessing patient?
abdominal pain
loose stools
possible unintentional loss
of weight and frequency,
consistency, and presence
of blood in stool
When performing an abdominal assessment for Crohn's, look for symptoms that are the same as _______ ________.
acute appendicitis
ex: tenderness
guarded movement
palpable mass in right
lower quadrant
When INSPECTING abdomen, assess for _________ masses
or visible _________.
INSPECTION of perianal area may reveal _________ or ________.
During AUSCULTATION, bowel sounds may be _______ or ________ if inflammation is severe or there is obstruction.
Upon AUSCULTATION, there may be an increase in _______-________ or rushing sounds over areas of narrowed bowel loops.
Upon PALPATION of abdomen, there may be?
muscle guarding
What do most clients report with presenting with Crohn's disease?
abdominal pain
low-grade fever (commonly
present with fistulas
and severe inflammation)
How often does diarrhea occur if disease is present only in the ileum?
five or six times per day, often with a soft, loose stool..

steatorrhea (fatty diarrheal
stools) is common

rarely does stool contain bright red blood
Patients may experience _________ pain before and after bowel movements.
If lower colon is diseased, pain is often experienced in both _______ abdominal quadrants.
_____ _____ is experienced in about 80% of Crohn's.
Weight loss
Patients often experience nutritional problems as a result of increased catabolism secondary to?
chronic inflammation
self-imposed dietary

results in fluid and electrolyte imbalances and protein, iron, vitamin, and mineral deficiencies
How does marked inflammatory bowel changes affect the small bowel's ability to absorb nutrients, which is worsened by surgery and fistulas
decreases its ability to absorb nutrients.
To minimize life-threatening complications, it is very important for the nurse to detect manifestations of?
bowel obstruction
nutritional and fluid
The psychosocial aspect of Crohn's is important to assess because?
of numerous lifestyle changes that must be made...assess coping skills and support systems
Are there disease-specific tests that can diagnose Crohn's?
Results of lab tests for Crohn's reflect extent and severity of ________ associated with disease.
How might H & H be affected if bleeding is present?

How about serum levels of folic acid and cobalamin (vitamin B12 group) be affected?


Amino acid malabsorption may result in decrease of _______ level.
decreased levels

decreased...which further contributes to?


What does an elevated ESR (erythrocyte sedimentation rate) indicate?

infection...and what might that be caused by?

bowel to bladder fistula
If signficicant diarrhea is present, the client will experience what electrolyte losses?
More specific diagnostic information might be found with what studies?
contrast barium enema
upper GI series
What can x-rays show with Crohn's disease?
narrowing, ulcerations, strictures, fistulas
If patient is in acute stage of Crohn's, which studies might be delayed to avoid perforation?
contrast barium enema
upper GI series
Which test is used to diagnose when the others are not definitive for Crohn's?
Because GI secretions are high in volume, electrolytes, and enzymes, what is the client at risk for? (3)
Antidiarrheals should be given with precaution, but due to the loss of fluid related to diarrhea, the patient may be rx'd?
diphenoxylate hydrochloride or atropine sulfate (Lomotil)
How many calories per day does the client need to promote healing of the fistula?
3000 daily...probably given TPN if client can't take in appropriate amount
What can the nurse do to assist a patient who has a fistula and is trying a TPN diet?
monitor patient's tolerance
to diet
help patient select high-
calorie, high-protein,
high-vitamin, low-fiber
record food intake for
accurate calorie count
For skin care of ostomies, refer to Medical 4-MS61-Ileostomy Care

be sure to measure effluent (drainage)
Patients with fistulas are at extremely high risk for?
intra-abdominal abscesses and sepsis
Subtle signs of infection or sepsis from fistula formation are? (3)
abdominal pain
change in mental status
Alternative therapies for treating Crohn's are?
herbs (ginger and peppermint
ayurveda (a combination of
diet, herbs, yoga,
Reasons for undergoing surgery for Crohn's includes?
failure on medical
fistula complications
massive hemorrhage
intestinal obstruction
(often caused by stricture)
adenocarcinoma (rare)
adeno means gland in Greek
What are the advantages of performing laparoscopy if this is the surgical method chosen over an open method?
minimally invasive
smaller incisions
less postop pain
quicker recovery
What is resected in a laparoscopy procedure?
small bowel (usually ileum)
What is stricturoplasty?
performed for bowel strictures related to Crohn's disease
What does stricturoplasty involve?
incising along length of the stricture and suturing the incised area on the hz plane...preop and postop care similar to other abdominal surgeries
Discharge care for Crohn's is similar to that of?
ulcerative colitis
What might the nurse teach the patient about home care?
manage nutrition
supplies for wound and
fistula care
easy access to bathroom
easy access to kitchen with
readily prepared food
The teaching plan for Crohn's disease is similar to that of?
Teaach client about?
usual course of disease
symptoms of complications
when to notify HCP
medication teaching
INCLUDE B12 vitamins as
ileum can't absorb
follow low-residue, high-
calorie diet and avoid
discomforting foods such
as milk, gluten, and
other foods that cause
GI stimulation
rest periods a must
stress management required
colonoscopies at regular
intervals can detect
changes in mucosa for
possible development of
fistula (ostomy) care

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