IBD-Crohn's Disease

IBD-Crohn's Disease

1. PATHOPHYSIOLOGY

   • (Mazal, 2014)
     • unknown cause
     • progressive, systemic autoimmune disorder
     • abnormal inflammation of any parts of GI tract
     • Discontinuous, “skip” lesions
   • (Hart & Ng, 2015)
     • varied mucosal ulcerations
       • burrow gut wall
         • fistula
       • narrowed lumen
         • obstruction
       • cobble stone apperance

2. DIAGNOTIC TESTS

   • (Gajendran et al., 2018)
     • Laboratories studies
       • Serology
         • CBC (anemia), C-reactive protein (CRP)
         • erythrocyte sedimentation rate (ESR)
           • monitor response to treatment
       • Stool studies
     • Imaging
       • confirm disease location and intestinal complications.
         • endoscopy
           • obtain tissue ->pathological evaluation
         • CT, MRI, contrast radiography

3. COLLABORATIVE CARE

   • Nutritional therapy
     • (Crohn’s and Colitis Canada, 2016, 2017)
       • No special diet →customized to fit pt.
       • a well-balanced diet
       • Enteral feeding
         • insert NG tube or stomach tube
           • primary therapy
           • secondary treatment: malnutrition
       • Total parenteral nutrition (TPN)
         • when oral & enteral feeding is inadequate
       • supplements
         • Calcium citrate, Iron, Vitamins D, and B12, Folic acid,
     • (Karakashian & Schub, 2018)
       • eliminate certain foods (e.g., bulky grains, hot spices, alcohol, milk products)
         • prevent worsening diarrhea, cramping

4. NURSING INTERVENTIONS

   • Total parenteral nutrition (TPN)
     • ( General Surgery North York General Hospital, 2013)
       • extended bowel rest
         • during exacerbation; pre-operation.
       • NOT compatible with any other solutions
         • be administered by itself
       • NOT obtain blood samples from same port as TPN infusions.
       • Do not abruptly discontinue
         • HYPOGLYCEMIA RISK
     • (Robertson, 2014; General Surgery North York General Hospital, 2013)
       • RISKS
         • Administration-related
           • Pneumothorax; Fluid excess/ pulmonary edema.
             • Monitor VS closely
           • sepsis, embolism, catheter occlusion
         • Formulation-related
           • nutritional imbalance; electrolyte imbalance
           • hypoglycemia, hyperglycemia
             • monitor blood glucose
   • Patient teaching
     • Ostomy care
       • (Crohn’s and Colitis Canada, 2017)
         • examine stoma daily
           • healthy stoma
             • moist, dark pink to red
           • skin around stoma
             • no redness or sores
         • Empty pouch when 1/3 full
         • Change pouch & skin barrier
           • if irritated->change skin barrier right away
           • regularly: at least 1-2X/week
         • not limited to sport and work
           • if physician says "all clear"
         • normal to experience diarrhea or constipation
           • Diarrhea → avoid foods make feces more watery
           • Constipated→ drinking fruit juices
     • Diet
       • (Crohn’s and Colitis Canada, 2017)
         • In remission
           • eating a well-balanced diet
           • no need to avoid any particular kind of food
         • 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
   • Overall goals (Cope, 2015)
     • induce & maintain remission
     • prevent complications

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