Crohn’s Disease

Submitted by Lilly Gareau, BSN, RN-BC

Tags: Chron's disease patient symptoms treatment

Crohn’s Disease

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Over the past five years, my closest friend has suffered from the chronic inflammatory bowel disease (IBD) known as Crohn’s disease.  Sadly, I have watched the disease affect both her physical and mental health.  My friend has been in and out of hospitals and clinics in order to better manage her symptoms. She has gone through numerous diagnostic tests, screenings, procedures, and treatments.  Crohn’s disease, affects more than half a million people in the United States, and the exact cause of the disease is still unknown (National Institute of Diabetes and Digestive and Kidney Disease [NIDDK], n.d.).  It is important to better understand Crohn’s disease and the symptoms, diagnosis, management, and treatment related to the disease in order to provide high-quality nursing care and education.

Identification

Crohn’s disease is an inflammatory bowel disease (IBD), similar to ulcerative colitis (UC), which affects the gastrointestinal tract.  Crohn’s disease usually affects the end of the small intestine and the beginning of the colon, but it can affect any part of the gastrointestinal tract.  It affects the entire thickness of the bowel wall which cause patches of inflammation in the intestine.  UC is different because it affects only the large intestine, and it involves the innermost lining of the colon (Crohn’s and Colitis Foundation, n.d.).  Crohn’s disease thickens the wall of the intestines, which can block the movement of food or stool in the intestines.  The inflammation of the disease can affect the inside of the intestinal walls creating fistulas, which create abnormal tunnels that can become infected.  The inflammation can also create abscesses, anal fissures, and ulcers in the mouth, intestines, perineum, or anus (Crohn’s and Colitis Foundation, n.d.). The inflammation of the disease can inflame other areas of the body and affect the absorption of nutrients in the intestines leading to malnutrition (Seyedian et al., 2019).

Etiology

The specific cause of Crohn’s disease is unknown.  Researchers have suggested that genetics and environmental factors play a large role in inflammatory bowel disease.  Studies have shown that inflammatory bowel diseases can depend on the patient’s susceptibility, mucosal immunity, and the microflora of the intestine (Seyedian et al., 2019).  Crohn’s disease may be an autoimmune reaction where bacteria in the digestive tract trigger the immune system. Research has also shown that there is a higher chance of developing Crohn’s disease if a parent or sibling has the disease (NIDDK, n.d.). Diet and nutrition, such as a high-fat diet, can also affect the prevalence of IBD (Seyedian et al., 2019). Other factors that could increase the chance of IBD or Crohn’s disease, include smoking, nonsteroidal anti-inflammatory drugs, antibiotics, and birth control pills (NIDDK, n.d.).

Diagnosis

The most common symptoms of Crohn’s disease include diarrhea, cramping, pain, and weight loss.  Other symptoms include anemia, eye redness, blood in stool, mouth sores, weakness, fatigue, fever, joint pain, nausea, loss of appetite, and skin change (Mayo Clinic, n.d.).  Crohn’s disease is first assessed using the presenting signs and symptoms and a physical exam. Diagnostic tests, such as blood tests, stool tests, computed tomography scans, and intestinal endoscopies can help diagnose Crohn’s disease (NIDDK, n.d.).  Fecal calprotectin is the most sensitive screening test for IBD.  Other medical examinations used for diagnosis include barium X-ray imaging, radiological tests, sigmoidoscopy, colonoscopy, upper endoscopy, and capsule endoscopy (Seyedian et al., 2019).  Combinations of these tests and exams are usually used in order to help diagnose Crohn’s disease.  Many individuals experience an array of symptoms, and the symptoms usually develop gradually.  Crohn’s disease is a progressive disease that begins with mild symptoms.  By treating and managing the disease in the early stage, the patient will reduce the risk of developing severe symptoms.

Treatment

Crohn’s disease can be treated using a variety of treatment options; however, there is currently no cure to fully treat the disease.  Anti-inflammatory drugs are the first step in treating the disease.  Corticosteroids and oral 5-aminosalicylates help reduce and control inflammation in the intestines (Seyedian et al., 2019).  Immune system suppressors, such as azathioprine and methotrexate, also help reduce inflammation by reducing immune system activity (NIDDK, n.d.). Antibiotics can help reduce the number of harmful bacteria in the gut and sometimes heal fistulas and abscesses.  Some antibiotics such as amoxicillin, ciprofloxacin, metronidazole, and azithromycin can improve the symptoms of Crohn’s disease (Seyedian et al., 2019).  It is important to control inflammation, while also using medications to help relieve signs and symptoms.  Pain relievers, antidiarrheals, iron supplements, and multivitamins may be recommended (Mayo Clinic, n.d.). 

Surgery may be necessary for patients who develop bowel complications from Crohn’s disease.  Complications include bowel perforation, abscess, intestinal obstruction, fistulae, and hemorrhage.  Surgery may also be needed for patients who do not respond to medications and lifestyle changes (Seyedian et al., 2019).  Surgeries include small bowel resection, colectomy, proctocolectomy, and ileostomy (NIDDKA, n.d.). During surgery, the damaged portion of the digestive tract is removed, and the healthy sections are connected together. Surgery can also help close fistulas and drain abscesses.  One study found that nearly 60 percent of people had surgery for Crohn’s disease within twenty years of having the disease.  Surgery does not cure the disease, but it does help to relieve symptoms and treat complications (NIDDK, n.d.).

Nutrition and Diet

Although the relationship between nutrition and Crohn’s disease is still being researched, nutrition may play a role in the prevention and management of the disease. Nutrition plays an important role in managing and relieving the symptoms of Crohn’s disease, and the patient must make changes in order to understand food items that irritate the disease.  Diet changes include avoiding carbonated drinks, avoiding high-fiber foods, drinking more liquids, eating small meals, and keeping a food diary to help identify foods that cause problems. Other diet recommendations are a diet that is high calorie, lactose-free, low fat, low fiber, and low salt (NIDDKA, n.d.). Diet is important in the management of the disease because malnutrition affects 65-75% of Crohn’s disease patients (Caio et al., 2021).

Nutritional complications associated with Crohn’s disease include drug-nutrient interactions, disease position, symptoms, and insufficient dietary restrictions.  The complications can impact the patient’s health, nutritional status, and quality of life (Rosso et al., 2021).  Because nutritional therapy is an important treatment for Cohn’s disease, patients often have a full liquid diet in order to meet the patient’s nutrient needs. Exclusive enteral nutrition (EEN) can also be used in patients with Crohn’s disease. Enteral nutrition can promote beneficial microflora, improve bile acid metabolism, and decrease microorganisms influencing disease and immune activity (Hansen & Duerksen, 2018).  Eternal feeding is often the first-line therapy for children because it is a non-steroid alternative, helps with weight gain, and improves nutritional intake (Rosso et al., 2021).

Nursing Assessment

The nursing assessment of Crohn’s disease begins with a health history assessment.  It is important to use subjective data in order to understand the symptoms relating to the disease.  The next step of the nursing assessment is the physical examination.  The nurse should inspect for hair loss, dry skin, muscle weakness, and lethargy (NIDDK, n.d.).  The nurse should also inspect and palpate the patient’s abdomen for pain or tenders and auscultate bowel sounds.  Hyperactive sounds are noted during an inflammatory episode of Crohn’s disease.  In addition, the disease may cause psychological problems. Psychological issues include stress related to the uncertainty of the disease and concerns for potential surgery, loss of bowel control, distortion of body image, and not being able to reach the full potential of life (Rosso et al., 2021).  It is important to assess any psychosocial issues when performing an initial assessment.  

Nursing Interventions

Nurses must collaborate with a multidisciplinary team, such as physicians and dieticians, in order to provide the patient with high-quality care. The nurse must be empathetic and provide emotional support by encouraging patients to express their concerns (Rosso et al., 2021).  The primary nursing interventions for Crohn’s disease include nutritional management, nutritional therapy, and nutritional counseling.  In addition, nurses must manage fluid and electrolyte balance.  Other nursing interventions include medication management, enteral tube feeding, intravenous therapy, and total parenteral nutrition administration (Caio et al., 2021). 

The nurse must be aware of the patient’s symptoms in order to provide proper medical management.  It is important to document vital signs, hydration status, and bowel signs.  In addition, the nurse must document the response to certain medications and tolerance of foods.  The documentation of pain and the number of diarrheal episodes and stool characteristics are also important.  The nurse must be aware of the patient’s nutritional status and document the findings in order to provide the best plan of care (Caio et al., 2021). It is important for the patient with Crohn’s disease to receive an adequate amount of nutrients and calories in order to relieve symptoms and improve overall health. 

Client Education

As a nurse, it is important to learn about dietary and nutritional considerations of Crohn’s disease. A nutritional assessment should be done for every patient, especially patients showing symptoms related to Crohn’s disease.  It is also important to provide support and education for the patient (Rosso et al., 2021).  The education of Crohn’s disease allows the patient to better understand the process of the disease.  It allows the patient to gain knowledge and self-determination in order to increase self-care and coping mechanisms.  Client education includes the diagnosis and treatment options, such as medications, nutrition, and surgical interventions.  It also includes beneficial lifestyle changes such as healthy eating habits and coping mechanisms (Rosso et al., 2021).  Patient education can begin at the initial encounter between the nurse and the patient.  There are a number of teaching and learning activities that can educate the patient, such as interactive dialogue, written information, websites, and support groups (Crohn’s and Colitis Foundation, n.d.).  By educating the patient about Crohn’s disease, the patient will be able to better understand the disease in order to make informed decisions about treatment options. 

References

  1. Caio, G., Lungaro, L., Caputo, F., Zoli, E., Giancola, F., Chiarioni, G., De Giorgio, R., & Zoli, G. (2021). Nutritional Treatment in Crohn's Disease. Nutrients, 13(5), 1628. https://doi.org/10.3390/nu13051628
  2. Crohn’s and Colitis Foundation. (n.d.). Overview of Crohn’s disease. https://www.crohnscolitisfoundation.org/what-is-crohns-disease/overview
  3. Hansen, T. & Duerksen, D.R. (2018). Enteral nutrition in the management of pediatric and adult Crohn’s disease. Nutrients, 10(5), 537. https://doi.org/10.3390/nu10050537
  4. Mayo Clinic. (n.d.). Crohn’s disease: overview. https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304
  5. National Institute of Diabetes and Digestive and Kidney Disease (NIDDK). (n.d.). Crohn’s Disease. https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/all-content
  6. Rosso, C., Aaron, A. A., Armandi, A., Caviglia, G. P., Vernero, M., Saracco, G. M., Astegiano, M., Bugianesi, E., & Ribaldone, D. G. (2021). Inflammatory Bowel Disease Nurse-Practical Messages. Nursing reports (Pavia, Italy), 11(2), 229–241. https://doi.org/10.3390/nursrep11020023
  7. Seyedian, S. S., Nokhostin, F., & Malamir, M. D. (2019). A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. Journal of medicine and life, 12(2), 113–122. https://doi.org/10.25122/jml-2018-0075