According to a 2003 article in the journal "RN," Crohn's disease is one of the two most common forms of inflammatory bowel disease. It is characterized by sudden, unpredictable bouts of diarrhea and abdominal pain. Crohn's disease can affect a person at any age, but those between the ages of 15 and 35 years are most susceptible.
Causes
Crohn's disease has no single confirmed cause. One theory is that the body reacts aggressively to an unidentified virus or bacteria by causing inflammation of the intestine. According to James Veronesi, R.N., genetics, age, race and ethnicity may play a role. A patient who has a relative with the disease is 10 times more likely to develop the disease than someone who does not. Diet is not the cause of Crohn's disease, but dietary modifications are essential for controlling symptoms.
Symptoms
If you care for patients with Crohn's disease, you should know the symptoms associated with the condition. Patients present with a low-grade fever, malaise, weight loss and intermittent nonbloody diarrhea. Abdominal pain may be either cramping or steady. Patients may experience bloating and hyperactive bowel sounds after meals.
On examination of the abdomen, a Crohn's patient may have a tender, palpable abdominal mass in the lower right quadrant. This mass is an indication of a thickened and inflamed intestine. Patients with Crohn's disease can develop fissures, perianal abscesses and fistulas. A high fever and chills could be signs of infection from the development of abscesses or a fistula. Veronesi also notes that Crohn's patients are at risk for developing gallstones and pancreatitis.
Treatment
Nursing care for patients with Crohn's disease focuses on adequate nutrition, proper fluid and electrolyte balance, pain relief and psychosocial support. Patients frequently require intravenous fluids and medications to treat acute episodes of the illness. Corticosteroids, the most commonly prescribed medications for Crohn's disease, decrease inflammation and control symptoms.
During medical management, remember that impaired absorption of oral medications is likely owing to the patient's irritated and inflamed bowel. When medical management fails, patients may require surgical resection of the diseased area of bowel and a temporary colostomy.
Patient Education
Encourage your patients to maintain a low-residue diet that is low in fiber and fat but high in calories, protein and carbohydrates. Teach patients to keep a list of foods that increase symptoms so that they can avoid them during flare-ups of the disease. Eating smaller, more frequent meals may also help decrease symptoms.
Encourage your patients to consume a minimum of 1,000 mL of fluid every 24 hours and even more during periods of diarrhea. Excessive diarrhea can cause electrolyte imbalances, and patients should monitor their health closely during these episodes. If your patient has a an ostomy, provide instruction on preventing odor and minimizing diarrhea, which will eliminate embarrassment for them.
Dietary Recommendations
An article in "Better Nutrition" notes that the most common problem foods for patients with Crohn's disease are those that include nuts and seeds, raw fruit and vegetables and leafy greens. Foods containing caffeine and as well as spicy foods may also aggravate symptoms. Crohn's patients can obtain adequate calories and nutrients from meats, fish, poultry and eggs. Cooked fruits and vegetables without skins or seeds are also generally well tolerated, especially butternut squash, sweet potatoes, carrots, asparagus and spinach.
References
- "RN"; Defenses Gone Awray: Inflammatory Bowel Disease; J. Veronesi; May 2003
- 'Nutrition and Diet Therapy"; C. Lutz.; K. Przytulski.; 2011
- "Better Nutrition"; Nutritional Rx for Crohn's and Colitis; Ligaya Figueras; May 2010
