CROHNS DISEASE

CROHNS DISEASEAnatomy and Physiology &PathophysiologyDefinition

Crohns disease, also known as crohn syndrome and regional entiritis, is a type of inflammation bowel disease that may affect an part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms, It primarily causes abdominal pain, diarrhea, vomiting or weight loss, but may also cause complication outside the gastrointestinal tract such as anemia, skin rashes, arthritis, inflammation of the eye ,tiredness and lack of concentration

Anatomy and Physiology of GI Tract

Mucosal Lining of the GI Tract

Pathophysiology Predisposing FactorsAgeRace/EthnicityGeneticEnvironmental (Smoking, Diet, LifestylePrecipitating FactorsMicrobesImmune/Inflammatory ResponseNSAIDSAppendectomy

Abnormal epithelial/mucosal barriersIncreased ANTIGENSUncontrolled Mucosal Inflammation Activation of Inflammatory Helper T Cells Release of Cytokinens TNF (Tumor Necrosis Factor) alpha Ulceration and Tissue/Bowel InjuryIleocolitisDiarrhea & cramping/pain of abdomenWeight lossIleitisDiarrhea & cramping/pain of abdomenWeight lossGastroduodenal crohns diseaseLoss of appetiteWeight lossNausea & vomitingJejunoileitisMild to intense abdominal pain & crampsDiarrheaCrohns (granulomatous) colitisDiarrheaRectal bleedingSkin lesionsJoint painsCOMPLICATIONS Malabsorption of nutrients, Intestinal bleeding, Disease of Anus (Abscess ,fistula, ulcers), Bowel Obstruction, Perforation of Colon, massive distention/dilatation of colon, erythema, ulcerating skin, visual difficulties, uveitis, Increased risk of cancer5Inflamed Mucosal Lining of Intestine

Cobblestones

AssessmentPatients history and presenting sign and symptoms:26 yrs old womanAbdominal pain NauseaConstipation alternating with periods of diarrhea.Pain in her jointsskin lessionsTirednessDepression

Dietary history

Eating fried foods and some fruits and vegetables worsen her condition.

Nursing Diagnosis: 1. Imbalance Nutrition less than body requirement related to restricted nutrient intake

2. Acute pain related to increase peristalsis.3. Anxiety to crisis situation and changes in health status.4.Diarrhea related to effect of inflammatory changes of the bowel.PlanningNutrition imbalance

Acute pain

In I week of nursing care patient able to demonstrate lifestyle changes to regain and maintain appropriate weight.In 1 week of nursing care patient able to demonstrate effective coping and able to participate the diet therapy.Anxiety to crisis situation and changes in health status.

Diarrhea In 1 week of nursing care patient able to determine the benefits of the diet therapy

In 1 week of nursing care patient able to tell the changes of her health status based on restricted food intake.In 1 week of nursing care patient will report of reduction of frequency of stool.Nursing interventionWeight dailyEncourage bedrestRecommended rest before mealProvide oral hygieneServe food in well-ventilated, pleasant surrounding, with unhurried atmosphere, congenital company.

Avoid limit foods that can cause abdominal pain.e.g milk product, high in fiber or fat and etc.Record intake and changes in symptomatology

Promote patient participation in dietary planning as possibleResume/advance diet as indicated, e.g., clear liquids progressing to bland diet.

Acute painEncourage patient to report painAssess report of abdominal cramping or pain