Part A
Etiology
Chron’s disease (CD) is a form of inflammatory bowel disease (IBD) that causes swelling of the tissues in an individual’s digestive tract. Chron’s disease is immunologically mediated and the inflammation extends through the thickness of the bowel wall from the mucosa to the serosa (Roda et al., 2020). Inflammation caused by this disease can occur in different locations of the digestive tract but it occurs most commonly in the small intestine, particularly the distal ileum and the colon (Roda et al., 2020). The exact aetiology of this disease is unknown. Nonetheless, research suggests that the condition results from an inappropriate immune response in the bowel due to environmental factors, such as drugs, toxins, and infections.
Pathophysiology
CD can affect any part of the GIT but most commonly targets the distal ileum and proximal colon. CD occurs when there is an inflammation, fissures, or an abscess, which progresses to tiny focal apthoid ulcers (Petagna et al., 2020). The disease’s pathogenesis is based on tissue inflammation caused by an immune response against an antigen. Immune cells, such as the CD4 T-cells, NK, B-cells and the CD8 T-cells are involved in this process as they infiltrate the gut of CD patients (Torres et al., 2020). The intestinal epithelial layer has a high permeability that allows pathogens to pass through the underlying mucosa. When this happens, the immune system is triggered to produce an autoimmune reaction with persistent activation of immune cells (Petagna et al., 2020). Neutrophils and lymphocytes produce pro-inflammatory cytokines that perpetuate this inflammatory response.
Risk Factors for Chron’s Disease
One risk factor for CD is family history. An individual with a family history of this condition is highly likely to have the disease. Research shows that approximately 12% of individuals diagnosed with CD have a family history of the disease (Roda et al., 2020). Another risk factor for this condition is race. Chron’s disease is more common in individuals from Northern Europe, Anglo-Saxon, and people of the Ashkenazi Jewish descent. The Ashkenazi Jewish people are highly likely to develop this condition than individuals who are not of Jewish descent (Roda et al., 2020). The condition occurs less frequently in regions, such as Southern Europe, South America, Africa, and Asia. Non-Hispanics white people, Hispanic, Asians, and pacific islanders have the lowest risk for this disease.
Another risk factor for CD is smoking. Smokers are at a higher risk of developing this disease than non-smokers. The rationale is that smoking interferes with a person’s immune system. Smoking also worsens the signs and symptoms in individuals who have already been diagnosed with the condition (Roda et al., 2020). Another risk factor for CD is medication. Antibiotic exposure during childhood increases the risk of the disease. Additionally, medication such as oral contraceptives, aspirin, and NSAIDS increases an individual’s risk of CD.
Clinical Manifestations
There are various signs and symptoms associated with CD. These symptoms often range from mild to severe and may occur suddenly. Some of the signs and symptoms associated with CD include diarrhea, fever, fatigue, abdominal pains, abdominal cramping, mouth sores, blood in stool, reduced appetites, and pain around the anus (Roda et al., 2020). Other signs and symptoms associated with this condition include inflammation of the skin, inflammation of the liver, and iron deficiency.
Part B
Developing a care plan is essential in providing quality care to patients and managing diseases in the healthcare setting. A nurse has to develop an appropriate care plan that identifies the needs of the patient and their potential risk. The case study for this task is about a patient known as Ruth. Ruth presents to the clinic with a 7/10 abdominal pain, frequent watery diarrhea, presence of blood in their fecal matter, and a clinical history of Chron’s disease. The patient’s clinical manifestations suggest that they have Chron’s disease. Their signs and symptoms include watery diarrhea, abdominal cramping and pain, and presence of blood in stool. The nursing problems identified for this patient is the risk of dehydration and acute pain. The care plan has to address these problems to improve the patient’s outcome. This essay focuses on identify the nursing problem specific to this patient, developing a care plan for a patient diagnosed with CD, and justifying the interventions selected for this patient.
Nursing Problem
One nursing problem specific to this patient is acute pain and the risk of exacerbation of symptoms. The patient expresses abdominal cramping and pain. The patient’s pain may be related to prolonged diarrhea, fistulas, fissures, or perirectal excoriation. The patient is also at risk of exacerbation of their symptoms due to their lifestyle behavior of smoking. According to Roda et al. (2020), smoking worsens the symptoms of CD.
A potential nursing problem specific to this patient is the risk for inefficient fluid volume. The patient is at risk of dehydration due to the excessive loss of fluids through diarrhea. The patient also has blood in their fecal matter.
Person-Centered Goal and Nursing Interventions
For the nursing problem of acute abdominal pain, the person –centered goal is to ensure the patient experiences relief from pain within four hours. One nursing intervention for this problem is to provide comfort measures, such as rubbing the patient’s back and repositioning, and asking the patient to conduct diversional activities (De Barros et al., 2020). According to Sulz et al. (2020), another nursing intervention for this problem is to ask the patient to report the pain, assess reports of abdominal pain, noting the location, intensity, and the duration of pain, and noting the non-verbal cues to investigate the discrepancies with the verbal cues.
For the nursing problem of the risk of dehydration due to excess loss of fluids by dehydration, the goal is to maintain the patient’s fluid volume to required levels within 24 hours. One nursing intervention for this problem is to monitor inputs and outputs. The nurse should note the character, number, and amount of stools (Lee, 2020). They should also estimate diaphoresis, specific gravity, and observe for oliguria (Heidary & Heidari, 2022; Roda et al., 2020). Another nursing intervention for this problem is to administer parenteral fluids as indicated and monitor laboratory studies and ABGs (Shi et al., 2021). Since the patient is experiencing diarrhea, they may need fluid replacement to reduce the risk of dehydration.
Justification of the nursing Intervention
Acute Pain
One nursing intervention for the nursing problem of acute pain was to provide comfort measures, such as rubbing the patient’s back and repositioning, and asking the patient to conduct diversional activities. The justification for this intervention is to minimise the abdominal tension and promote a sense of pain control (de Barros et al., 2021). The selected nursing intervention will be useful in achieving the set goal, which is to ensure the patient experiences relief from pain within four hours.
Another nursing intervention for the problem of acute pain was to ask the patient to report the pain, assess reports of abdominal pain, noting the location, intensity, and the duration of pain, and noting the non-verbal cues to investigate the discrepancies with the verbal cues. The justification for this intervention is to assess whether the patient can tolerate the pain or needs analgesics (Torres et al., 2021). Noting the non-verbal cues and the body language of the patients will be useful in determining the degree and the severity of the patient’s pain.
Risk for inefficient fluid volume
One nursing intervention for this problem was for the nurse to monitor inputs and outputs. The nurse should note the character, number, and amount of stools. They should also estimate diaphoresis, specific gravity, and observe for oliguria. The justification for this intervention is to collect information about the patient’s overall fluid balance, bowel disease control, and renal function and the guidelines for fluid replacement (de Barros et at., 2021). Monitoring enables a nurse to track the patient’s recovery and determine the effectiveness of the therapy or treatment provided to the patient.
Another nursing intervention for this problem is to administer parenteral fluids as indicated and monitor laboratory studies and ABGs. The justification for administering these fluids is because the maintenance of bowel rest requires alternative fluid replacement to correct losses and prevent anemia (de Barros et al., 2021). Monitoring laboratory studies, such as anemia and ABGs will help the nurse to identify the fluid replacement needs of the patient and assess the effectiveness of the therapy or treatment.
Conclusion
In conclusion, CD is a form of IBD that causes swelling of the tissues in an individual’s digestive tract. Inflammation caused by this disease can occur in different locations of the digestive tract but it occurs most commonly in the small intestine, particularly the distal ileum and the colon. The exact aetiology of this disease is unknown. Nonetheless, research suggests that the condition results from an inappropriate immune response in the bowel due to various factors. The disease’s pathogenesis is based on tissue inflammation caused by an immune response against an antigen. The intestinal epithelial layer has a high permeability that allows pathogens to pass through the underlying mucosa. When this happens, the immune system is triggered to produce an autoimmune reaction with persistent activation of immune cells. The risk factors associated with this condition include race, age, medications, and smoking. The clinical manifestations include blood in stool, diarrhea, fever, and abdominal cramping. The identified nursing problem includes the risk of dehydration and acute pain. The interventions for acute pain include providing comfort measures and asking the patient to report pain. The interventions for the risk of dehydration are asking monitoring the patients and identify the fluid replacement needs of the patient.
References
de Barros, J. R., Herrerias, G. S. P., Ramdeen, M., Saad-Hossne, R., Alencar, R. A., & Sassaki, L. Y. (2021). Nursing Process in a Patient with Crohn’s Disease: Case Report. Open Journal of Nursing, 11(04), 258. http://www.scirp.org/journal/Paperabs.aspx?PaperID=108725
Heidary, S., & Heidari, H. (2022). Crohn’s disease and nursing care from a patient treated with corticosteroids: a case report. Nursing and Health Sciences Journal (NHSJ), 2(1), 1-4. https://doi.org/10.53713/nhs.v2i2.82
Lee, S. A. (2020). A Model of the Quality of Life in Patients with Crohn’s Disease. Journal of Korean Academy of Fundamentals of Nursing, 27(4), 333-343. https://doi.org/10.7739/jkafn.2020.27.4.333
Petagna, L., Antonelli, A., Ganini, C., Bellato, V., Campanelli, M., Divizia, A., … & Sica, G. S. (2020). Pathophysiology of Crohn’s disease inflammation and recurrence. Biology direct, 15(1), 1-10. https://doi.org/10.1186/s13062-020-00280-5
Roda, G., Chien Ng, S., Kotze, P. G., Argollo, M., Panaccione, R., Spinelli, A.,& Danese, S. (2020). Crohn’s disease. Nature Reviews Disease Primers, 6(1), 1-19. https://doi.org/10.1038/s41572-020-0156-2
Shi, L., Wang, L., & Cui, Q. (2021). The clinical effects of high-quality nursing interventions after a diagnosis of upper gastrointestinal bulging lesions with mEUS. American Journal of Translational Research, 13(8), 9655. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430168/
Sulz, M. C., Burri, E., Michetti, P., Rogler, G., Peyrin-Biroulet, L., & Seibold, F. (2020). Treatment algorithms for Crohn’s disease. Digestion, 101(1), 43-57. https://doi.org/10.1159/000506364
Torres, J., Bonovas, S., Doherty, G., Kucharzik, T., Gisbert, J. P., Raine, T.. & Fiorino, G. (2020). ECCO guidelines on therapeutics in Crohn’s disease: medical treatment. Journal of Crohn’s and Colitis, 14(1), 4-22. https://doi.org/10.1093/ecco-jcc/jjz180
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