ETIOLOGY

 Idiopathic/ Unknown
NON-MODIFIABLE RISK
MODIFIABLE RISK FACTORS  Faulty immune system
FACTORS
 Smoking
 Medications  Age
 Diet  Ethnicity
 Genetic Predisposition
 Family History of crohn’s Disease
 Dysregulated immune response

PATHOPHYSIOLOGY
Crohn’s Disease

Genetic Susceptibility
Systemic Immune response
primarily against GI tract

Inflammatory cytokines Inflammation of Gastrointestinal Chronic Inflammation

destroy the epithelial cells of
GIT.
Cell apoptosis and Ulceration
Bloody Diarrhea
track lining
Dysregulated wound
Inflammation is oral mucosa healing
to anal mucosa in skip lesion
pattern.
Excess extracellular
matrix deposition.
Increase Permeability of BV
supplying GIT
Fibrosis

Leakage of Fluid out of

capillaries into GIT Tissue scarring and
thickening of all layers of
GIT.
Lumina edema and swelling

Structures
Narrowing of GI lumen

Stomach Upset
Bowel Obstruction

Abdominal Nausea & Loss of

cramping and pain Vomiting Appetite

Fatigue
 CLINICAL MEDICAL DIAGNOSIS DIAGNOSTIC TESTS
MANIFESTATIONS Crohn’s Disease
 Endoscopy
-Period of abdominal
 Imaging Test
cramps especially after
 Fecalysis
eating. Medical & OR/Surgical Management
 Colonoscopy
- Pain along with bouts
Anti- Inflammatory Drugs  biopsy
of bloody diarrhea.
- Pain while passing
 Corticosteroid
stools.
- Loss of appetite and  Prednisone
weight loss.  Budesonide
- passing 10 watery
Biologics
stools per day and
complain of pain while  Natalizumab (tysabri) & Vedolizumab (Entyvio)
passing stools.
- Complains of fatigue, Antibiotics
anorexia, nausea &
vomiting.  Ciprofloxacin & Metronidazole
Others
 Anti-Diarrheals
 Pain Relievers
 Vitamins & supplements
Surgical Management
 Laparoscopy
 Strictureplasty
 Subtotal Colectomy

SIGNIFICANCE/ PERTINENT FINDINGS

- Abdominal cramps especially after eating meals.

- Pain along with bouts of bloody diarrhea.
- Loss of appetite and weight loss.
- 10 Watery stools per day.
- Passing 10 watery stools per day and complain of pain while passing stools.
- Complains of fatigue, anorexia, nausea & vomiting.
- Regular smoker.
- Family history of IBD (father died because of IBD).
- Low Protein.
- Low Albumin.
- Decreased level in Hgb.
- CT scan shows bowel wall thickening and fistula formation.
- Barium enema showed ulceration, fissures, and fistulas.
 NURSING DIAGNOSIS
Acute pain related to gastric tissue irritation as evidenced abdominal
cramping and pain along bouts of bloody diarrhea.

NURSING INTERVENTIONS
INDEPENDENT
-Position the client in the left position with knees flexed. To reduce abdominal tension and promote sense
of control.
-Check the patient vital signs & characteristics of pain at least 30 minutes after administration of medication.
To Reduce stress levels, thereby relieving the symptoms of crohn’s disease especially stomach pain
heartburn.
-Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated
drinks, alcohol and high fiber, high fat foods.To relieve abdominal pain and cramping, alleviate
diarrhea, and healthy food habits.
-Review factors that aggravate or alleviate pain. May pinpoint precipitating or aggravating factors (e.g.,
stressful events, food intolerance) or identify developing complications.
-Encourage client to report pain. May try to tolerate pain rather than request medication.
DEPENDENT
Administer medications prescribed by the physician as ordered. To decrease and Reduce Inflammation

COLLABORATIVE
Implement prescribed dietary modifications. Commence with liquids and increase to solid foods as tolerated.
Bowel rest can reduce pain and cramping.

EXPECTED OUTCOME
Short Term Goal:
After 30 minutes of
Nursing intervention, patient’s will be relieve from abdominal pain .
 DISCHARGE PLAN
M-EDICATION:
Remind patient to take medication as directed by the doctor and do not skip doses. .
Anti-inflammatory Drugs
Azathioprine (Azasan)
Mercaptopurine (Purinethol
Methotrexate (Trexall)

E-NVIRONMENT/EXERCISE:
Inform patient to refrain from exercising and doing physical activity if it aggravate symptoms of gastric ulcer.
Advise patient to avoid places with secondhand smoke source and avoid smoking. 

T-REATMENT:
Remind patient to take medication as prescribed by the physician.
Remind patient to don’t stop medicines without talking with his doctor.

H-EALTH TEACHING:
● Remind patient to take a rest and avoid being stress.

● Try eating several small meals a day instead of 3 large ones.

● Encourage smoking and alcohol cessation

O-UTPATIENT CONSULTATION:
● Remind patient to attend follow up appointment and consult a doctor if she is having uncomfortable feeling.

D-IET:
● Low residue food (bland diet) High Protein Diet.

● Increase fluid intake

● Monitor food intake that irritate the bowel. These may include caffeine (coffee, tea, and cola), spicy foods,
milk products, and raw fruits and vegetables

S-PRITIUAL/SUPPORT SYSTEM:
Encourage to seek support with family or friends, get counselling if needed


 NURSING CARE PLAN
NURSING CARE PLAN Diagnosis Acute Pain related to inflammation in the gastric mucosa as Patient’s
evidenced by burning pain in the stomach and pain scale of 8/10 Initials:

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Short Term INDEPENDENT: Short Term
No subjective Goal: -Position the client in the -To reduce abdominal Goal:
cues Acute pain left position with knees tension and promote
related to After 30 minutes flexed. sense of control. After 30 minutes
Objective: gastric tissue of     of
- Rigid body irritation as Nursing -Check the patient vital -To Reduce stress Nursing
posture evidenced intervention, signs & characteristics of levels, thereby intervention,
- Abdominal abdominal
patient’s will be pain at least 30 minutes relieving the patient relieved
Guarding cramping and
relieve from after administration of symptoms of crohn’s from abdominal
- Facial Grimace pain along
bouts of abdominal pain medication  disease especially pain
bloody .   stomach pain
diarrhea heartburn 

-Encourage client to -May try to tolerate

report pain.
-Help the patient to select
appropriate dietary
choices to reduce the
intake of milk products,
caffeinated drinks, alcohol
and high fiber, high fat
foods.
-Review factors that
aggravate or alleviate
pain.
-Provide comfort
measures (e.g., back rub,
reposition) and
diversional activities.
DEPENDENT:
-Administer medications
prescribed by the
physician as ordered.
pain rather than
request medication.
  
-To relieve abdominal
pain and cramping,
alleviate diarrhea, and
healthy food habits.
-May pinpoint
precipitating or
aggravating factors
(e.g., stressful events,
food intolerance) or
identify developing
complications.
-Promotes relaxation,
refocuses attention,
and may enhance
coping abilities.
-To decrease and
Reduce Inflammation

COLLABORATIVE:
-Implement prescribed -Bowel rest can reduce
dietary modifications. pain and cramping.
Commence with liquids
and increase to solid foods
as tolerated.
 NURSING CARE PLAN
NURSING CARE PLAN Diagnosis Risk for imbalanced Nutrition: less than body Patient’s Initials:
requirements possibly evidenced by associated conditions of
inability to ingest food or absorb nutrients.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Imbalance INDEPENDENT: Short term goal:
No subjective Nutrition: less Short term goal: -Monitor weigh daily -Provides After 1 to 2 hours
cues. than body After 1 to 2 hours   information about of nursing
requirements of nursing   dietary and intervention the
Objective: may be intervention the   monitor patient was able to:
─ Weight loss related to patient will be effectiveness of ─ improve
─ Loss of appetite inability to able to: therapy hydration status
─ diarrhea absorbed ─ improve   ─ increase
nutrients as hydration status -Monitor frequency -To evaluate nutritional status
evidenced by ─ increase and consistency of volume losses and ─ gradually
loss of nutritional status stools check for the increase activity
appetite and ─ gradually   presence of blood within level of
weight loss increase activity     ability
within level of -Instruct the patient -To decrease  
ability to avoid or limit abdominal  
  foods that might cramping and  Long term goal:
  Long term goal: cause or exacerbate alleviate diarrhea. After 3 days of
After 3 days of abdominal cramping These food can nursing
nursing like caffeinated make your intervention the
intervention the beverages, symptoms worse patient will be able
patient will be chocolates, orange to:
able to: juices. ─ demonstrate
 ─ achieve -To create baseline progressive weight
progressive -Evaluate the of the patients gain
weight gain patients nutritional nutritional status ─verbalize selection
─verbalize daily food intake and and preference of foods or meals
selection of foods habits.   that will achieve a
or meals that will -To avoid cessation of weight
achieve a -Encourage dehydration loss
cessation of adequate fluid intake because of
weight loss diarrhea

Dependent Dependent
-Administer -To reduce the
medicines such as number of bowel
antidiarrheal as movement the
prescribed patients have each
  day.
 

-To effectively
monitor the
patients daily
-Create a daily nutritional intake
weight chart and a and progress in
food and fluid chart. weight goals
-Discuss with the  
patient the weight -NPO status can
goals help rest the bowel
  by decreasing
-Start the patient on peristalsis and
a NPO status, and diarrhea. Gradual
gradually progress to progression from
clear liquids, NPO up to a low fat
followed by bland and low fiber diet
diet, and low residue can help manage
diet. the symptoms.

Collaborative
-To provide a more
specialized care for
Collaborative the patient in
-Refer patient to terms of nutrition
dietitian and diet.
 NURSING CARE PLAN
NURSING CARE PLAN Diagnosis Patient’s Initials:

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Risk for INDEPENDENT: Short term goal:
No subjective Deficient Fluid Short term goal: Ascertain onset and -Provides After 30 minutes of
cues. Volume After 30 minutes pattern of diarrhea, information about nursing
related to of nursing noting whether dietary and intervention the
Objective: Excessive intervention the acute or chronic monitor patient will be able
─ Weight loss losses through patient will be effectiveness of to:
─ Loss of appetite normal routes able to: Obtain history and therapy ─ improve
(severe
─ diarrhea ─ improve observe stools dor   hydration status
frequent
hydration status volume, frequency -To evaluate
diarrhea,
vomiting) volume losses and -Verbalize
-Verbalize Notes reports of check for the understanding of
understanding of abdominal or rectal presence of blood causative factors
causative factors pain associated with   and rationale for
and rationale for episodes -To decrease treatment regimen.
treatment abdominal
regimen. Notes reports of cramping and
thirsts, less frequent alleviate diarrhea.
or absent urination, These food can
   dry mouth and skin, make your
weakness, light symptoms worse
headedness and
headaches.
-To promote return
-Increase oral fluid to normal bowel
intake and return to functioning
normal diet, as
tolerated.
 
-Review laboratory -Chronic diarrhea
studies for may require more
abnormalities. invasive testing,
  including upper
  and/or lower
gastrointestinal
radiographs,
ultrasound,
endoscopic
evaluations,
biopsy, and so on.

Dependent
-To allow for
bowelrest and
reduced intestinal
workload
 
-IV fluids may be
needed either
Dependent short term to
-Restrict solid food restore hydration
intake, as indicated status (e.g., acute
gastroenteritis) or
long term (severe
osmotic diarrhea).
-Administer IV fluids, Enteral or
electrolytes, enteral parenteral
and parenteral nutrition is
fluids, as indicated reserved for clients
unable to maintain
adequate
nutritional status
because of long-
term diarrhea (e.g.,
wasting syndrome,
malnutrition
states)

Collaborative
To avoid foods or
substances that
precipitate
diarrhea.
 
-

Collaborative
-Provide for changes
in dietary intake
DRUG STUDY