WESTERN LEYTE COLLEGE OF ORMOC

CROHN’S DISEASE

Submitted by:
Mocorro, Javer
Cabcad, Camille
Abilar, Jennalyn
Solamo, Lj Franz
Tapang, Izza Mae
Omega, Mark Armin D
Apostol, Almira Venus
Lam, Christine Bridgette
Pantollana, Christian Mar
San Juan, Kristelle Jovi

Submitted to:
Mrs. Antoneth Penaflor – Lazaro
Clinical Instructor
 WESTERN LEYTE COLLEGE OF ORMOC

Contents

Crohn’s Disease.........................................................................................................................3
Classic Signs and Symptoms.....................................................................................................4
Pathophysiology.........................................................................................................................5
Diagnostic Procedures and Nursing Management.....................................................................6
Medications................................................................................................................................7
Nursing Management.................................................................................................................8
Sample Care Plan.......................................................................................................................9
 WESTERN LEYTE COLLEGE OF ORMOC
Crohn’s Disease
Crohn’s disease, also known as regional enteritis, is a chronic, relapsing inflammatory
disorder affecting the gastrointestinal tract. Crohn’s disease can affect any portion of the GI
tract from the mouth to the anus, but usually affects the terminal ileum and ascending colon.
 WESTERN LEYTE COLLEGE OF ORMOC
Classic Signs and Symptoms
The GI system involvement in Crohn’s disease can be so diverse, manifestations vary among
patients. The majority of people with Crohn’s disease experience persistent diarrhea. Stools
are liquid or semi formed and typically do not contain blood, although blood may be passed if
the colon is involved. Abdominal pain and tenderness are also common. The pain may be
located in the right lower quadrant and relieved by defecation. A palpable right lower
quadrant mass is often present. Systemic manifestations such as fever, fatigue, malaise,
weight loss, and anaemia are common. Anorectal lesions such as fissures, ulcers, fistulas, and
abscesses also are common and may occur years before intestinal disease is apparent. If the
stomach and duodenum are involved, nausea, vomiting, and epigastric pain may occur.
 WESTERN LEYTE COLLEGE OF ORMOC
Pathophysiology
Crohn’s disease typically begins as a small inflammatory aphthoid lesion (shallow ulcers with
a white base and elevated margin, similar to a canker sore) of the mucosa and submucosa of
the bowel. These initial lesions may regress, or the inflammatory process can progress to
involve all layers of the intestinal wall. Deeper ulcerations, granulomatous lesions, and
fissures (knife-like clefts that extend deeply into the bowel wall) develop. The inflammatory
process involves the entire bowel wall (transmural). The lumen of the affected bowel assumes
a “cobblestone appearance” as fissures and ulcers surround islands of intact mucosa over
edematous submucosa. The inflammatory lesions of Crohn’s disease are not continuous;
rather, they often occur as “skip” lesions with intervening areas of normal-appearing bowel.
Some evidence suggests that despite its normal appearance, the entire bowel is affected by
this disorder.
Depending on the severity and extent of the disease, malabsorption and malnutrition may
develop as the ulcers prevent absorption of nutrients. When the jejunum and ileum are
affected, the absorption of multiple nutrients may be impaired, including carbohydrates,
proteins, fats, vitamins, and folate. Disease in the terminal ileum can lead to vitamin B12
malabsorption and bile salt reabsorption. The ulcerations can also lead to protein loss and
chronic, slow blood loss with consequent anemia.

Aphthoid in lesion of
mucosa and submucosa

Regression and healing Transmural inflammatory process with ulceration,

granuloma formation, and development of fissures

Diarrhea, abdominal pain, fever, fatigue, malaise, Bowel wall edema Fistula and abscess
malabsorption with weight loss and fibrosis formation

Narrowing of Fever,
lumen worsening
diarrhea and
malnutrition,
Obstruction chronic urinary
tract infection

Abdominal
distention and
pain,
borborygmi,
nausea and
vomiting
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Diagnostic Procedures and Nursing Management

Diagnostics:
Physical examination and history
Imaging studies and endoscopy:
- Sigmoidoscopy
- Colonoscopy
- Barium X-ray/Lower X-ray
Laboratory test:
- Stool Examination
- Stool Culture
- CBC
- C-reactive Protein
- Serum Albumin Test

Nursing Management:

 Collaborate with the healthcare team to address anemia, which may involve iron
supplementation, blood transfusions, or dietary changes
 Monitor for signs of infection and collaborate with physicians on appropriate
antibiotic therapy if abscess formation is suspected.
 Explain that Crohn's disease is a chronic condition with periods of remission and
flare-ups.
 Offer emotional support to help the patient cope with the diagnosis.
 Track C-reactive protein levels as an indicator of inflammation.
 High levels may suggest active disease, and the patient should be monitored closely
during flare-ups.
 Monitor electrolyte levels, especially if diarrhea is severe, to assess for imbalances.
 Assist the patient in managing symptoms such as abdominal pain and diarrhea
through pain relief measures
 Treatment by surgery
- Bowel Resection
- Strictureplasty
- Colectomy
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Medications
o 5 - ASA
Sulfasalazine (Azulfidine) - is a sulfonamide antibiotic and
anti-inflammatory that is poorly absorbed from the gastrointestinal tract and acts
topically on the colonic mucosa to inhibit the inflammatory process.

Olsalazin

mesalamine

o Immunosuppressant
Mercaptopurine (6-MP, Purinethol)

azathioprine (Imuran)

methotrexate

cyclosporine (Sandimmune)

o Corticosteroids
Methylprednisolone (Medrol, Solu-Medrol)

Prednisolone (Delta-Cortel) Prednisone

***Note: The active anti-inflammatory ingredient in sulfasalazine, 5-aminosalicylic acid (5-

ASA), also is available in preparations that do not contain sulfa, such as olsalazine and
mesalamine. They have the advantage of causing fewer adverse effects than sulfasalazine.
 WESTERN LEYTE COLLEGE OF ORMOC
Nursing Management
Strictureplasty is a surgical procedure used to treat strictures or narrowing in the intestines,
often associated with conditions like Crohn's disease.

Preoperative Care:
 Educate the patient about the procedure, including its purpose, risks, and expected
outcomes.
 Ensure the patient follows any prescribed bowel preparation regimen to cleanse the
intestines before surgery.
 NPO Status: Ensure the patient is NPO (nothing by mouth) for the appropriate period
before surgery to prevent complications during anesthesia.
Intraoperative Care:
 Continuously monitor the patient's vital signs, including blood pressure, heart rate,
and oxygen saturation.
 Accurately document the surgical procedure, any complications, and the time taken
for the surgery.
Postoperative Care:
 Initiate enteral or parenteral nutrition as needed and gradually reintroduce oral intake
when appropriate
 Encourage early mobilization to prevent complications such as deep vein thrombosis
 Provide the patient with postoperative instructions, including dietary restrictions and
signs of complications to watch for
 WESTERN LEYTE COLLEGE OF ORMOC
Sample Care Plan

Assessment Nursing Goals and Interventions Evaluation

Diagnosis Outcome
Chief Complaint: ***Imbalanced The patient  Regularly The goal was me
Nutrition: Less will maintain monitor the after nursing
 Abdominal pain, than Body or regain a patient's intervention the
diarrhea, and weight Requirements healthy weight, patient gained 2
loss. related to weight. albumin pounds over a 1-
malabsorption levels, and month period.
Medical History: and dietary dietary The Albumin
restrictions The patient's intake. levels improved
 Crohn's disease associated with albumin levels and returned to
diagnosed 5 years Crohn's disease. will return to  develop a the normal range
ago, current within the nutrition The patient
medications include normal range. plan reports decreased
corticosteroids and tailored to abdominal pain
immunosuppressants. the patient's and improved
Vital Signs: Stable needs, tolerance to oral
blood pressure, heart focusing on intake.
rate, and respiratory easily
rate. digestible
Laboratory Data: and low-
residue
 Elevated foods.
inflammatory
markers (CRP and  document
ESR), decreased frequency,
albumin levels, and consistency,
electrolyte and any
imbalances. signs of
blood or
mucus in
the stools

 .