Case Study Chron’s Disease

A 25-year-old self-identified female client experienced remission of her Crohn’s disease for the past 2
years. She is a single mother of two small children and finds that she needs to go to bed at night when
her children do because of increasing fatigue. Today she presents to the emergency department (ED)
with reports of frequent diarrhea, severe abdominal pain, and low-grade fever. She is admitted to the
hospital to rule out potentially life-threatening complications and to manage her chronic disease.

Indicate which nursing action listed in the far-left column is appropriate for each potential complication.
Note that not all actions will be used.

Nursing Action Potential Complication Appropriate Nursing Action

for Each Complication
1.Administer blood or blood products via a Enteroenteric fistula
large-bore IV catheter.
2 Observe stool for undigested food or
undissolved medication. Small bowel obstruction
3 Administer IV sodium heparin. Lower GI bleeding
4 Monitor client for hematemesis. Malabsorption
5 Monitor for signs and symptoms of
irritable bowel syndrome.
6 Insert a nasogastric tube and connect to
suction.
7 Administer antibiotic therapy.

A 25-year-old self-identified female client with Crohn’s disease was admitted to the hospital yesterday
to rule out potentially life-threatening complications and to manage her chronic disease.
Selected client assessment findings on admission and this morning are listed below.

Assessment Findings on Admission 24 Hours Ago

Current Assessment Findings

Temperature 100°F (37.8°C) 101.8°F (38.8°C)

Heart rate 78 beats/min 82 beats/min
Blood pressure 128/76 mm Hg 124/72 mm Hg
White blood cell count 9.2 3 109 /L (9200/mm3) 13.5 3 109 (13,500/mm3)
Sodium 138 mmol/L (138 mEq/L) 133 mmol/L (133 mEq/L )
Potassium 3.6 mmol/L (3.6 mEq/L) 3.2 mmol/L (3.2 mEq/L)

Highlight or place a check mark next to the current assessment findings that require follow-up by the
nurse.
A 25-year-old self-identified female client with Crohn’s disease was admitted to the hospital 2 days ago
to rule out potentially life-threatening complications and to manage her chronic disease. She was
diagnosed as having lower GI bleeding this morning.
Use an X to indicate whether the nursing actions listed below are Indicated (appropriate or necessary),
Contraindicated (could be harmful), or Non-Essential (make no difference or are not necessary) for the
client’s care at this time.

Nursing Action Indicated Contraindicate Non-Essential

d
Monitor the client’s hemoglobin and hematocrit
levels.
Prepare to administer a blood or blood product
transfusion.

Decrease the rate of the IV infusion.

Prepare the client for a GI bleeding scan.
Monitor pulse and blood pressure frequently.
Document the number of the client’s daily stools.

A 25-year-old self-identified female client with Crohn’s disease was admitted to the hospital to
rule out potentially life-threatening complications and to manage her chronic disease. Today
the assistive personnel (AP) reported that the client has foul drainage from an open area on her
lower abdomen. On closer inspection, the nurse finds that the client developed an
enterocutaneous fistula from her small bowel to her skin. Which nursing actions are indicated
for her care at this time? Select all that apply.
_____ A. Apply a skin barrier and pouch to collect drainage and protect the surrounding skin.
_____ B. Consult with the registered dietitian nutritionist to increase the client’s caloric intake.
_____ C. Monitor the client for signs and symptoms of sepsis to prevent septic shock.
_____ D. Ensure that the staff takes daily weights in the morning using the same scale.
_____ E. Monitor fluid and electrolyte balance to identify dehydration or electrolyte
imbalances.
_____ F. For copious fistula drainage, apply negative-pressure wound therapy.
_____ G. Provide oral enteral supplements to increase protein intake.
_____ H. Administer IV antibiotic therapy as prescribed.
A 25-year-old female client with Crohn’s disease was admitted to the hospital to rule out potentially life-
threatening complications and to manage her chronic disease. Her drug therapy regimen is being re-
evaluated and changed to better control her disease.

Choose the most likely options for the information missing from the table by selecting from the lists of
options provided.

Medication Dose, Route, Frequency Drug Class Drug Action

Sulfasalazine 2 g orally each day 5-ASA drug 1

Infliximab
5 mg/kg IV at 0, 2, and 6 weeks 2 Decreases inflammatory
followed by maintenance and immune response
infusions of 5 mg/kg every 8
weeks

3 Manages infection
Ciprofloxacin 500 mg orally each day
XR
Methotrexate 4 Decreases disease activity
Immunosuppressant
5 Antibiotic Manages infection
750 mg orally 3 times a day

Options for 1 Options for 2 Options for 3 Options for 4 Options for 5
Manages Nonsteroidal Calcium channel 200 mg/mL Doxycycline
infection anti- blocker subcutaneously Metronidazole
Decreases inflammatory Macrolide once daily Azithromycin
inflammatory drug (NSAID) Antihistamine 200 mg orally Linezolid
response Corticosteroid Biguanide once daily Gentamicin
Reduces fever Biologic response 150 mg topically Trimethoprim
modifier Fluoroquinolone twice daily
Decreases Antidiarrheal Aminoglycoside 25 mg orally once
diarrheal stools agent Antipyretic weekly
Manages drug 10 mg orally once
refractory Anticholinergic daily
disease drug 1 g by infusion
Decreases pain once daily

A 46-year-old male client who has had a long history of Crohn’s disease was recently diagnosed with
colon cancer. Yesterday afternoon he had a colectomy and creation of a permanent colostomy and
is receiving patient-controlled analgesia (PCA) to manage pain. Which nursing assessment findings
will the nurse report immediately to the primary health care provider? Select all that apply.
_____ A. Colostomy has no effluent (drainage).
_____ B. Colostomy stoma is dark red-purplish.
_____ C. The nasogastric tube is draining a small amount of yellowish-green effluent.
_____ D. The client reports pain of 8/10 on a 0 to 10 pain intensity scale.
_____ E. The client states he is anxious about caring for the new ostomy.
_____ F. The colostomy stoma is slightly swollen with a small amount of bleeding.
_____ G. The colostomy stoma protrudes about 3⁄4 in (2 cm) from the abdominal wall.