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Crohn’s Disease Case Study

Josephine Garcia

Department of Nursing, St. Francis Xavier University

NURS 332 Advanced Therapeutics for Care of Persons Experiencing Complex

Multisystem Challenges

Dr. Janet Purvis RN, MN, PhD

March 19, 2024

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Crohn’s Disease Case Study

This is a case study analysis of a 35-year-old woman named Shannon, who has been

managing Crohn’s disease for eight years. Crohn’s disease is a chronic autoimmune condition

affecting the lining of the digestive tract, leading to symptoms such as severe abdominal pain,

diarrhea, fatigue, weight loss and malnutrition (Lewis et al., 2019, p. 1076). As a nurse preparing

for Shannon’s discharge, the three areas of concern that I have identified for Shannon’s self-

management are medication management, dietary adherence, and the psychological impact of the

disease. In this paper, I will explain these areas of concern and provide effective strategies to

help Shannon manage her condition. Additionally, I will discuss the various resources available

within her community that can support Shannon and her family, as well as the role of the

interdisciplinary team in managing her condition.

Based on Shannon’s medical records, medication management is one concern for her self-

management. She had been taking prednisone for several months but was weaned off a couple of

months ago. Prednisone helps with inflammation, but long-term use can cause side effects such

as osteoporosis (Sealock et al., 2017, p. 571). Unfortunately, her symptoms have worsened after

stopping the medication. Although she is not sure what is the reason for her flare-ups, this

situation indicates a potential issue with medication management, particularly in managing her

chronic diseases. A recent study by Gade et al. (2020) highlighted that medical therapy aims to

attain remission through medication. However, their research also emphasizes the need for

maintenance medication to avoid disease recurrence.

There is no cure for Crohn's disease, but medications can help manage the disease and avoid

relapse and exacerbation. She needs to work with her gastroenterologist or healthcare provider to

find the proper medication, such as an immunosuppressant, to manage her chronic disease and
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prevent relapse. Treatment should be individualized, and according to Cushing & Higgins

(2021), the treatment approach depends on the location, disease severity and patient risk factors.

The second concern for Shannon’s self-management is her diet and nutritional intake.

Although she has been adhering to a low-residue diet for years, she has recently admitted to

cheating, which might trigger her flare-ups. Shannon has lost 6-7 pounds because of loss of

appetite due to her abdominal pain. Although there is no exact diet for people with Crohn’s,

Shannon needs to determine the foods that can trigger her symptoms and other factors that can

affect her nutritional intake, such as stress. Recent research by Reddavide et al. (2018) suggests

that diet is critical in maintaining a healthy balance of microorganisms in the digestive system,

and specific diets, such as the Western diet (e.g., processed foods), can increase intestinal

inflammation.

Certain foods, such as fruits and vegetables (e.g., bananas, raspberries, carrots, green leafy

vegetables), are good sources of nutrients and have been found to help decrease inflammation.

Modifying them into soup or blending them into smoothies is one recommendation for her to

tolerate the food and get the nutrients she needs to avoid malnutrition. Diet and nutritional intake

can impact overall well-being, and Shannon needed a solid plan to manage her dietary intake.

The third area of concern for her self-management is stress management and the

psychological impact of the disease. She has expressed concern regarding her ability to manage

her work and her children's activities, as well as feeling tired and unwell due to her symptoms. It

is crucial to prioritize mental health and emotional well-being in self-management, as they can

significantly impact a patient's ability to cope with chronic conditions. Studies have shown that

IBD-related fatigue can reduce a patient's quality of life, leading to social isolation and difficulty

adjusting to daily life (Graffigna et al., 2021).

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Providing education is essential to help Shannon with her self-management. However,

according to Shannon's record, she attained higher education and worked as an occupational

therapist. Before offering education and resources to assist Shannon in managing her symptoms,

I would inquire about her knowledge regarding her condition and what resources she might have

available. From there, I would provide resources and education aligning with her interests. An

example of a resource that I believe would be helpful for Shannon is to keep a daily food journal

to identify the food that triggers her symptoms; I would encourage her to eat small, frequent

meals throughout the day and increase her fluid intake to avoid malnutrition and dehydration. I

will encourage her to collaborate with a dietitian to create a nutritional plan tailored to her needs.

Additionally, I would encourage her to explore stress reduction techniques such as exercise and

getting involved with a group that can understand her condition, such as social support in the

community.

Shannon and her family live in Pictou County, but they are originally from out of the

province. She may be unfamiliar with the resources in her community. To help Shannon and her

family, I will suggest the various resources available in her community. For instance, she can

access the Pictou Community in Crohn's and Colitis website; almost 300 people are dealing with

IBD in her community with whom she can connect, share her experience, and ask for some

advice (Crohn’s and Colitis Canada, 2019). According to Adriano et al., 2022 support from the

community with the same condition can improve psychosocial outcomes by allowing the patients

to receive emotional support and learn coping strategies.

The Pictou Wellness Centre offers general wellness resources, including fitness programs

such as a walking track and public skating (PCWC, 2024). In a recent study by Davis et al.

(2022), physical activity such as walking can improve a patient’s quality of life and help their
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mental health. Additionally, Aberdeen Hospital offers medical care and treatment for Crohn’s

disease, and patients can also access in-patient and outpatient care with a registered dietitian for

dietary support. She can access nutrition and education counselling every Monday, Tuesday, and

Thursday from 0800-0400 (NSHA, 2024). Dietitians are medical experts specializing in

evaluating and treating malnutrition by guiding dietary adjustment (McCarthy et al., 2023).

Crohn's disease is a chronic condition that requires long-term treatment, and multidisciplinary

teams play a crucial role in improving patients' quality of life. Prasad et al. (2019) identified

various healthcare providers managing Crohn’s disease. These include GPs, dietitians,

pharmacists, psychologists, nurses, and gastroenterologists. The research emphasized the critical

roles played by nurses and gastroenterologists. While gastroenterologists specialize in treating

the disease, nurses provide ongoing care, monitor patient progress, educate, and conduct

research. With the support of these healthcare professionals, patients with Crohn's can effectively

manage their condition and enhance their quality of life.

Managing Crohn’s disease is a complex and ongoing process that requires attention to

multiple areas of concern. Three areas of self-management that could be improved for Shannon’s

disease management are medication management, diet and nutrition and stress. Comprehensive

care for Shannon requires a holistic approach to address her needs. Shannon must work closely

with an interdisciplinary team to develop a personalized care plan that addresses her unique

challenges. Providing education, resources, and support to manage her symptoms at home is

essential.

Additionally, connecting Shannon with community resources such as support groups,

dietitians, and wellness centers is important for her ongoing care and managing her condition.

Through a collaborative effort between Shannon, her healthcare team and community resources,
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she can effectively manage her condition and enhance her quality of life. As a nurse preparing

for Shannon’s discharge, it is imperative to prioritize her self-management and ensure that she

has the necessary tools and support to navigate the complexities of managing Crohn’s disease.
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