Crohn’s Disease NCLEX Review

This NCLEX review will discuss Crohn’s Disease.

As a nursing student, you must be familiar with Crohn’s Disease, its complication, major signs and symptoms, treatment, and the nursing care for a patient experiencing this condition.

These type of questions may be found on NCLEX and definitely on nursing lecture exams.

Don’t forget to take the Crohn’s Disease quiz.

You will learn the following from this NCLEX review:

• Definition of Crohn’s Disease
• Types of Crohn’s Disease
• Complication of Crohn’s Disease w/ mnemonic
• Signs and Symptoms of Crohn’s Disease
• Nursing Interventions

Lecture on Crohn’s Disease

NCLEX Review on Crohn’s Disease

What is Crohn’s Disease? A type of inflammatory bowel disease (another type is ulcerative colitis) that causes inflammation and ulcers formation in the GI tract.

Key Points to Remember about Crohn’s:

• Disease can be found throughout both the large and small intestine (it tends to be most prominent in the terminal of the ileum and beginning of the colon). The terminal ileum is the last part of the small intestine that connects to the large intestine.
  • Ulcerative colitis tends to be found in the large intestine only and starts in the rectum.
• Crohn’s Disease affects the WHOLE bowel wall (not just the inner lining as with ulcerative colitis) and this causes ulcer formation that extends all the way through the serosa, which leads to its very unique complications (see below).
• It presents in scattered in patches throughout GI tract (not a continuous fashion that starts in the rectum like with ulcerative colitis). Patients can have healthy patches of lining next to diseased parts which gives it a cobble-stone appearance when the patient is scoped.
• Cause is unknown at this time but is seems to be caused by a faulty immune system that may be triggered by:
  • Environment (allergens to foods like cow’s milk, stress, illness (gut bacteria causes autoimmune response) or virus/bacteria from GI illnesses as with gastroenteritis, smoking, medications like NSAIDs usage)
  • Genetic factors: run in families
• Patients experience periods of flare-ups and remission which leads to the chronic cycle of healing vs lining damage…hence the develop of scar tissue.
• No cure (surgery can’t cure as with a colectomy in ulcerative colitis). A bowel resection surgery can help improve the patient’s symptoms which is where the diseased part of the bowel is removed.

Types of Crohn’s Disease depending on its location:

Ileocolits: inflammation found in the ileum and colon

Gastroduodenal Crohn’s: inflammation found in part of the stomach and duodenum (first part of the small intestine)

Jejunoileitis: inflammation found in the jejunum of the small intestine

Ileitis: inflammation found in the ileum of the small intestine

Granulomatous Colitis: inflammation found only in the colon

*many patients can have multiple forms

Complications of Crohn’s Disease

*for exams be familiar with the complication of Crohn’s vs ulcerative colitis

Crohn’s Disease has more complications than ulcerative colitis, so try to remember this mnemonic which will help you remember each complication

“Abscessing Fistulas May Form Sepsis”

Abscesses: the development of pockets of infection that form in the wall of the intestine and anal area. These can lead to the formation of a fistula.

Fistulas: due to ulcer or abscess formation in the deep wall of the intestine that creates an opening which acts like a “passage/channel” between either:  intestine to intestine, intestine to organ, or intestine to skin’s surface….this can lead to sepsis

Types of Fistulas:

• Enterovesical (intestine to bladder)
• Perianal: most commonly due to an anal abscess
• Enterovaginal (intestine to vagina)
• Enterocutaneous (intestine to skin’s surface)
• Entero-enteric (intestine to intestine)

Malnourishment: more common with Crohn’s Disease than ulcerative colitis because it affects the small intestine which is inflamed and not working correctly. Remember the small intestine is the part of the GI tract that is responsible for absorbing most of our nutrients from our food.

Fissure (tears): specifically anal  due to the loss of the integrity of the bowel lining.

Strictures which may lead to obstructions: very common….this is major narrowing of the intestinal wall due to chronic inflammation that has led to scarring of the lining…strictures can lead to obstructions…they limit the flow of GI contents through intestines which causes food that passes through the lining to get stuck OR the tissue becomes so inflamed/scarred it blocks the flow of food . Patients may start to vomit emesis that looks like fecal matter due to the back-flow of the contents.

Other miscellaneous symptoms: arthritis, gallstones, mouth ulcers, eye and skin problems

Signs and Symptoms of Crohn’s Disease:

• Abdominal pain mainly located in the right lower side (due to inflammation and possible stenosis)
• Ulcers (mouth and GI tract)
• Diarrhea (may have blood, mucous, pus…blood more common in ulcerative colitis but can be present in Crohn’s)
• Loss of appetite and weight (malnourished…electrolyte imbalance, dehydration. Remember small intestine not working due to inflammation)
• Fissures (anal) w/ bleeding
• Bloating of abdomen (inflammation)

Nursing Interventions for Crohn’s Disease

Nursing Goals:

Help patient understand:

• the disease (no cure)
• medication treatment
• diet
• staying healthy
• surgery to correct strictures “strictureplasty” (many patients will develop these at some time), fistulas, abscesses, or bowel resections to remove diseased parts of the bowel, removal of full colon or partial which many patients will have an ileostomy.

Ostomy care if patient has ileostomy or colostomy

Smoking cessation if the patient smokes (makes Crohn’s Disease worst)

Administering per MD order TPN (total parenteral nutrition) in severe cases (due to malnourishment and for resting the GI system)…monitor weights risk for imbalance nutrition

Monitoring weights on all patients with Crohn’s

Calculating precise intake and output

Monitoring GI system: bowel movements, pain/bloating, frequency of BM (characteristics: blood?, bowel sounds, tenderness, vomiting…what does it look like?)

Diet Education:

Watch foods that can cause a “flare-up” or should be avoided during a “flare-up”:

• High-fiber foods (they require a lot of digestion and the gut needs to rest)
• Foods hard to digest like: nuts, raw vegetables or fruits (cooked are better with skins removed)
• Allergen type foods: dairy or certain foods that the person may be intolerant too like wheat, fish along with spicy, high-fat foods, gluten, gas causing foods like onions, beans etc.

Foods to eat during “flare-up” or to prevent one:

Low fiber (easier on the gut to digest), high-protein and stay hydrated

Medications for Crohn’s Disease

Goal: control flare-ups and maintain remission

• Medications prescribed depend on the severity of the disease.
• Combination of medications are used if patient has moderate to severe cases.

Anti-inflammatory: decrease the inflammation in the bowel

• 5-Aminosalicylates (5-ASA): “Sulfasalazine” ….first line for mild cases…helps maintain remission..prevents flare-ups…if not responding MD may add on corticosteroids (can’t take if allergic to sulfa)
• Steroids: “corticosteroids” Prednisone….used when Aminosalicylates aren’t working…not used long term…patient will be tapered off…nasty side effects high glucose, thinning skin, easy bruising, osteoporosis, increases risk for infection

Immuno-suppressors/modulators: used when other medications haven’t work or patient needs to be off of steroids due to their side effects or added on with corticosteroids

• Suppressors: suppress immune system ” Azathioprine/Imuran “…risk for infection and cancer, no live vaccines (MMR, varicella, shingles etc.)
• Biologic types: changes how the immune system works  “Adalimumab/Humira” or “Infliximab/Remicade: tumor necrosis factor blocker (anti-TNF): blocks a protein that plays a role in the inflammatory process….md will check patient for TB before starting medication…can reactivate a previous infection or put patient at risk for a TB infection and increases risk of cancer….no live vaccines, increase rare cancers

Antibiotics: treat or prevent infections during flare-ups “Ciprofloxacin”

Antidiarrheal Meds

Pain: NO NSAIDS can cause flare-up..use Tylenol type medications

More NCLEX Reviews

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