Question

PN 200 Fundamentals of Nursing II Concept Map: Crohn Disease Carley Downs is a 32-year-old with a 14-year history of Chron Disease who presents with a three-day history of diarrhea and steady abdominal pain. She has been referred by her family physician to the GI clinic. The clinical course of her disease has included obstruction due to small intestine stricture and chronic steroid dependency with disease relapse when trying to taper her steroids. Endocrine tests reveal that she has developed adrenal insufficiency as a result of her steroid use and a DEXA scan that has demonstrated significant demineralization of the bone. B/P 165/95, P 69, R 15, afebrile, Ht 61 inches, Wt 154 1/20

Answer 1

Crohn disease; is an inflamatory bowel disease .it causes inflamation of digestive tract which leads to abdominal pain, diarrhea,fatigue ,weight loss and malnutrition.

NURSING DIAGNOSIS: Diarrhea related to inflamed intestinal mucosa.

imbalanced nutrition less than body requirement related to diarrhea and malabsorption

acute pain related to inflamed mucosa.

risk for ineffective coping related to stress of disease and exacerbations related to stress.

INTERVENTIONS : DIARRHEA - antidiarrheal medications may be administered to control diarrhea.

perianal excoriation often occurs with diarrhea.After every bowel movement gently clean the skin with warm water and apply protective moisture barrier products.

NUTRITION : monitor the nutritional intake of patient.

if the patient can tolerate a diet encourage intake of food and fluids because eating stimulates the gastrocolick reflex and the urge to deficate.

ACUTE PAIN: asses the client's pain and give the pain medication as ordered.

opioids are generally used to sparingly so that they do not mask manifestation.

RISK FOR INEFFECTIVE COPING : prolonged often precedes the onset IBD and exacerbation.

POSITIVE OUTCOMES : DIARRHEA : client will experience a decrease diarrhea as evidence by decrease in number and more solid consistency of stool

NEGATIVE OUTCOMES : DIARRHEA : worsening of perianal skin excoriation due to the frequent Diarrhea.

POSITIVE OUTCOMES : NUTRITION : the client will increase nutritional intake to meet metabolic requirements as evidence by weight stablisation and possibly weight gain.

NEGATIVE OUTCOMES : NUTRITION: weight due to less nutrition intake

POSITIVE OUTCOMES : ACUTE PAIN : the client wil experience a relief in abdominal pain as evidence by the client"s statement that pain has been relieved.

NEGATIVE OUTCOMES : ACUTE PAIN : Note any changes in the complaints of pain because they may indicate the development of complications.  

POSITIVE OUTCOMES : COPING : the client will cope effectively with the disease as evidence by fewer exacerbations and an improved coping style.

NEGATIVE OUTCOMES : COPING: ineffective coping will report a poor quality life.

EVALUATION : it is hoped that the client's disease will respond to medical management and that the client will achieve remission, improved coping and adequate nutritional intake. if the client's IBD does not respond to medical management, surgical intervention may be required.