Question

Write two nursing diagnoses for the client who has Crohn’s disease and gastritis, looking for similarities and differences between the treatment and nursing interventions. Include one for discharge planning.

Answer 1

Crohn's disease is a type of inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by this disease can involve different areas of the digestive tract in different people. The most common pathologic finding encountered in crohn's disease is H. pylorinegative focal patchy gastritis, or focally enhanced gastritis, with or without granulomas, in small and/or large intestine.

Gastritis is an inflammation, irritation, or erosion of the lining of the stomach. It can occur suddenly (acute) or gradually (chronic) due to excessive alcohol use, chronic vomiting, stress, or the use of certain medications such as aspirin or other anti-inflammatory drugs.

Crohn’s disease may affect any part of your digestive tract and often spreads beyond the intestinal lining and into other tissues, but gastritis is inflammation of your stomach lining.Gastritis and chron's disease don’t always produce signs or symptoms. When they do, common symptoms include nausea,vomiting,stomach burning or cramping,stomach pain that goes through to the back, indigestion,feeling full shortly after you begin eating.In some cases, your stool may appear black in color and vomit may look like used coffee grounds. These symptoms can indicate internal bleeding.

The type of recommended treatment and recovery time will depend on the cause of your condition. Gastritis and chron's disease often clear up without complications, especially when they’re caused by medications or lifestyle choices.

Antibiotics
If H. pylori is the cause, these infections are treated with antibiotics. Your doctor may recommend a combination of drugs to kill the infection. You’ll most likely need to take antibiotics for two weeks or longer.

Acid reducers
Reducing acid production in the stomach is an important step in treatment. Over-the-counter acid blockers, which are drugs that work to reduce the amount of acid released into your digestive tract, may be recommended. These include:

cimetidine (Tagamet)
famotidine (Pepcid)
Proton pump inhibitors that block cells that produce acid are most often needed to treat these conditions. They may also need to be taken long-term. Some of these include:

esomeprazole (Nexium)
lansoprazole (Prevacid)
omeprazole (Prilosec)

Antacids
For temporary relief of your symptoms, your doctor may suggest antacids to neutralize stomach acid and relieve pain. These are over-the-counter medications and don’t need to be prescribed. Antacid options include:

calcium carbonate (Tums)
magnesium hydroxide (milk of magnesia)
calcium carbonate and magnesium hydroxide (Rolaids)
Antacids can prevent your body from absorbing other medications, so it’s recommended you take antacids at least an hour before other medications to avoid this side effect. However, antacids are recommended for occasional use only. If you are having symptoms of heartburn, indigestion, or gastritis more than twice a week for more than two weeks, see your doctor. They can provide a proper diagnosis along with other medications to treat your condition.

Lifestyle changes
Smoking, regularly using alcohol, and taking medications such as aspirin and NSAIDs increases inflammation of the digestive track. Both smoking and heavy alcohol use (more than five drinks per day) also increase the risk for stomach cancer. Completely quitting smoking and drinking alcohol is often recommended. Stopping the use of pain relievers such as aspirin, naproxen, and ibuprofen may also be necessary if those medications are the cause.

Surgical options in gastroduodenal Crohn's disease include bypass surgery with gastrojejunostomy (with or without vagotomy), commonly to bypass a duodenal stricture, gastroduodenostomy, duodenojejunostomy, and stricturoplasty .

Nursing Interventions for Gastritis

1. Nursing Diagnosis: Acute Pain

Purpose: Pain is gone / no pain

Nursing Interventions:
• Review the level of pain.
• Provide information about the different strategies chosen to reduce pain.
• Encourage clients to use the chosen strategy to reduce pain.
• Encourage clients to avoid eating foods that stimulate an increase in stomach acid.
• Collaboration with the medical team for the administration of anti-analgesic.

Rationale:
• In order to determine the level of pain experienced by the client.
• Able to learn methods of pain reduction and can do it.
• Assist in menurunhkan experienced pain threshold.
• In order for clients to find foods that stimulate stomach acid and does not consume them.

2. Nursing Diagnosis: Imbalanced Nutrition Less Than Body Requirements

Purpose: Nutrition balanced.

Nursing Interventions:
• Describe the client and family about the importance of food for the body.
• Monitor the amount of food intake.
• Monitor and record the number of vomiting, frequency and color
• Provide a varied diet according to his diet to stimulate appetite.
• Provide food in small portions but frequently.
• Collaboration with the medical team for the administration of anti-emetic drugs.

Rational
• Clients and families can learn the importance of
• To know the food is consumed.
• As the data to perform nursing actions and subsequent treatment.
• To klirn be motivated and stimulates appetite.
• To reduce the feelings and needs food for patients.
• As a therapy for inhibiting / stimulating nausea and vomiting.

3. Nursing Diagnosis: Risk for Fluid Volume Deficit

Purpose: volume of body fluids are met

Nursing Interventions:
· Assess the possibility of signs of dehydration and record intake and output.
· Assess the balance of fluids and electrolytes every 24 hours.

· Encourage clients to keep the peroral intake is to eat and drink a little but often.
· Encourage clients to avoid consuming foods and beverages that contain caffeine.

Rational:
· Detecting the early signs of dehydration.
· Detecting early indicator of fluid and electrolyte imbalance.
· In order for the client's body fluid balance can be maintained.
· Caffeine is a central nervous system stimulant that can increase the activity of gastric and pepsin secretion leading to increased secretion of gastric acid that can cause reactions of nausea and vomiting.

4. Nursing Diagnosis: Anxiety

Purpose: No Anxiety

Nursing Interventions:
• Assess the client's anxiety.
• Give the client an opportunity to express his anxiety.
• Explain to clients that can challenge dijalankankan diet after recovery.
• Explain to the client about medical procedures / treatments will be done and encouraged cooperative therein.
• Provide motivation to the client about his recovery.

Rational:
• As the initial data to determine the client's anxiety level.
• In order to determine the cause of anxiety is experienced as well as reduce the psychological burden of the client.
• The client can adhere to diet and avoid disease relapse again.
• Able to understand and accept all the measures taken to cure the disease process.
• Clients and families are optimistic for the healing of disease and comply with all recommended clients are given.

Discharge planning:·

Discharge Instructions for Crohn’s Disease . Your digestive tract is swollen and inflamed. All layers of your digestive tract may be affected. There is no cure for Crohn’s disease. But you can get treatment for the symptoms. Help manage your symptoms by following your healthcare provider’s advice and watching what you eat recommendations for taking care of yourself at home:

Work closely with your healthcare provider to find the types of treatment that are best for you.

Take your medicines exactly as you were told.

Let your healthcare provider know if you are having uncomfortable side effects.

Don’t stop taking your medicines without talking with your healthcare provider first.

It may be helpful to stay away from certain foods for a little while. Depending on your condition, these may include caffeine (coffee, tea, and cola), spicy foods, milk products, and raw fruits and vegetables. For certain people, these can be hard to digest and can worsen symptoms in a flare-up. Your healthcare provider may have you work with a nutritionist to come up with the best food choices for you.

Try eating several small meals a day instead of 3 large ones.

Don't smoke. Tobacco smoking makes the disease worse.

Keep appointments for all checkups even if you are not having symptoms.

Talk to your healthcare provider about surgery for Crohn’s disease. Surgery won’t cure Crohn’s disease. But it may help control the symptoms. Only you and your healthcare provider can decide if this choice is right for you.

Managing nutrition
You may be able to eat most foods until you have a flare-up. But like anyone else, you need to make healthy eating choices. Some of the healthiest foods can make symptoms worse, though. Keeping track of your "problem foods" may help. Ask your healthcare provider any questions you have about healthy eating.

When to call your healthcare provider
Call your healthcare provider right away if you have any of these:

Severe pain or bloating in your belly after meals

Sores in your mouth

Sores in your anal area (around your rectum)

Fever of 100.4° F ( 38°C) or higher, or as directed by your healthcare provider

Chills

Poor appetite or weight loss

Bloody diarrhea

Nausea or vomiting

Skin rashes or skin that weeps (or drains)

Changes in your vision.

Dietary patterns:

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.