Question

Diagnostic tests/special procedures or surgeries for crohn's disease and implications for nursing care.

Answer 1

* Crohn's disease = It is an inflammatory disease of diagestive tract. it mainly affects terminal ileum and leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations and abscess.

* It is also called inflammatory bowel disease.or regional enteritis.

* Commonly occur among adolescent and young adult.

* Patient with crohns disease are at increased risk for colon cancer.

*** Diagnostic test for Crohns disease =

# The diagnosis is based on a combination of laboratory radiologic, endoscopic and histologic finding.

# CBC may show mild leukocytosis and anemia .

# Elevated ESR, Hypoalbumininemia.

# Stool analysis may reveal leukocytosis but no enteric pathogens, guiac- positive stool.

# Barium enema may permit visualization of lesions in the large intestine and terminal ileum.

# Colonoscopy is the procedure of choice typical finding include presence of skip lesions.

***Special surgeries and procedure for crohn's disease =

Approximately 70 % of crohn's disease patient will eventually require one or more operation to relieve obstruction, close fistulae, drain abscess and for repair perforations.

Depending on the patient , surgical options include =

* Strictureplasty = Blocked narrowed section o the bowel is widened, leaving intact. in which removed and resection of diseased tissue it usefull for avoide lossing the valuable tissue.

* Total colectomy with ileostomy = Colon is completely removed and an opening is created in the ileum as a stoma on the abdominal wall.  It diverts faeces into a bag attached to the opening.In which removed dead part through open or laprscopic surgery.

* Total colectomy with continment ileostomy = Colon is completely removed and ileal reservoir is created. Need for external reservoir is eliminated 30cm of the ileum is created as pouch with nipple valve. A catheter is inserted via nipple vaalve to empty the pouch.

* Total colectomy with ileoanal anastomosis = Colon is completely removed and ileum is connected . No external stoma.

***** Implications for Nursing care =

# Achieving Adequate Nutritional Balance =

* Encourage a diet that is low in reidue fiber and fat and high in calories protein, and charbohydrate with vitamin and mineral supplements.

* Monitor weight daily.

* Provide small frequent feeding to prevent distention.

* Prepare the patient for elemental diet or TPN if the patient is debilitated.

# Maintaining fluid and electrolytes balance=

* Monitor intake and output chart .

* Provide fluid as prescribed to maintain hydration .

* Monitor stool frequency and consistency.

# Controlling pain =

* Administer medication for control of inflammatory process.

* Observe and record changes in pain - frequency location characteristic and duration.

* Monitor for distention .

* Clean rectal area and apply ointment .

# Provide psychological support to the patient .

# Provide stoma care and monitor stoma color if any abnormalty find then notify physician.