Patient Education Plan: Crohn’s Disease
NUR/427 Health and Chronic Disease Management

Patient Education Plan: Crohn’s Disease
Patient Case History The patient is a 24-year-old, Caucasian, female who was recently diagnosed with Crohn’s Disease. She is single and currently lives alone in Philadelphia, Pennsylvania. The patient admits to eating a poor/unbalanced diet; she cites her busy schedule as the main factor contributing to her poor nutrition. She is not a smoker. Her father’s sister also has Crohn’s Disease but no one else in the immediate family, at least no one that she knows of, has the disease. She was diagnosed after coming to the emergency room with blood in her stool; she has also experienced bouts of diarrhea off and on for the past several weeks. She takes Advil for headaches daily and complains of constant fatigue, which she attributes to stress. Stress can be attributed to her lifestyle; she is a college graduate who is currently enrolled in a Masters program working toward her MBA. She also works as a teller at a local bank. The field is extremely competitive and between the demand of her job and her schoolwork she has limited time left for a social life. She goes on occasional dates and goes out with girlfriends fewer than two nights a week. Because she is a full-time student she spends a large portion of her time on the computer; she is extremely comfortable using the Internet. The patient has a very busy life and a very full schedule, finding adequate time to learn about and manage her disease will be difficult. She lives alone and does not have any family living in the immediate area, but she will still need support, both medically and emotionally. Her doctors can help her to manage the disease and can help her to establish a diet that works best for her. A counselor and/or support group will help to meet her emotional needs and will give her access to additional information that she may find helpful.
Crohn’s Disease: The Process Crohn’s Disease, also called regional enteritis and regional ileitis, is an inflammatory bowel disease (IBD) that can affect any area of the digestive tract from the mouth to the anus. However, it is often localized to the lower part of the small intestine called the ileum (Medline Plus, 2010). Crohn’s disease is often difficult to diagnose because the symptoms are very similar to those of other intestinal disorders, including irritable bowel syndrome and ulcerative colitis ("Crohn's Disease," 2006). There are several symptoms associated with Crohn’s disease and while not all of them may be present in each patient, it is not entirely uncommon for most of them to be. According to an article that was released from the Mayo Clinic in 2009, while there is a litany of symptoms associated with Crohn’s disease, there are five main symptoms: diarrhea, abdominal pain and cramping, blood in your stool, ulcers, and reduced appetite resulting in weight loss. Diarrhea occurs because the affected areas of the intestines often secrete large amounts of water and salt which cannot be absorbed into the colon; diarrhea is one of the most common symptoms of Crohn’s. Swelling and ulceration in the affected areas of the bowels can lead to abdominal pain and cramping; the pain can range in severity from mild to severe enough to cause nausea and vomiting. While food moves through the digestive tract it has the potential to cause inflamed tissues to bleed, which can be seen in the form of bright red blood in the toilet bowl or darker blood mixed with stool. Ulcers often appear in the mouth in the form of small canker sores. They can also grow into very large ulcers on the surface of, and sometimes through, the intestinal walls. Because Crohn’s affects the body’s ability to digest and absorb food, patients of the disease may develop a decrease in appetite and weight loss. Other symptoms include fever, fatigue, arthritis, eye inflammation, skin disorders, inflammation of the liver or bile ducts, and delayed growth or sexual development in children. The exact causes of Crohn’s disease are not known. It was previously believed that stress and diet were the main causes of the disease (Mayo Clinic staff, 2009), but the most popular and widely accepted theory today is that the body’s immune system reacts abnormally in people with Crohn’s, mistaking foods, bacteria, and other substances as foreign. The body attacks the food causing a build-up of white blood-cells in the intestinal lining, thus causing chronic inflammation ("Crohn's Disease," 2006). While Crohn’s disease can occur at any age, most people are diagnosed between the ages of 20 and 30. Also, Caucasians run a higher risk of developing the disease, and people of Ashkenazi Jewish decent run the highest risk of all. Family history also plays a significant role; it has been estimated that as many as one in five patients with Crohn’s also have another family member with the disease. Lifestyle is believed to play a role as well. People who smoke run a higher risk of developing Crohn’s, as do people who live in urban settings. This may indicate that environmental factors, including a diet high in fat and refined food, do in fact play a role in the development of the disease. Also, the use of nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin, others), naproxen (Aleve), diclofenac (Cataflam, Voltaren) and others have been show to make already existing Crohn’s worse (Mayo Clinic staff, 2009). Although there is currently no cure for Crohn’s disease, people diagnosed with the disease can expect to live a normal life span (Francis, 2010). Many patients are encouraged to alter their diets and lifestyles as a way to help control symptoms and lengthen the time between flare-ups. Limiting the intake of dairy products may help to decrease abdominal pain, gas, and diarrhea. If the disease is primarily located in the small intestine, reducing the intake of fatty foods may also help. Sometimes it helps to eat five or six smaller meals a day, as opposed to the typical three larger ones. Also Crohn’s patients must be sure to drink plenty of water and should consider taking a multivitamin. While it may not be for everyone, a dietitian may be a huge help to a patient with Crohn’s disease. This can help those with a limited diet find alternative ways of getting the proper nutrition that their body needs (Mayo Clinic staff, 2009). Although most Crohn’s patients live relatively normal lives there can be life-threatening complications associated with the disease. As many as 70 percent of patients will need an operation to fix irritated and sometimes perforated intestines at some point in their lifetime (Thomas Jefferson University Hospitals, 2010). It is not just the physical symptoms that can be an issue; depression is more common in people with chronic conditions such as Crohn’s disease. According to Frank Sileo, PhD, “Individuals with Crohn’s disease are dealing with an illness that is out of their control. There is no cure, and it impacts work, social, academic, family and other areas of one’s life (Brichford, 2010).” The words “no cure” are difficult to come to terms with. It is important for Crohn’s patients that are experiencing signs of depression to seek professional help. Because Crohn’s is a disease associated with the immune system, depression has the potential to wreak havoc on an already compromised system; staying mentally and emotionally healthy are important elements to managing Crohn’s. It is important that patients take the necessary steps to care for their mind as they would with their body.
The Patient: Her Needs and Perceived Challenges The patient is a well-educated young woman that made it through four years of undergraduate work and is now working her way towards a Masters degree; she is no stranger to the academic lifestyle and the stresses that come with it. She currently lives alone and spends the majority of her time either at work or at school; most of her time at home is spent on homework. Her Crohn’s diagnosis will put an added stressor on her already busy life, but it is imperative to her health that she learns how to manage her disease. She needs support, but her solo lifestyle may hinder that. She lives away from her parents and her aunt, who is her only other relative with Crohn’s disease. Her medical support will come from her doctor; she will need to follow up with him so that together they can monitor the progression of her disease. It would also be advisable for her to make an appointment with her school’s counseling center; her Crohn’s diagnosis will add a new, and sometimes freighting, stressor in her life and the counselors at her school are equipped to help deal with her emotional needs. As a student at a major university she should have access to free counseling sessions. There are also a wide range of support groups, many of which are accessible through the Internet, and she may find it helpful and comforting to interact with other people that have been diagnosed with Crohn’s. She does not have a lot of free time, but she does spend a lot of time online, so an Internet based support group such as The Crohn’s Disease Support Network, which can be found at www.crohnsdiseasesn.com, may work well for her. This site offers groups, blogs, and chats, as well as educational opportunities. Another great online support network is WeAreCrohns.org; it is a patient led social support network that allows users to discuss the ordeal that they are going through. Another great group that the patient should get in contact with is The Crohn's and Colitis Foundation of America, which can be found at www.ccfa.org. This foundation has over 40 staffed volunteer chapters and can offer support and education; there is even a Philadelphia chapter that will be able to help the patient. She doesn’t even have to alter her schedule to contact them; they can be reached at Philadelphia@ccfa.org or 215-398-9100 (Krans, 2010). The patient already leads a very hectic and stress-filled lifestyle, this may create some complications and challenges in the treatment and maintenance of her Crohn’s disease. Stress can cause symptoms to worsen and can cause more frequent flare-ups (Mayo Clinic staff, 2009). Ideally patients with the disease would work to reduce the amount of stress in their life; but for most, including the patient, that may not be possible. She has to balance her job, school, bills, and now her disease; stress is inevitable. Her poor diet may also be a challenge for her. The patient’s diet of fatty, processed foods may aggravate her system and cause abdominal pain and diarrhea. She will need to change her diet and with her busy lifestyle that may prove extremely difficult. Time will be an issue; it will take time to figure out what works for her and what her body needs, but she won’t always have the time that she needs to do that properly. For someone as young and independent as her, living with and managing Crohn’s disease will be a definite challenge.
Summary of the Disease Process To sum it all up, Crohn’s Disease is an inflammatory bowel disease, as well as an immune disease that can affect any part of the digestive tract. It causes the body to treat food and nutrients traveling through the digestive tract as foreign, causing inflammation in portions of the bowel. It is often diagnosed in the patient’s 20s and usually presents with abdominal pain, diarrhea, bloody stool, ulcers, and weight loss. There is no cure, but the disease can be managed diet, medications to treat the symptoms, and surgery to repair or remove sections of affected bowel (Mayo Clinic staff 2009).

References
Brichford, C. (2010). Battling depression in crohn's disease. EverydayHealth.com, Retrieved from http://www.everydayhealth.com/crohns-disease/crohns-disease-and-depression.aspx
Crohn's Disease. (2006). National digestive diseases information clearinghouse. Retrieved December 4, 2010, from http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/
Francis, A. (2010, March 24). Life expectancy of crohn's disease. EzineArticles.com, Retrieved from http://ezinearticles.com/?Life-Expectancy-of-Crohns-Disease&id=3990429
Krans, B. (2010, May 18). Getting the right support. Retrieved from http://www.healthline.com
Mayo Clinic staff. (2009). Crohn's disease. MayoClinic.com, Retrieved from http://www.mayoclinic.com/health/crohns-disease/DS00104
Medline Plus. (2010, November 16). Crohn's disease. Retrieved from http://www.nlm.nih.gov/medlineplus/crohnsdisease.html
Thomas Jefferson University Hospitals. (Producer). (2010). Crohn's disease treatment at jefferson. [Web]. Retrieved from http://www.jeffersonhospital.org/diseases- conditions/crohns-disease.aspx
Zeratsky, K. (2009, October 24). Prebiotics: what are they?. Consumer Health, Retrieved from http://www.mayoclinic.com/health/prebiotics/AN02032