Nursing Diagnosis for Crohn's Disease / Regional Enteritis

Regional Enteritis (Crohn's Disease, Granulomatous Ileitis or Ileocolitis)

• Regional enteritis is a subacute and chronic inflammation that extends through all layers of the bowel wall from the intestinal mucosa. It is characterized by periods of remissions and exacerbations.
• Regional enteritis commonly occurs in adolescents or young adults but can appear at any time of life.
• It is more common in women, and it occurs frequently in the older population (between the ages of 50 and 80).
• The most common areas are the distal ileum and colon.
• Crohn’s disease is seen two times more often in patients who smoke than in nonsmokers.

Clinical Manifestations

• Prominent lower right quadrant abdominal pain and diarrhea unrelieved by defecation.
• There is abdominal tenderness and spasm.
• Weight loss, malnutrition, and secondary anemia.
• Disrupted absorption causes chronic diarrhea and nutritional deficits. The result is a person who is thin and emaciated from inadequate food intake and constant fluid loss.
• In some patients, the inflamed intestine may perforate,leading to intra-abdominal and anal abscesses. Fever and leukocytosis occur.
• Chronic symptoms include diarrhea, abdominal pain, steatorrhea, anorexia, weight loss, and nutritional deficiencies.
• The clinical course and symptoms can vary; in some patients, periods of remission and exacerbation occur, but in others, the disease follows a fulminating course.

Complications

• Complications of regional enteritis include intestinal obstruction or stricture formation, perianal disease, fluid and electrolyte imbalances, malnutrition from malabsorption, and fistula and abscess formation.
• The most common type of small bowel fistula that results from regional enteritis is the enterocutaneous fistula.
• Abscesses can be the result of an internal fistula tract into an area that results in fluid accumulation and infection.
• Patients with regional enteritis are also at increased risk for colon cancer.

Nursing Diagnosis for Crohn's Disease / Regional Enteritis

1. Chronic pain related to Irritable bowel, abdominal cramps and surgical response.
2. Risk for fluid and electrolyte imbalance related to discharge of excessive vomiting.
3. Risk for Imbalanced nutrition: less than body requirements related to the inadequate nutritional intake secondary to pain, stomach and intestinal discomfort.
4. Risk for infection related to the post-surgical wounds.
5. Anxiety related to the prognosis of the disease and surgical plans.