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Q7- In Relation to this how would you plan an education programmed within the patients care plan to help them understand new treatments?

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Q7- In Relation to this how would you plan an education programmed within the patients care plan to help them understand new treatments?

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1- Advise them to access NHS choices. Although it is not the most academic source; it is free and easy to access and it is free from medical jargon. Rowan will find lots of info and tips on new medications, treatments and symptoms. Hence, the NMC (2015) has clear guidelines on giving patient information in a format that they can clearly understand.

2- Research local support groups within the community? As a source of support, source of further info and to address Rowans psychological health- her worries and concerns.  (HOLISTIC CARE, IMPORTANT TO ADRESS THE PATIENT AS A WHOLE).

3- Non smoking cessation within community- Referral for health promotion and group support to quitting the nicotine habit.

4- Patient friendly Chron's booklet to take home. Patient can refer to at any time.

5- https://www.crohnsandcolitis.org.uk/about-inflammatory-bowel-disease/crohns-disease. Another useful source. free from medical jargon

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Alex.  Question 11.   What might be the next medical/surgical step in managing Rowan's Crohn's disease?

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Alex.  Question 11.   What might be the next medical/surgical step in managing Rowan's Crohn's disease?

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Further surgical investigations my include a colonoscopy, this will rule out any further intestinal problems.

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Gender- female
Job- Accounts manager (Local Bank)
Marital Status – Living with female 6 years Significant others – current partner
Living - Lives with partner in own 2 bedroom house.                                         Presenting condition or problem Diagnosis/Reason for admission, appointment or home visit
Rowan was admitted from gastroenterology clinic.  She was referred by her GP with a 2 week history of frank blood in her stools with cramping abdominal pain, increasing fatigue and weight loss.   Patient/Service user perception of their health and social needs (Why are they here today?) Rowan states that she is here to manage an exacerbation of her Crohn’s disease. She is very anxious and concerned about being hospitalised for a long period of time and of possibly needing surgery as medical treatment is failing  History of presenting complaint or problem She has been experiencing increasing fatigue, she complains of “horrible” abdominal discomfort, nausea, pain and diarrhoea with blood and mucus.  She has been anxious and has reported that she is not coping.  Within the past year, Rowan has been admitted three times to address exacerbation of her symptomology.  Previous medical history This patient has a history of Crohn's disease diagnosed at the age of 23 years.   She has also reports persistent headaches over the past year.  Family/social history Lives with her partner Family Members – Parents: Mother (Crohn’s) age 66yrs, father (67yrs).fit and well. No siblings Smokes 20 per day Drinks  6 units per day BMI 17.5 mm/Kg
Medication: Prednisolone 20mg/application foam enema.  Sulfasalazine 1.5 grams daily¸ Azathioprine 50mgs daily. Tramadol 50 mgs TDS.
Allergies – Nut
Initial Assessment on Admission Respiratory rate regular 14/min Cardiovascular – Looks waxy pale, Pulse rate 105 bpm, Blood pressure 100/70 mm Hg. Temp-38c ·         FBC- Haemoglobin level is 10g/dl, ESR-30mm/1st hr, CRP , White blood cell count 13x109/L, Serum iron
Serum B12  ·         LFTs - Serum total protein  58 g/L, Serum albumin 3.9 g/dL ·         U & E s– Low haematocrit 28%, Potassium level 3.4 mmol/L; Sodium level 135mmol/L
ADL's Breathing (and circulation):   Continues to smoke 20 cigarettes daily, no obvious breathlessness, mild tachycardia and dehydration may be linked to low serum Hb.  Safety:  Currently feeling very fatigued and so is at immediate risk of possible falls.   Communication: Communication is unimpeded normally by limited during periods of intense cramping and pain.  Eating and drinking: This is affected by the gastrointestinal state.  Currently the acute inflammatory phase is causing nausea which is impeding appetite.  Weight loss is 6 kilos over the past year. She drinks 6 units of alcohol per day and says that this helps to ease her cramps.  Elimination: Intermittent bouts of constipation then diarrhoea are normal but during the exacerbation she has suffered increasing bloody diarrhoea with much mucous.  Presently she is passing stool at least every hour.  Mobility: Mobility is affected by fatigue  Temperature: Complains of that hands and feet feeling chilly despite her temperature 38C.  Hygiene: maintains reasonable personal hygiene.  She says that she prefers being close to the bathroom and likes time for personal cleansing.  Sexuality: appears happy in her relationship with her partner. She has recently been less able to attend to personal grooming due to her acute pain and cramping and prefers to wear loose comfortable clothing.   She is concerned  that her condition has been limiting her chances of having a child  Sleep and Rest:  complains of little sleep due to abdominal cramping and rises to refill hot compresses which she finds eases cramps to a degree.   She says that she feels tired all of the time.  Work and Play: she has had to take a lot of time off work because of her condition and is worried about this.   Dying: Ms James thinks that her life expectancy will be limited because her condition has not been well controlled.    MEDICAL DIAGNOSIS: Exacerbation of Crohn’s disease. DECISION:  Medical management –rest GI tract, treat symptomatically and undertake a medication review, Rx Metronidazole IV.

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(Courtney) Question 1: Describe Crohn’s disease, and the complications that may manifest.

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(Courtney) Question 1: Describe Crohn’s disease, and the complications that may manifest.

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Crohn’s Disease is an inflammatory bowel disease (IBD) that causes inflammation of the digestive system or gut. Crohn’s can affect any part of the gut, though the most common area affected is the end of the ileum (the last part of the small intestine), or the colon.

The areas of inflammation are often patchy with sections of normal gut in between. A patch of inflammation may be small, only a few centimetres, or extend quite a distance along part of the gut. As well as affecting the lining of the bowel, Crohn’s may also go deeper into the bowel wall. Crohn’s is a chronic condition. This means that it is ongoing and life-long, although you may have periods of good health (remission), as well as times when symptoms are more active (relapses or flare-ups).

The inflammation caused by Crohn’s disease can cause the patient to have abdominal pain, weight loss, severe diarrhoea and fatigue. Crohn’s can lead to scarring, abscesses, fistulas, and ulcerations in the intestine. This is characterised by the remissions and relapses or flare ups.
(Chron's and Colitis UK 2018)

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(Courtney) Question 3: What is the nursing diagnosis and goals of care for this patient? 

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(Courtney) Question 3: What is the nursing diagnosis and goals of care for this patient? 

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We know that the Mrs James has an exacerbation of her Crohn’s disease and for the nursing diagnosis, what needs to be done to help Mrs James are:

· Make sure Mrs James is free from infection by assess vital signs as having a fever is often the first sign of infection and making sure her laboratory values are in normal ranges because if they are abnormal it could be an indicator of infection.

· Try to get the pain related to the inflammatory process of the Crohn’s Disease under control. This is by using pain scales to monitor the level of pain and to see if there is any other pain relief we can put Mrs James on.

· Make sure Mrs James rests to minimise pancreatic secretions and pain.

·Identify contributing factors such as smoking and alcohol and help Mrs James understand about how these factors are affecting her condition.

· Monitor her stools by putting her on a stool chart which can monitor how frequent Mrs James is going, the amount and the consistency of the stool. This can be to assess the severity of her flare up.

· Promote bed rest.

·Try to reduce Mrs James anxiety by reassuring her not to be embarrassed and remove her stools promptly. Also provide Mrs James with room deodorisers as it will remove any odours and avoid Mrs James getting embarrassed.

·Identify and restrict foods and fluids that speed up diarrhoea such as whole grain bread, pasta, cereals, certain vegetables and fruit, fizzy drinks, alcohol and milk products.

·Talk to Mrs James as see if she is worried or stressed about anything as stress can lead to a more aggravate condition.

· Promote only clear liquids to drink such as water or even squash.

The nursing goals for Mrs James are:

· To help her understand the disease and that there is no cure so it needs to be managed effectively.

·  That taking her medications are important and reducing her alcohol intake will make her medications work better.

· Talk to her to see if she is worried, anxious or stressed about anything and see why she is drinking alcohol every day. Refer to alcohol support services if Mrs James wants to.

· To eat an appropriate diet by avoiding high fibre foods and foods that are hard to digest such as nuts, raw vegetables or fruits as they can cause a flare up or make flare ups worse. Also allergen type foods such as dairy, spicy, high fat foods and gluten.

· Encourage to keep active because exercise reduces the severity of Crohn’s symptoms.

· To help and educate Mrs James to stop smoking as it makes Crohn’s Disease worse. The nurse should refer her to smoking cessation but only if Mrs James wants to.

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Abey. Q7: 7.	In relation to this how would you plan an education programme within the patients care plan to help them to understand new treatments?  

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Abey. Q7: 7.	In relation to this how would you plan an education programme within the patients care plan to help them to understand new treatments?  

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Abey. Q6: What are the Discharge Goals??

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Abey. Q6: What are the Discharge Goals??

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Please summarise one study that relates to the scenario

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What are the desired outcomes in this case?
These would be Rowan is seen holistically, by multi-agency health care and third sector support services.
Plans of action can be created with dieticians, gastroenterologists to review her current medication and support to reduce her alcohol intake.
A referral to counselling services may address Rowan's relationship and support her to improve her sense of body image.
Charities such as the Crohn's and colitis organisation can provide practical support to come to terms with the treatment and work with health care professionals so that best efforts can be made to avoid surgery.

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Crohn's Disease is a condition that causes inflammation of the digestive system or gut. Some of the common questions are addressed.

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Things to consider:
Pain Controlled before discharge
Any infection to be treated
Diarrhoea controlled & Nausea controlled.
Weight maintained, no further drop in weight.
Headaches solved.
Health promotion around smoking, drinking and healthy diet which is suited to Chrons: simple foods, little dairy, no caffeine, avoiding spicy foods and sauces.
Solve Dehydration
Solve fatigue and fall risk.
Address the sleeplessness.

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What sources of Information have you found useful for this case study?
Aside from the Crohn's and Colitis UK site, there are journals such as the British Journal of Gastroenterology, NICE evidence based guidelines and a Facebook group for sufferers to get together and share experiences.