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)

· 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.