Which of the following interventions is most appropriate for managing mild abdominal pain in a patient with symptoms as described in the initial assessment?

B) Advise the patient to apply a warm compress to the affected area.

A) Encourage the patient to increase physical activity significantly.

B) Advise the patient to apply a warm compress to the affected area.

C) Suggest the patient drink carbonated beverages to relieve pain.

D) Instruct the patient to fast and avoid all food intake.

Based on the initial assessment findings, what is the most appropriate nursing intervention to address the patient's mild fatigue?

B) Suggest scheduling short rest periods throughout the day.

A) Encourage the patient to increase her fluid intake.

B) Suggest scheduling short rest periods throughout the day.

C) Recommend a high-protein diet to increase energy levels.

D) Advise the patient to take over-the-counter vitamins.

Which dietary recommendation is most appropriate for a patient experiencing increased bowel frequency with loose stools?

B) Low-fiber diet with small, frequent meals

A) High-fiber diet with frequent large meals

B) Low-fiber diet with small, frequent meals

C) Low-protein diet with high-fat content

D) High-carbohydrate diet with reduced fluid intake

A patient reports increased frequency of bowel movements and mild fatigue. What dietary recommendation should the nurse emphasize to help manage these symptoms?

B) Consume small, frequent meals low in fiber and fat

What is the primary purpose of monitoring the patient's C-reactive protein (CRP) levels in this case?

B) To evaluate the level of inflammation

C) To measure blood sugar levels

Which of the following clinical findings indicates that the patient is responding positively to her treatment plan?

A) Abdominal pain rated 2 out of 10

B) Blood pressure of 140/90 mmHg

C) Increased frequency of bowel movements

D) Elevated C-reactive protein (CRP) level

A patient with Crohn's disease reports intermittent joint pain and swelling. Which nursing intervention is most appropriate to initially address these symptoms?

C) Advise the patient to rest and elevate the affected joints

A) Encourage increased physical activity to strengthen joints

B) Apply warm compresses to the affected joints

C) Advise the patient to rest and elevate the affected joints

D) Suggest the use of high-dose NSAIDs for immediate relief

What is the most important nursing consideration when advising a patient on long-term NSAID use?

B) Monitor for signs of gastrointestinal irritation

A) Increase physical activity to prevent joint stiffness

B) Monitor for signs of gastrointestinal irritation

C) Encourage a high-protein diet to promote healing

D) Advise the patient to discontinue NSAID if pain subsides

What is the most appropriate nursing intervention to prevent potential complications associated with long-term NSAID use in patients with Crohn's disease?

B) Advise the patient to take NSAIDs with food or milk.

A) Encourage the patient to take NSAIDs on an empty stomach.

B) Advise the patient to take NSAIDs with food or milk.

C) Suggest increasing the NSAID dose if joint pain returns.

D) Instruct the patient to discontinue NSAIDs immediately if joint pain is absent.

crohn's disease - Nursing Case Study

Pathophysiology

• Primary mechanism: Immune system dysfunction - In Crohn's disease, the immune system mistakenly attacks the digestive tract, leading to chronic inflammation. This results in damage to the intestinal walls, causing symptoms like abdominal pain and diarrhea.

• Secondary mechanism: Genetic predisposition - Certain genetic variations increase susceptibility to Crohn's disease by affecting immune regulation and intestinal barrier function, contributing to the disease's development and persistence.

• Key complication: Intestinal strictures - Chronic inflammation and healing can lead to scar tissue formation, narrowing the intestinal passage and potentially causing bowel obstruction, requiring medical or surgical intervention.

Patient Profile

Demographics:

28-year-old female, elementary school teacher

History:

• Key past medical history: Diagnosed with Crohn's disease 1 year ago, no hospitalizations

• Current medications: Mesalamine 800 mg twice daily

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Mild abdominal pain and occasional diarrhea

• Key symptoms: Intermittent cramping, 2-3 loose stools per day, mild fatigue

• Vital signs: Blood pressure 118/76 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

During the initial nursing assessment, the patient reports her abdominal pain as mild and localized to the lower right quadrant, rating it at a 3 out of 10 on the pain scale. She describes the pain as cramping but notes it is alleviated somewhat after passing stool. Upon physical examination, the abdomen is soft with mild tenderness noted in the lower right quadrant, but no rebound tenderness or guarding is present. Bowel sounds are present and active in all four quadrants.

The patient expresses concern about her energy levels, noting mild fatigue that affects her daily activities, especially in the afternoons. She reports drinking plenty of fluids to stay hydrated, as advised by her healthcare provider, and maintains a balanced diet, albeit sometimes limited by her symptoms. Her weight has remained stable since her last clinic visit, and she denies any significant changes in appetite. Given these assessment findings, the nursing team plans to monitor her symptoms closely and consider the potential for minor nutritional deficiencies due to her occasional diarrhea. This will help to ensure her condition remains stable and to address any emerging needs promptly.

Section 2

As the nursing team continues to monitor the patient's symptoms, they notice a slight change in her condition. During a routine follow-up visit, the patient reports experiencing increased frequency of bowel movements, now averaging four to five times per day. She describes the stools as loose but still formed, without any visible blood. Despite these changes, her abdominal pain remains at a manageable level, still rated at a 3 out of 10, and localized to the lower right quadrant. However, she mentions a slight increase in her fatigue, which is starting to impact her morning activities as well.

Vital signs are stable with a blood pressure of 118/72 mmHg, heart rate of 78 beats per minute, respiratory rate of 16 breaths per minute, and a temperature of 98.6°F. Upon further physical examination, the abdomen remains soft with mild tenderness in the lower right quadrant, consistent with previous findings. Laboratory results indicate a mild elevation in inflammatory markers, with a C-reactive protein (CRP) level of 10 mg/L, slightly above the normal range. Hemoglobin and hematocrit levels are within normal limits, suggesting no significant anemia at this point.

Based on these findings, the nursing team collaborates with the healthcare provider to adjust the patient's management plan. They decide to reinforce dietary recommendations, emphasizing the importance of small, frequent meals that are low in fiber and fat to minimize gastrointestinal irritation. Additionally, they discuss the possible need for a mild anti-inflammatory medication to address the increased bowel frequency and elevated CRP levels. The patient is encouraged to maintain her hydration and report any further changes in her symptoms promptly. This approach aims to stabilize her condition and prevent further complications, while also addressing her concerns about fatigue and bowel habits.

Section 3

Response to Interventions:

Following the collaborative adjustment of the management plan, the patient adheres to the recommended dietary modifications and begins a regimen of mild anti-inflammatory medication. Over the next two weeks, the nursing team closely monitors her symptoms and overall well-being through regular follow-up calls and scheduled clinic visits. The patient reports a gradual decrease in the frequency of her bowel movements, now averaging two to three times per day. She notes that the stools are more formed and easier to pass, providing her with some relief. Her abdominal pain remains consistent, rated at a 2 out of 10, and continues to be localized to the lower right quadrant, indicating a positive response to the dietary changes and medication.

Her fatigue has also shown signs of improvement, with the patient feeling more energetic in the mornings, allowing her to resume her usual activities with less difficulty. During a follow-up appointment, her vital signs remain stable with a blood pressure of 116/74 mmHg, heart rate of 76 beats per minute, respiratory rate of 16 breaths per minute, and a temperature of 98.4°F. A repeat laboratory test shows a slight decrease in her C-reactive protein (CRP) level to 8 mg/L, suggesting a reduction in inflammation. Hemoglobin and hematocrit levels remain within normal limits, confirming that the patient has not developed anemia.

The nursing team and healthcare provider are encouraged by these improvements and decide to continue the current management plan while maintaining regular monitoring of her condition. The patient is advised to keep a symptom diary to track any further changes in her bowel habits and fatigue levels, which will help guide future adjustments to her treatment. This proactive approach aims to ensure sustained control of her symptoms and prevent any potential complications from arising, highlighting the importance of patient engagement and adherence to the treatment plan.

Section 4

New Complications:

As the patient continues with her management plan, the nursing team remains vigilant in monitoring her progress. During a routine follow-up clinic visit four weeks into her treatment, the patient reports experiencing intermittent joint pain, primarily affecting her knees and ankles. She describes the pain as mild but persistent, rating it at a 3 out of 10 on the pain scale. The patient also mentions slight swelling in her joints, particularly noticeable after prolonged periods of activity. These new symptoms prompt the healthcare team to consider the possibility of an extraintestinal manifestation of Crohn's disease, which can occasionally affect the joints.

A focused physical assessment reveals mild tenderness and swelling in the affected joints, but no significant warmth or erythema, which suggests a non-infectious inflammatory process. The patient's vital signs remain stable, with a blood pressure of 114/72 mmHg, heart rate of 78 beats per minute, respiratory rate of 16 breaths per minute, and temperature of 98.6°F. Given these findings, the healthcare provider orders additional laboratory tests to assess for markers of inflammation and to rule out other potential causes of the joint symptoms.

The results of the laboratory tests show a slight increase in the patient's erythrocyte sedimentation rate (ESR), now at 25 mm/hr, which may indicate a systemic inflammatory response related to her Crohn's disease. However, rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies are negative, reducing the likelihood of a concurrent autoimmune arthritis. The team decides to introduce a low-dose nonsteroidal anti-inflammatory drug (NSAID) to manage the joint discomfort while continuing the current Crohn's treatment plan. The patient is advised to monitor her joint symptoms closely and report any changes, emphasizing the importance of ongoing communication and collaboration in managing her condition effectively. This development prompts the team to reinforce education on recognizing signs of exacerbation and the need for prompt reporting of any new symptoms, ensuring that the patient remains an active participant in her care.

Section 5

Response to Interventions:

Two weeks after the introduction of the low-dose NSAID for her joint discomfort, the patient returns to the clinic for a scheduled follow-up. She reports a noticeable improvement in joint pain and swelling, now rating her pain as a 1 out of 10 on the pain scale. She is able to engage in her daily activities with minimal discomfort, and the swelling in her knees and ankles has significantly decreased. During the physical assessment, the nursing team observes only slight residual puffiness in the joints, with no tenderness or restriction in range of motion. These findings suggest that the NSAID is effectively managing her joint symptoms associated with Crohn's disease.

In addition to the improvement in joint symptoms, the patient mentions that she has been adhering to her dietary modifications and medication regimen without difficulty. She feels more energetic and reports no gastrointestinal symptoms such as abdominal pain or changes in bowel habits. Her vital signs remain stable: blood pressure is 116/74 mmHg, heart rate is 76 beats per minute, respiratory rate is 16 breaths per minute, and temperature is 98.5°F. The healthcare team commends her on her proactive management of her condition and underscores the importance of maintaining regular follow-up visits to monitor her progress and prevent potential complications.

The patient's positive response to the interventions provides an opportunity to review and reinforce her current management plan. The team discusses the potential side effects of long-term NSAID use, such as gastrointestinal irritation, and emphasizes the importance of using the medication only as needed. They also recommend continuing to monitor for any new symptoms or changes in her condition, encouraging her to report these promptly. This collaborative approach ensures that the patient remains engaged in her care and helps anticipate any future adjustments that might be necessary in her treatment plan.