NCLEX Review Guide: Crohn's Disease

Disease Overview

• Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the GI tract from mouth to anus, characterized by transmural inflammation (affects all layers of bowel wall).
• Most commonly affects the terminal ileum and ascending colon, creating a "skip pattern" with areas of normal tissue between inflamed segments.
• The inflammation leads to cobblestone appearance of mucosa, deep ulcerations, and potential complications like strictures, fistulas, and abscesses.

Priority Interventions

1. Monitor for signs of intestinal obstruction: severe cramping, vomiting, absence of flatus, distended abdomen
2. Assess nutritional status regularly using albumin, prealbumin, and BMI
3. Monitor fluid and electrolyte balance, especially potassium and magnesium
4. Provide emotional support as this is a chronic, unpredictable condition

Pharmacological Management

• Aminosalicylates (5-ASA) like mesalamine reduce inflammation in mild to moderate disease.
• Corticosteroids (prednisone, budesonide) for acute flares but not for maintenance due to side effects.
• Immunomodulators (azathioprine, methotrexate) for maintenance therapy in steroid-dependent patients.
• Biologic agents (infliximab, adalimumab) for moderate to severe disease unresponsive to conventional therapy.

Dietary Interventions

• During acute flares: low-residue, high-protein, high-calorie diet to reduce bowel stimulation while meeting nutritional needs.
• Avoid trigger foods: high-fiber foods, dairy, spicy foods, alcohol, and caffeine during active disease.
• Consider enteral nutrition or TPN for severe malnutrition or to rest the bowel during acute exacerbations.
• Supplement with vitamin B12, iron, folate, and fat-soluble vitamins due to malabsorption.

Potential Complications

• Intestinal obstruction from strictures - most common complication requiring surgical intervention.
• Fistula formation (abnormal connections between bowel and other organs or skin) - requires surgical repair.
• Perforation and abscess formation - medical emergency requiring immediate intervention.
• Increased risk of colorectal cancer with long-standing disease, especially with colonic involvement.

NCLEX Success Strategies

• Remember: Crohn's can affect "mouth to anus" while UC is "colon only"
• Think "Crohn's = Cramping + Complications" (fistulas, obstruction)
• Priority nursing diagnosis: Imbalanced nutrition less than body requirements