Crohn’s Disease: a Patient Education Plan

Sarah is a bright, energetic 18-year-old high school senior. She leads a very active life playing soccer and lacrosse for her high school and excels academically. Recently, Sarah has been losing weight and has been less energetic. For the past few months she has been experiencing abdominal pain, cramping, and diarrhea. Her lack of energy has begun to show by recently missed practices and declining grades. Sarah's parents were concerned about their daughter's health so they brought her to the doctor's in which she was recently diagnosed with Crohn's disease.

Sarah lives with both parents and two younger brothers in suburban Maryland. It is noted that Sarah's maternal grandmother had irritable bowel syndrome. Sarah is planning on going to college in the fall and will need a large amount of education on nutrition, medications, and symptoms of the disease so that she can manage the disease independently. Sarah states that she learns best by reading. Crohn's disease is a chronic disorder that causes inflammation of the gastrointestinal tract, usually the colon, although it can be found anywhere in the digestive tract.

There is no proven cause of Crohn's disease but according to the National Institute of Diabetes and Digestive and Kidney Disease's (2006), "the most popular theory is that the body's immune system reacts abnormally mistaking bacteria, foods and other substances for being foreign" (Crohn's Disease, para 5), the intestines become inflamed and swell and ulcers form leading to diarrhea and gastrointestinal bleeding. Other symptoms associated with Crohn's disease include abdominal pain and cramping, bloody stools, ulcers, fever, reduced appetite and weight loss, arthritis, and skin problems.

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A diagnoses of Crohn's disease to an active 18year old girl can be devastating. At 18, girls are usually concerned with their image and outward appearance. Sarah would also be concerned about her independence and quality of life. Fitting in with her peers and feeling "normal" are a big concern. She may be concerned about having intimate relationships in the future or going out to eat with friends. There is no known cure for Crohn's disease so Sarah needs to focus on the things she can do to control the symptoms and educe the time between flare ups. There is obviously a lot of emotional stress that can go along with Crohn's disease. A young girl, trying to have a social life may find it difficult to go out in public for fear of having an attack of gas , pain or diarrhea, and not be near a bathroom. Knowing where the public bathrooms are before you go out can reduce anxiety. Special dietary needs may be restrictive when going out with friends. Figuring out the trigger foods and avoiding them is necessary. If surgery is needed, this can impact her self image.

Talking with a doctor about possible surgical procedures may be helpful. Sarah will also have to be monitored for depression, which is common when living with a chronic disease. Sarah will need education on how manage her disease independently. Besides medication, there are many other things Sarah can do to manage her disease and improve her quality of life. Sarah will need to be taught about her nutritional needs. She should limit dairy products. Often people with Crohn's are lactose intolerant. Sarah should eat low fat foods.

Fattier foods can worsen diarrhea. Drink plenty of liquids avoiding caffeine and alcohol. Eat small meals. Take a multivitamin. She should also pay attention to and avoid the foods that cause gastrointestinal upset. In addition to her dietary needs, Sarah needs to manage stress. Avoiding stressful situations or using exercise or yoga to reduce stress may help prevent flare-ups. Other educational needs for Sarah include teaching about the possibility of surgery if or when the medications and diet modifications cannot control the symptoms any longer.

As stated on the Crohn's and Colitis Foundation of America website (2009), "Two-thirds to three quarters of patients with Crohn's disease will require surgery at some point in their lives" (About Crohn's Disease, para 24). Sarah will be provided with informational handouts and videos along with a list of website resources such as www. ucandcrohns. org and www. ccfa. org/kidsteens. Counseling will be provided for emotional support. Sarah's family will also be educated and taught how to provide support and acceptance.

Sarah may believe her life will be very different but with education and support, she should be able to live a relatively normal life. Diagnoses with a chronic disease at any age is difficult. For Sarah, educational on how to best manage Crohn's disease and prevent flare-ups will decrease stress and help her live a normal life. Follow-up doctor appointments for medication management and updated disease information is important so she has current treatment options. Ongoing emotional support and guidance are needed to maintain a healthy attitude and lifestyle.

References

American Society of Colon and Rectal Surgeons. (2008). Crohn's Disease. Retrieved June 12, 2010 from http://www.fascrs.org/patients/conditions/crohns_disease/ Crohn's and Colitis Foundation of America. (2009). Retrieved June 12, 2010 from http://www.ccfa.org/info/about/crohns Mayo Clinic. (2009). Mayo Clinic. Retrieved June 12, 2010 from http://www.mayoclinic.com/health/crohns-disease/DS00104 National Institute of Diabetes and Digestive and Kidney Diseases. (2006). Retrieved June 12, 2010 from http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/ University of Maryland Medical Center. (2010). Crohn's Disease. Retrieved June 13, 2010 from http://www.umm.edu/altmed/articles/crohns-disease-000043.htm

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