NMIH207 Developing Nursing Practice 2 | Crohns Disease

She wants the diahorrea and abdominal pain to go away, but is worried how her she will cope with the ileostomy and how this will affect her family and social life and relationships.

This assessment task requires the student to explore the following as they relate to a person with Crohn’s disease.

• Discuss the clinical presentation of Crohn’s disease.
  
  
• Explain the pathophysiology of Crohn’s disease.
  
  
• Discuss the role diet and medication play in the management of Crohn’s disease .
  
  
• Discuss the pre and post-operative management and care needed for a person who has surgery to create an ileostomy. Include a discussion of health education and social implications for Martina and her family

Answer:

According to the given scenario, Martina is a 25-year-old girl who has suffered from Crohn's disease and to reduce this problem she eats healthy foods and also follows the proper medication program. Crohn’s is defined as a disease which is a type of inflammatory bowel illness and this type of disease associated with gastrointestinal tract (Bouguen, Levesque, Feagan, Kavanaugh, Peyrin, Colombel, & Sandborn, 2015). This type of disease can disturb any portion of the gastrointestinal tract and this illness does not occur through food. There are many symptoms of Crohn's disease such as rectal bleeding, fever, frequent recurring diarrheic, weight loss, reduced appetite, and feeling of low energy. According to the world health organization it is projected that around 1.6 million persons in America were diagnosed due to Crohn's disease. Around 70,000 new cases are diagnosed in the US and it is observed that this type of disease does not occur by eating food (Chuang, Villaverde, Hui, Mortha, Rahman, Levine, & Facey, 2016). Crohn’s disease is well-defined as a swelling of the bowel which includes ileum and right colon. This type of disease occurs after meals and it shows the partial intestinal obstruction. In chronic illness, the figure system bouts the gastrointestinal tract which is absorbed at microbial antigens but in Crohn's illness, the human body scheme is not activated by the form itself. It is projected that the amount of Crohn's illness is increased rapidly in the last few years and this occurs due to smoking. This type of health disorder affects around 3 per 1000 individuals in America and Europe and it is observed that this health disorder is less in Africa and Asia (Cleynen, Boucher, Jostins, Schumm, Zeissig, Ahmad, & Brant, 2016).  There are mainly two factors that can reduce this type of health disorders such as healthy diet and medication. Martina was suffered from Crohn's disease because she smokes regularly and this type of problem can be reduced by eating healthy diets and medication process. 

Crohn’s disease is one of the most common diseases and it is characterized by a chronic inflammation that affects any part of human body system (Colombel, Sands, Rutgeerts, Sandborn, Danese, D'haens, & Parikh, 2017). Inborn susceptibility plays a significant part in the pathogenesis of Crohn's illness and it is observed that this health disorder is a single gene disorder. This type of problem can be resolved by eating healthy diets and medication process. It is estimated that medication can reduce Crohn's disease by around 50% and Martina who was suffered from this disease eat always healthy diets and also follow the medication process. According to health programmes susceptibility can improve the understanding of the pathogenesis of Crohn's illness (Feagan, McDonald, Panaccione, Enns, Bernstein, Ponich, & Fedorak, 2014). According to research, Crohn's disease is a systematic health disorder which is a part of inflammation and any system of GI tract can be pretentious from the entrance to the anus of the human body system. There are main two commons symptoms of this disease such as diarrhea and abdominal and this type of disease is related to a chronic health disorder. Crohn disease is a group of IBD and this type of problem occur in children and adults. Crohn illness identification is based on numerous clinical structures. The early stage is a thorough examination of the patient’s giving symptoms, counting any connected medicinal, communal, and domestic past. This is shadowed by an engrossed bodily inspection of the abdomen and any additional symptom-related figure schemes. If found on the antiquity and physical inspection, Crohn illness is a possible diagnosis, most clinicians check for generic inflammatory activity with a variety of humble laboratory tests, counting an erythrocyte sedimentary rate (ESR), C-reactive protein (CRP), and leukocyte and platelet total. Lastly, medicinal imaging can be used to settle diagnosis and screen illness action. The site of symptomatic agony is often one of the most solid pointers of Crohn illness kind and if the patient criticizes of agony in the correct lower quadrant of the abdomen, this might designate a circumstance of Crohn illness (Feagan, Sandborn, Gasink, Jacobstein, Lang, Friedman, & Adedokun, 2016). Still, agony in the correct lower quadrant, particularly when related with a high infection, also can show acute appendicitis, which must be ruled out with soreness since it can central to a life-threatening alternative. According to the given scenario, Martina eats healthy diets and also follow proper medication process which can reduce the problem of Crohn's disease. Crohn disease initiates with crypt inflammation and boils, which advancement to minute focal ulcers. Crohn health disorder is divided into three patterns such as primarily obstructing, inflammatory, and primarily fistulising (Gevers, Kugathasan, Denson, Vázquez, Van, Ren, & Morgan, 2014).

There are many treatment options for Crohn's disease and other health disorders such as healthy diets, medication, nutrition, and surgical process. Medication plays a significant part in the reduction of Crohn's illness and other health disorders. Medication process is generally used to improve the human immune system and it is estimated that medication can reduce 50% of Crohn's disease. Medication process also reduces many health risks such as fever, pain, and diarrhea. To control and suppressing signs and symptoms of any health disorder medication can be utilized to reduce the number of symptoms. Healthy diet and nutrition also play a significant role to reduce this type of health disorder and it is observed that Crohn's disease does not occur due to foods. If Martian eats regularly healthy foods and drinks soft water rather than beverages than she can improve her health and can reduce this type of health disorders. People can follow a proper healthy diet plan and Australia provided a dietary plan for all people. According to Australian dietary plan, healthy diets include vegetables, fruits, fish, eggs, and protein and people can drink milk which can reduce other health disorders (Gionchetti, Dignass, Danese, Magro Dias, Rogler, Lakatos, & Laureti, 2016). If any person who is suffering from Crohn's disease, therefore, he can eat healthy food which can reduce this type of health disorders. It is estimated that healthy diets and medication can reduce Crohn's disease by 50% and other 50% can be resolved by surgery treatments (Jansson, Willing, Lucio, Fekete, & Schmitt, 2018). Chron's disease also required surgical treatment and Martina should follow this treatment and she can reduce this health disease.  Surgery system is used when medication cannot control Crohn's disease and this process can help to avoid this type of health risks. There are some key factors to know about the surgery process which are following

• Around 70% of individuals with Crohn's illness generally need surgery process
  
  
• Various types of process can be performed which depends on the type of illness, reason, and location of the disease
  
  
• Around 32% of patients who have surgery for this disease experience recurrence of their symptoms.

For surgery treatment for Crohn's illness, it is very impotent to understand Crohn's illness and symptoms of this disease. There are many nurses in hospitals who do not know about this type of health disorder therefore first hospital should provide education and training programmes for nurses through which they developed their knowledge regarding Crohn's disease and other health disorders (Monteleone, Neurath, Ardizzone, Di, Fantini, Castiglione, & Rogai, 2015). There are many hospitals that provided education and training programmes for nurses and it is observed that this programmes developed a platform where nurses can interact with the patient and can help to motivate patient and provide diets and medication process (Panés, García, Van Assche, Colombel, Reinisch, Baumgart, & Grimaud, 2016).  Before surgery operation, nurses can interact with patients and provide complete information about their health problem and motivate to people which can develop a stage where patients can understand this type of disease. To reduce this type of problem Australian government developed many strategies and policies which reduced this type of health risks by 50% and they also promote healthy diets and medication by providing education and training program in Australia. If Martina eats healthy foods and follows proper exercise plan than this disease can be reduced because many doctors promote healthy diets and exercise to improve health and they always motivate their patients to avoid unhealthy foods (Ruemmele, Veres, Kolho, Griffiths, Levine, Escher, & Buderus, 2014). If any person that requires surgery operation regarding his Crohn's disease than doctors and nurses can help to reduce his fear by providing complete detail about his health problem because if any person who is suffering from any disease and any doctor or nurses motivate him and produce some hopes which can reduce fear from any person. Therefore there are many steps can be used for pre-processing regarding Crohn's disease such as hospitals can provide education and training program for nurses to improve their knowledge, nurses can motivate patients, patient can understand his problem and nurses can provide complete information related to health disease, doctors can provide a platform where patients can relief from health disorders, and family members should support when any person suffer from this type of disease. These all thing can be used before surgery operation because all these steps can develop confidence in any patient. After surgery operation doctors provide many steps and health process which helps to patients and also reduce this type of health disorder. It is observed that Crohn's disease is increased in Australia and the rate of Crohn’ s disease has doubled in the last few years. According to the world health organization, around 5% of people in Australia were diagnosed due to Crohn's disease and the main reason for this problem is lack of medication and healthy diets. There are mainly two factors through which Crohn's disease and other health disorders can be avoided such as healthy diets and medication. Martina always eats healthy foods and also do medication which help to reduce Crohn's disease and after her surgery operation doctors and nurses can provide prevention process and method that help to reduce pain and improve her health. Nurses play an important role in the reduction of this type of disease and they provide a platform where patients improve health and wellbeing (Sands, Feagan, Rutgeerts, Colombel, Sandborn, Sy, & Fox, 2014). Family members can help to avoid health risks by giving motivation information and providing medication programmes. There are many health programs developed in Australia and they provide proper healthy diets and exercise plan through which any Crohn's patient can improve his health. Teacher and friends motivate Crohn's patients and always promote for eating healthy diets. All these things can be used for post-operation which can help to avoid this type of problem and nurses should more communicate with a patient that will help to avoid human health risks.

However, Martina can improve her health by eating healthy diets and follow proper medication process which really reduces Crohn's disease. Her family more interact with Martina because it reduces the communication gap between Martina and her family and also reduces the fear of Martina. If any person who is suffering from Crohn's disease that he can follow the proper healthy diet plan and medication process because it is observed that healthy diets and medication both are main key factors to reduce Crohn's problem in people. Therefore, the Australian government should develop strategies and policies regarding Crohn's disease and also improve health and wellbeing programmes. The teacher should increase education and training programmes because students eat fast foods and it is very dangers for human health so teachers can motivate students which can help to reduce this type of problem. Parents should follow the proper care and treatment process and also provide healthy diets to Crohn's patients which can reduce human health disorders.

References

Bouguen, G., Levesque, B. G., Feagan, B. G., Kavanaugh, A., Peyrin–Biroulet, L., Colombel, J. F., & Sandborn, W. J. (2015). Treat to target: a proposed new paradigm for the management of Crohn's disease. Clinical Gastroenterology and Hepatology, 13(6), 1042-1050.

Chuang, L. S., Villaverde, N., Hui, K. Y., Mortha, A., Rahman, A., Levine, A. P., & Facey, J. A. (2016). A frameshift in CSF2RB predominant among Ashkenazi Jews increases the risk for Crohn's disease and reduces monocyte signaling via GM-CSF. Gastroenterology, 151(4), 710-723.

Cleynen, I., Boucher, G., Jostins, L., Schumm, L. P., Zeissig, S., Ahmad, T., & Brant, S. R. (2016). Inherited determinants of Crohn's disease and ulcerative colitis phenotypes: a genetic association study. The Lancet, 387(10014), 156-167.

Colombel, J. F., Sands, B. E., Rutgeerts, P., Sandborn, W., Danese, S., D'haens, G., & Parikh, A. (2017). The safety of vedolizumab for ulcerative colitis and Crohn's disease. Gut, 66(5), 839-851.

Feagan, B. G., McDonald, J. W., Panaccione, R., Enns, R. A., Bernstein, C. N., Ponich, T. P., & Fedorak, R. N. (2014). Methotrexate in combination with infliximab is no more effective than infliximab alone in patients with Crohn's disease. Gastroenterology, 146(3), 681-688.

Feagan, B. G., Sandborn, W. J., Gasink, C., Jacobstein, D., Lang, Y., Friedman, J. R., & Adedokun, O. J. (2016). Ustekinumab as induction and maintenance therapy for Crohn’s disease. New England Journal of Medicine, 375(20), 1946-1960.

Gevers, D., Kugathasan, S., Denson, L. A., Vázquez-Baeza, Y., Van Treuren, W., Ren, B., & Morgan, X. C. (2014). The treatment-naive microbiome in new-onset Crohn’s disease. Cell host & microbe, 15(3), 382-392.

Gionchetti, P., Dignass, A., Danese, S., Magro Dias, F. J., Rogler, G., Lakatos, P. L., & Laureti, S. (2016). 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: surgical management and special situations. Journal of Crohn's and Colitis, 11(2), 135-149.

Jansson, J. R., Willing, B., Lucio, M., Fekete, A., & Schmitt-kopplin, P. (2018). U.S. Patent Application No. 15(669), 733.

Monteleone, G., Neurath, M. F., Ardizzone, S., Di Sabatino, A., Fantini, M. C., Castiglione, F., & Rogai, F. (2015). Mongers, an oral SMAD7 antisense oligonucleotide, and Crohn’s disease. New England Journal of Medicine, 372(12), 1104-1113.

Panés, J., García-Olmo, D., Van Assche, G., Colombel, J. F., Reinisch, W., Baumgart, D. C., & Grimaud, J. C. (2016). Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn's disease: a phase 3 randomized, double-blind controlled trial. The Lancet, 388(10051), 1281-1290.

Pariente, B., Mary, J. Y., Danese, S., Chowers, Y., De Cruz, P., D’Haens, G., & Schreiber, S. (2015). Development of the Lémann index to assess digestive tract damage in patients with Crohn's disease. Gastroenterology, 148(1), 52-63.

Ruemmele, F. M., Veres, G., Kolho, K. L., Griffiths, A., Levine, A., Escher, J. C., & Buderus, S. (2014). Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. Journal of Crohn's and Colitis, 8(10), 1179-1207.

Sands, B. E., Feagan, B. G., Rutgeerts, P., Colombel, J. F., Sandborn, W. J., Sy, R., & Fox, I. (2014). Effects of vedolizumab induction therapy for patients with Crohn’s disease in whom tumor necrosis factor antagonist treatment failed. Gastroenterology, 147(3), 618-627.

Wright, E. K., Kamm, M. A., De Cruz, P., Hamilton, A. L., Ritchie, K. J., Krejany, E. O., & Lawrance, I. C. (2015). Measurement of fecal calprotectin improves monitoring and detection of recurrence of Crohn's disease after surgery. Gastroenterology, 148(5), 938-947.