Nursing Assessment, Management and Treatment of Autoimmune Diseases
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EVIDENCE-BASED PRACTICE Research shows that Crohn’s disease peaks at two specific age ranges: be - tween 15 and 30 and again at 60 to 70 years of age. Women are more of- ten affected than men during the age range of 60-70 (Gersch et al., 2017). These age ranges should be consid- ered when evaluating patients. The disease is most often diagnosed in adolescents and adults between the ages of 20 and 30 (Crohn’s & Colitis Foundation, 2021b). Pathophysiology and assessment Crohn’s disease starts with crypt (glands of the intestinal lining) inflammation and abscesses, which evolve into tiny focal aphthoid ulcers (mucosal lesions). These lesions may advance into deep longitudi- nal and transverse ulcers accompanied by mucosal edema, which creates the char- acteristic cobblestoned appearance of the bowel (Merck Manual, 2020a). Bowel thickening causes stenosis of the bowel, which can occur in any part of the intestine and cause varying degrees of in- testinal obstruction (Rebar et al., 2019). Abscesses are common Fistulas frequently penetrate adjoining structures and may even extend into the skin of the anterior abdomen or flanks (Merck Manual, 2020a). EVIDENCE-BASED PRACTICE Research shows that perianal fistulas and abscesses occur in 25% to 33% of cases of Crohn’s disease. These complications can be the most prob- lematic aspects of the disease (Merck Manual, 2020a).
As the inflammation of Crohn’s disease progresses, evident pathophysiology in- cludes the following (Rebar et al., 2019): ● As lymph nodes enlarge the lymph flow in the submucosa is impeded. ● Lymph flow obstruction leads to edema, ulceration of the mucosa, fissures, abscesses, and, possibly, granulomas. ● Peyer’s patches form. These patches are oval, elevated, closely packed lymph follicles. ● Fibrosis develops, causing further thickening of the walls of the bowel, stenosis, and/or narrowing of the lumen. ● Inflamed loops of the bowel adhere to not only other diseased portions of the bowel, but to healthy portions as well. ● The diseased parts of the bowel continue to thicken and narrow. Complications Anal fistula is the most common compli - cation. Fistulas may develop to the blad- der, vagina, or even in the area of an old scar. Additional complications include the following (Rebar et al., 2019): ● Intestinal obstruction. ● Nutrient deficiencies. ● Fluid and electrolyte imbalances. ● Peritonitis. There is also a long-term risk of col- orectal cancer (Merck Manual, 2020a). Patients and families should be taught to monitor for signs and symptoms of col- orectal cancer and adhere to screening guidelines. Risk factors Crohn’s disease appears to be initiated by alterations in intestinal microbes or al- terations in the mucosa of the intestine. Gastrointestinal (GI) infections, nonsteroi- dal anti-inflammatory drugs, and antibi -
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