Nursing Assessment, Management and Treatment of Autoimmune Diseases
216
Treatment Lab tests should be conducted every 1 to 2 years to detect vitamin D and B12 deficiencies. Additional lab tests are con - ducted to screen for anemia, hypoalbu- minemia, additional vitamin deficiencies, and electrolyte abnormalities. Any nutri- tional deficiencies may be treated with supplements and, possibly, dietary alter- ations (Merck Manual, 2020a). | NURSING CONSIDERATION In general, treatment requires drug therapy, lifestyle changes, and, possi- bly, surgery. When acute attacks occur, it is imperative that fluid and electro - lyte balance is maintained. If patients are debilitated, parenteral nutrition is prescribed to ensure adequate caloric and nutrition intake while allowing the bowel to rest (Merck Manual, 2020a; Rebar et al., 2019). General treatment interventions For relief of cramps and diarrhea, oral loperamide, 2 to 4 mg or antispasmodic drugs can be taken up to four times a day, preferably before meals. These drugs are typically safe for patients. However, if the patient is suffering from severe, acute Crohn colitis (that may progress to toxic colitis and bowel obstruction), antidiar- rheal and antispasmodic drugs are not used (Comerford & Durkin, 2021; Merck Manual, 2020). Hydrophillic mucilloids such as meth- ylcellulose are sometimes given to help prevent anal irritation by increasing the firmness of the stool. Patients should avoid dietary roughage in cases of struc- turing or active colonic inflammation (Merck Manual, 2020a).
mouth to anus. Can affect the entire thickness of the bowel wall. ● Ulcerative colitis : Only the colon and rectum are affected. The disease affects the inner-most lining of the colon. Nurses must be aware of these differ- ences, which are important as part of the diagnostic and treatment process. Various diagnostic test results support a diagnosis of Crohn’s disease. These in- clude the following (Rebar et al., 2019): ● Fecal occult test : Minute amounts of blood in the stool. ● X-rays of the small intestine : Irregular mucosa, ulceration, and stiffening. ● Barium enema : The string sign, which occurs when segments of stricture are separated by normal bowel. Fissures, ulceration, and narrowing of the bowel may be observed. ● Sigmoidoscopy and colonoscopy : Patchy areas of inflammation are observed. (This sign helps to rule out ulcerative colitis). The surface of the mucosa has a cobblestone appearance. Ulcers may be seen if the colon is affected. | NURSING CONSIDERATION Colonoscopy has been found to be more accurate than barium enema in assessing the degree of inflammation present (Rebar et al., 2017). Since repeated testing can be quite stressful, patients need to understand that a combination of these test are typically used since no one test is definitive.
Powered by FlippingBook