and inflammation within the bowel. Bobby was admitted to a hospital and treated with corticosteroids. Surgery was performed to remove the damaged portion of his small intestine. He had developed a fistula, in addition to a bacterial infection in his bloodstream. He was given antibiotics to control the bacterial infection and was told he would need follow-up treatment of vitamin B

12 injections monthly. He was also told

to monitor his diet, to get plenty of rest, and to avoid stressful situations.

NursiNg Care PlaNA Client with Crohn’s Disease Taking Vitamin B

12Bobby Joe Hegeman, age 28, was on vacation with his wife and two small children when he became ill. He returned home and was diagnosed as having Crohn’s disease. He asked for an explanation of the disease and was told that it is a chronic type of inflammatory bowel disease that leads to malabsorption

Chapter 23 Agents Used to Treat Anaemias

Assessment nursing diAgnosis PlAnning/goAls imPlementAtion evAluAtion

Abdominal pain Acute pain related to bowel inflammation and recent surgery.

Client will verbalise relief of pain following pain relief interventions.

Encourage client to follow health care provider’s instructions. Steroids prescribed to reduce inflammation. Take antacid with steroid to lower stomach irritation. Avoid aspirin to minimise gastrointestinal upset and bleeding and avoid contact with infected persons to minimise infections.

Client has healing of bowel and no further abdominal pain.

Tolerance for physical activity

Activity intolerance related to generalised weakness and pain.

Client utilises energy conservation techniques.

Encourage client to plan for extra rest following surgery. The client should be taught to slow down and increase periods of rest and sleep consistently.

Client maintains activity level within capabilities as evidenced by normal heart rate.

Dietary habits, food preferences

Imbalanced nutrition: less than body requirements related to malabsorption.

Client plans a high-protein, high-calorie diet, low in residue and fat prior to discharge.

Teach client to avoid spices, chocolate, pork, caffeine, alcohol, fresh fruit, and carbonated drinks. Instruct on high-protein, high-calorie, low-fat, low- residue diet.

Client’s nutritional status improves as evidenced by weight gain, controlled diarrhoea, and normal serum electrolyte balance.

Dietary supplements, vitamin B

12

Deficient knowledge related to surgical procedure and need for consistent replacement of vitamin B

12.

Client verbalises understanding of disease process and long-term management.

Teach client that the removal of the distal ileum means that he will need lifelong B

12 injections. Rare side

effects include diarrhoea, oedema, congestive heart failure, anaphylaxis, and hypokalaemia. Remind client that additional B

12 may be

needed during injections. Signs of B

12 deficiency include

fatigue, anorexia, pallor, dyspnea on exertion, and visual disturbances.

Client can list the signs of vitamin B

12 deficiency. He has

a nurse give him his monthly injections and has no adverse side effects.

CONTINUED

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Assessment nursing diAgnosis PlAnning/goAls imPlementAtion evAluAtion

Lifestyle patterns, stress

Deficient knowledge related to stress management and follow-up care.

Client will identify stress management techniques and will follow schedule for yearly physical examination and colonoscopy.

Client is encouraged to verbalise feelings of increased stress, need to escape personal problems, and frustration. Teach client to deal with the problem and feelings, and reduce the physiological responses by staying calm and using available support from family, friends, or professional sources.

Client identifies stresses in life and ways to reduce them. Maintains regular schedule of follow-up appointments with health care provider.

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