Crohn's Disease and Treatment

Case Study: Crohn’s Disease

Crohn’s disease can often be difficult to diagnose, given it shares many similarities with inflammatory bowel disease (IBS), colitis, and irritable bowel syndrome. In this case, a 27-year-old man with Crohn’s disease has been admitted to the emergency room. Crohn’s disease is usually initially treated with drug therapy, although depending upon its severity, surgical intervention may be required. “Though most patients respond to medical therapy, mainly steroids, with the addition of immunomodulators and more recently biologics agents, surgical intervention is usually required only for obstructing gastroduodenal disease secondary to strictures” (Schwartzberg et al., 2019, p. 231). Asking the patient if he has had any surgery, a review of his drug treatment regime, and the degree to which he has been adhering to it (and when he discontinued specific medications) before abandoning it would all be essential in a first interview.

One advantage for the patient in this instance is his diagnosis is already clear, given it is noted that has just experienced a flare -up of his condition due to being unable to afford his medication. Still, even though his diagnosis is clear versus IBS or another possible diagnosis, a series of diagnostic tests should be performed. One common test is a c-reactive protein test (CRP), screening for signs of inflammation (Roybal, 2020). Testing liver function is useful to determine the degree of disease activity, as well as predicting the course of the disease (Roybal, 2020). One of the most common complications of Crohn’s disease is malnutrition. A complete blood cell count can be used to detect anemia, and iron and B12 levels should also be screened (Roybal, 2020). Since electrolytes, particularly potassium, may be low due to dehydration, an electrolyte panel would likely also have to be performed (Roybal, 2020).

After determining the physical severity of the condition, the nurse should also discuss the severity of the condition and its impact on psychological health. Diseases affecting food, digestion, and excretion can often be profoundly disturbing for a patient, in terms of carrying on a normal social life (Chiba et al., 2018). Avoiding certain foods and alcohol is often necessary to mediate the effects of the condition. Unfortunately, given the patient is 27-years-old, this may present obstacles in terms of living a normal social life. It can also create obstacles in maintaining a hectic job and school schedule, particularly during a flare-up. A flare-up can cause the patient to miss work and school. This can make it difficult to secure adequate employment with the type of heath insurance needed to maintain what can be an expensive drug and treatment regime. The patient should also be interviewed to describe and express on a personal level what led him to go to the ER and to seek out medical attention this time, in terms of his pain, discomfort, and other presenting symptoms.

Ethical Considerations

It is very important not to reprimand the patient for not adhering to the drug regime he was prescribed. The goal of treatment is not to judge the patient, but to ensure that he can resume his drug treatment regime with the maximum level of financial support available. The nurse’s role of patient advocate is critical not simply in assisting in prescribing a treatment regime, but ensuring that the patient can follow the plan. This is one reason why it is so necessary for providers to take an interest in terms of how healthcare is managed and costs are allocated on an institutional and policy level, as well as an individual level (Cleveland et al., 2019).

The nurse can connect the patient with a healthcare liaison, or suggest valuable helplines to discuss the patient’s current insurance policy, the medications it covers, and options such as health savings accounts (HSA) to increase affordability. Even if the nurse is not an expert in healthcare policy and navigating the difficulties of the insurance industry, the nurse can put the patient in contact with a network of service providers who can do so. It is critical that the patient does not simply leave the hospital with a medication plan or a treatment plan, but also a financially feasible treatment plan. If the patient’s condition is likely to worsen, and surgery may be required, this is particularly critical. Finally, the nurse can also put the patient in touch with support groups and other organizations which can offer (often free) emotional and psychological support, and may have additional ideas and input which can make adhering to treatment more feasible.

Concepts, Theories, and Principles

One critical concept evident in this case study is the need for the nurse to act as an informed patient advocate. Nurses must uphold the ideas both of beneficence, or benefiting the patient, and autonomy, or ensuring the patient can make informed decisions about his condition. The patient’s prioritization of cost over health does not have to be accepted unquestioningly, however. One way of conceptualizing the role of the nurse, according to Dorothea Orem’s Self-Care Deficit Theory is that the nurse will step in when the patient cannot engage in self-care, and the nurse can work to provide the patient with the necessary tools to engage in self-care (Khademian et al, 2020).

Although providing strategies to balance his lifestyle demands with side-effects of the medication and the disease may be necessary, self-care in this instance also involves patient education about the risks of not taking his medication and plan of how to afford them. Patient self-care and education, particularly for a chronic disease, means the patient must be able to engage in self-care after his release, and also understand the future consequences of failing to adhere to an evidence-based plan of medication. The patient also requires emotional support to manage his disease, and motivation to continue in a more positive direction.