Discussion: Crohn Disease and High Fiber Diet Analysis Paper

Discussion: Crohn Disease and High Fiber Diet Analysis Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Crohn Disease and High Fiber Diet Analysis Paper The requirements for your Project include the following: Discussion: Crohn Disease and High Fiber Diet Analysis Paper Must be 6 pages. Must include an introductory paragraph that describes the entire project. The paper must have all of the following: identification of the alteration in health (disease), the role nutrition plays in the prevention of this disease, its etiology, progression, treatment, recommended diet, type of nursing assessment and nursing interventions needed with regard to nutrition, outline of what should be included in client education and two strategies to help ensure adherence (overcome barriers) to the recommended diet . Must have a title page and an APA Editorial formatted Reference page with at least three scholarly peer reviewed references within the last five years. There must also be appropriate APA Editorial formatted in-text citations. please use the rubric attached rubric_detail.pdf crohn_dis.pdf crohn_disese_diet.pdf crohn_diseaes_nurse_care.pdf crohn_dis_4.pdf Rubric Detail A rubric lists grading criterion that instructors use to evaluate student work. Your instructor linked a rubric to this item and made it available to you. Select Grid View or List View to change the rubric’s layout. Content Name: Module 10 – Course Project Exit Proficient Identification of alteration in health (disease) Points: Role nutrition plays in disease prevention for this disease Points: Etiology and progress Points: 1.8 (4.00%) 3.6 (8.00%) 2.7 (6.00%) Treatment Points: 5.85 (13.00%) Recommended Diet Points: 7.65 (17.00%) Type of nutrition assessment and nursing interventions Points: Client education outline Points: 7.65 (17.00%) 7.65 (17.00%) Two strategies to ensure diet adherence Points: APA Editorial Format (Title Page ½ pt., Citations ½ pt., References ½ pt., Overall APA Format [double spaced, indented paragraphs, 1 inch margins, Points: 3.6 (8.00%) 4.5 (10.00%) Proficient 12 font in Times New Roman ½ pt.) Name: Module 10 – Course Project Crohn’s Disease:?Diagnosis and Management Brian Veauthier, MD, and Jaime R. Hornecker, PharmD University of Wyoming Family Medicine Residency Program, Casper, Wyoming Crohn’s disease is a chronic inflammatory condition that affects the gastrointestinal tract. It can cause lesions from mouth to anus and may result in extraintestinal complications. The prevalence of Crohn’s disease is increasing in adults and children. Genetic predispositions to Crohn’s disease have been identified, and specific environmental factors have been associated with its development. Common presenting symptoms include diarrhea, abdominal pain, rectal bleeding, fever, weight loss, and fatigue. Physical examination should identify unstable patients requiring immediate care, include an anorectal examination, and look for extraintestinal complications. Initial laboratory evaluation identifies inflammation and screens for alternative diagnoses. Measurement of fecal calprotectin has value to rule out disease in adults and children. Endoscopy and cross-sectional imaging are used to confirm the diagnosis and determine the extent of disease. Treatment decisions are guided by disease severity and risk of poor outcomes. Patients commonly receive corticosteroids to treat symptom flare-ups. Patients with higher-risk disease are given biologics, with or without immunomodulators, to induce and maintain remission. For children, enteral nutrition is an option for induction therapy. All patients with Crohn’s disease should be counseled on smoking avoidance or cessation. Patients with Crohn’s disease are at increased risk of cancer, osteoporosis, anemia, nutritional deficiencies, depression, infection, and thrombotic events. Maximizing prevention measures is essential in caring for these patients. (Am Fam Physician. 2018;?98(11):?661-669. Copyright © 2018 American Academy of Family Physicians.) Crohn’s disease is a chronic inflammatory condition disease. Genetic loci have been identified that increase risk. affecting the gastrointestinal tract that often causes extraintestinal complications. Inflammation may occur at any point from mouth to anus (Table 11). Specific clinical and diagnostic characteristics distinguish Crohn’s disease from ulcerative colitis1,2 (Table 2 1). In the United States, the prevalence is estimated at 58 per 100,000 children and 119 to 241 per 100,000 adults, and is increasing for both groups.3,4 Most cases are diagnosed in the 20s to 40s, but new cases do occur later.5 White race and higher education levels are associated with increased prevalence.4 The estimated annual economic burden to U.S. health care is $6.3 billion.6 For example, homozygosity for the NOD2 gene has shown a 20- to 40-fold increased risk of developing Crohn’s disease.5 Environmental factors associated with increased risk include smoking, oral contraceptive use, antibiotic use, regular use of nonsteroidal anti-inflammatory drugs, and urban environment.5,7 Factors associated with decreased risk include exposure to pets and farm animals, bedroom sharing, having more than two siblings, high fiber intake, fruit consumption, and physical activity. Discussion: Crohn Disease and High Fiber Diet Analysis Paper 5,8 Vaccines have not been associated with the development of Crohn’s disease.9 Risk Factors Current data suggest an interplay between genetic susceptibility and environmental factors in the development of Crohn’s HISTORY AND PHYSICAL EXAMINATION Additional content at https://?w ww.aafp.org/afp/2018/1201/ p661.html. CME This clinical content conforms to AAFP criteria for continuing medical education (CME). See CME Quiz on page 640. Author disclosure:?? No relevant financial affiliations. Patient information:? A handout on this topic, written by the authors of this article, is available at https://?w ww.aafp.org/ afp/2018/1201/p661-s1.html. Clinical Findings Crohn’s disease most often presents insidiously but can present as an acute toxic illness. Common symptoms include diarrhea, abdominal pain, rectal bleeding, fever, weight loss, and fatigue.1,2 A case review of 201 participants compared patients with Crohn’s disease and patients without Crohn’s disease who had irritable bowel syndrome or were otherwise healthy. The study identified eight red flag findings for Crohn’s disease in adults. In order of strength of association, the findings were perianal lesions other than hemorrhoids, a first-degree relative with inflammatory bowel disease, weight loss (5% of usual body weight) in the past three months, abdominal pain for longer than three months, Downloaded Family Physician Copyright © 2018 American Academy of Family Physicians. For the private, noncomDecember 1,from 2018the? American Volume 98, Number 11 website at www.aafp.org/afp. www.aafp.org/afp American Family Physician 661 mercial use of one individual user of the website. All other rights reserved. Contact [email protected] for copyright questions and/or permission requests. CROHN’S DISEASE hematologic system, joints, and skin (Table 41). History, physical examination, laboratory testing, and imaging are important in identifying these manifestations.1,13 TABLE 1 Location of Crohn’s Disease and Associated Symptoms Frequency (%) Location Symptoms Comments Ileum and colon Diarrhea, cramping, abdominal pain, weight loss Most common form 35 Colon only Diarrhea, rectal bleeding, perirectal abscess, fistula, perirectal ulcer Skip lesions and arthralgias more common 32 Small bowel only Diarrhea, cramping, abdominal pain, weight loss Complications may include fistula or abscess formation 28 Gastroduodenal region Anorexia, weight loss, nausea, vomiting Rare form 5 May cause bowel obstruction Adapted with permission from Wilkins T, Jarvis K, Patel J. Diagnosis and management of Crohn’s disease. Am Fam Physician. 2011;?84(12):?1365. nocturnal diarrhea, fever, no abdominal pain for 30 to 45 minutes after meals, and no rectal urgency.10 A case review of 606 children with chronic abdominal pain identified three red flag findings for children:?anemia, hematochezia, and weight loss.11 The history should identify findings specific for Crohn’s disease, identify alternative diagnoses (Table 31,2,12), and search for extraintestinal findings (Table 41). Important areas to cover are nocturnal symptoms;?urgency findings;?food intolerance;?travel;?medications (including antibiotic exposure);?smoking status;?family history of inflammatory bowel disease;?and eye, joint, or skin symptoms. The physical examination should first identify unstable patients that need immediate attention. Pulse, blood pressure, temperature, respiratory rate, and body weight should be measured. Abdominal examination findings can include tenderness, distention, and/or masses.1,2 An anorectal examination is required, and a pelvic examination should be considered because abscesses, fissures, or fistulas are common in Crohn’s disease.1,2 Perianal findings (e.g., fistulas, abscesses) increase the likelihood of Crohn’s disease.10 EXTRAINTESTINAL FINDINGS The inflammatory effects of Crohn’s disease can extend beyond the intestinal lumen, causing abscesses, fissures, and/or fistulas, and can affect organs outside of the intestinal tract. Patients can present with extraintestinal findings before gastrointestinal symptoms are prominent. Areas affected include, but are not limited to, the eyes, 662 American Family Physician Diagnostic Studies and MonitoringDiscussion: Crohn Disease and High Fiber Diet Analysis Paper LABORATORY TESTING Laboratory testing has multiple purposes for the evaluation of Crohn’s disease, including diagnosis, monitoring of disease activity, and tracking adverse effects and effectiveness of medications. Fecal calprotectin is a reasonable test to rule out Crohn’s disease for adults (sensitivity of 83% to 100%;?specificity of 60% to 100%) and children (sensitivity of 95% to 100%;?specificity of 44% to 93%) with equivocal symptoms, and may spare them from more invasive testing.2,14 When the diagnosis of Crohn’s disease is considered, a complete blood count;?a complete metabolic panel;?pregnancy test;?C-reactive protein level;?erythrocyte sedimentation rate;?and stool studies for Clostridium difficile, ova and parasites, TABLE 2 Characteristics of Crohn’s Disease and Ulcerative Colitis Characteristic Crohn’s disease Ulcerative colitis Location Any area of gastrointestinal tract Continuous lesions starting in rectum Generally occurs only in the colon Thickness Transmural involvement Mucosa and submucosa only Colonoscopy findings Skip lesions, cobble­ stoning, ulcerations, strictures Pseudopolyps, continuous areas of inflammation Anemia + ++ Abdominal pain ++ + Rectal bleeding + ++ Colon cancer risk ++ ++++ + = more common or prevalent. Adapted with permission from Wilkins T, Jarvis K, Patel J. Diagnosis and management of Crohn’s disease. Am Fam Physician. 2011;?84(12):?1366. www.aafp.org/afp Volume 98, Number 11 ? December 1, 2018 TABLE 3 TABLE 4 Celiac disease Differential Diagnosis for Crohn’s Disease Irritable bowel syndrome Prevalence of Extraintestinal Manifestations of Crohn’s Disease Chronic pancreatitis Ischemic colitis Extraintestinal manifestation Prevalence (%) Colorectal cancer Lymphoma of small bowel Diverticulitis Sarcoidosis Anemia 9 to 74 Anterior uveitis 17 Aphthous stomatitis 4 to 20 Cholelithiasis 13 to 34 Episcleritis 29 Erythema nodosum 2 to 20 Inflammatory arthropathies 10 to 35 Nephrolithiasis 8 to 19 Osteoporosis 2 to 30 Pyoderma gangrenosum 0.5 to 2 Scleritis 18 Venous thromboembolism 10 to 30 Infection (e.g., Yersinia, Mycobacterium) Ulcerative colitis Adapted with permission from Wilkins T, Jarvis K, Patel J. Diagnosis and management of Crohn’s disease. Am Fam Physician. 2011;?84(12):?1366, with additional information from references 2 and 12. and culture may be useful. Results can provide information to support the diagnosis, identify the severity of disease, or determine alternative diagnoses.1,2 Measurement of C-reactive protein, fecal calprotectin, and stool lactoferrin can help assess disease activity and potentially limit the need for endoscopy in disease management decisions.15 Anemia is common, so hemoglobin and hematocrit should be monitored periodically. Deficiencies of folate, iron, and 25-hydroxyvitamin D are also common;?thus, screening is prudent. Patients with extensive bowel resection have increased risk of vitamin B12 deficiency and should be screened.16 Tuberculosis screening should be considered before using biologic agents. A complete blood count and renal and hepatic function testing should be done periodically when methotrexate, thiopurines, and/or biologic agents are used for treatment.16 Therapeutic drug monitoring can guide therapy.17 Adapted with permission from Wilkins T, Jarvis K, Patel J. Diagnosis and management of Crohn’s disease. Am Fam Physician. 2011;?84(12):?1366. TABLE 5 Endoscopic Procedures for Diagnosis and Management of Crohn’s Disease Procedure Comments Ileocolonoscopy First procedure to pursue for diagnosis ENDOSCOPY AND IMAGING Endoscopy and imaging are essential tools for diagnosing and monitoring Crohn’s disease. Endoscopic procedures allow direct visualization of and access to the bowel lumen. Direct visualization allows for identification of characteristic lesions, monitoring the success or failure of therapy, and screening for colorectal cancer. Endoscopic procedures (except capsule endoscopy) also allow for biopsy and therapeutic interventions (Table 5 2,13,18,19). Discussion: Crohn Disease and High Fiber Diet Analysis Paper Cross-sectional imaging techniques, including computed tomography (CT), magnetic resonance imaging, and ultrasonography, have come to the forefront in the management of Crohn’s disease. These techniques are all useful and provide similar accuracy for making the initial diagnosis, monitoring disease activity, and identifying complications (e.g., fistulas, abscesses).20,21 They complement endoscopy because they can identify extraluminal pathology and examine the gastrointestinal tract not accessible to endoscopic procedures. If the patient can tolerate the contrast load, CT and magnetic resonance enterography are preferred to standard CT and magnetic resonance imaging protocols. CT studies provide the most consistent results but have the downside of radiation exposure. Magnetic resonance studies have no radiation exposure, but are expensive, may have limited December 1, 2018 ? Volume 98, Number 11 Can obtain biopsy Can provide intervention* Used for colon cancer surveillance Capsule endoscopy Noninvasive Can examine entire small bowel Very good negative predictive value Unable to biopsy Unable to provide intervention* Risk of retention Esophago­ gastro­duo­ deno­scopy Not routine for adults Can obtain biopsy Can provide intervention* More common to have isolated upper gastrointestinal lesions in children, so may be considered as part of initial workup in children Enteroscopy Usually not part of initial evaluation Imaging and/or capsule endoscopy often guides use Can obtain biopsy Can provide intervention* *—Hemostasis, dilatation, or foreign body retrieval. Information from references 2, 13, 18, and 19. www.aafp.org/afp American Family Physician 663 TABLE 6 Imaging Modalities Used in Crohn’s Disease availability, and are more difficult for patients to tolerate. Ultrasonography is readily available and has no radiation exposure, but it is highly operator dependent and can be limited by body habitus. Choosing which modality to pursue depends on the patient’s age, pregnancy status, current clinical condition, local expertise, and availability 13,20,21 (Table 6 13,21,22). Imaging modality Comments CT enterography Preferred for initial evaluation Preferred CT technique High volume of contrast media might not be tolerated by acutely ill patient High radiation exposure Magnetic resonance enterography Preferred magnetic resonance technique Preferred for children Preferred for surveillance Diagnostic Approach The diagnosis of Crohn’s disease results from clinical findings coupled with endoscopic, histologic, radiologic, and/or biochemical testing. History, physical examination, and basic laboratory findings drive the decision to pursue the diagnosis. If the patient has a toxic presentation, standard CT should be the first test. If the patient does not have a fulminant presentation, ileocolonoscopy with biopsy should be the first test, and esophagogastroduodenoscopy should be considered for children. Cross-sectional imaging should follow so that the full extent of disease seen by endoscopy can be determined or to identify disease not visualized by endoscopy. Identifying the complete extent of disease is important for developing a treatment plan. When ileocolonoscopy and cross-sectional imaging are negative and concern for Crohn’s disease is still high, capsule endoscopy would be the next step. If this study is negative, it is moderately certain that the disease is not present1,2,13,20,21 (Figure 11,2,13,14,18,19,21). Management Management has two aims. First is treating the inflammatory process and its associated complications (e.g., abscesses, fistulas, strictures, intestinal obstructions) with the goal of achieving and maintaining remission. Second is minimizing the negative health impacts from Crohn’s disease itself and the therapies used to treat it.13,16,22,23 MEDICAL TREATMENT Treatment decisions are guided by age, comorbidities, symptoms, inflammation status, disease location and extent, and overall risk of more severe and complicated disease (Table 7 2,24). Discussion: Crohn Disease and High Fiber Diet Analysis Paper More severe disease and the presence of risk factors that predict poor prognosis justify the use of high-risk medications.2,24 Significant advancements have been made in treatment. Whereas 5-aminosalicylates were 664 American Family Physician Differentiates inflammatory from fibrotic strictures No radiation exposure More variability in quality of examinations than CT More prone to artifact than CT High volume of contrast media might not be tolerated by acutely ill patient Magnetic resonance requirements might not be tolerated by acutely ill patient Availability may be limited Abdominal/pelvic ultrasonography No radiation exposure Readily available Highly operator dependent Quality can be limited by body habitus Standard abdominal/ pelvic CT with intravenous contrast media Preferred study for acutely ill patient not able to comply with magnetic resonance requirements or tolerate contrast media volume for enterography High radiation exposure Standard abdominal/ pelvic MRI with and without intravenous contrast media Option for patients not able to receive iodinated contrast media for CT Standard abdominal/ pelvic MRI without contrast media Preferred for pregnant patients Fluoroscopic contrast examinations with small bowel follow-through Cross-sectional studies preferred because?more accurate for active disease Scintigraphy Cross-sectional studies preferred for initial evaluation Study of choice to evaluate perianal disease Availability may be limited No radiation exposure Availability may be limited Less likely to identify extramural complications May assist surgeon for preoperative planning Potential limited role for surveillance;?however, cross-sectional studies preferred Abdominal radiography Only role is to detect bowel perforation for acutely ill patient CT = computed tomography;?MRI = magnetic resonance imaging. Information from references 13, 21, and 22. www.aafp.org/afp Volume 98, Number 11 ? December 1, 2018 CROHN’S DISEASE FIGURE 1 Crohn’s disease suspected based on history, physical examination, and basic laboratory findings A Crohn’s disease diagnosis likely Crohn’s disease diagnosis uncertain Fecal calprotectin testing Negative No further evaluation for Crohn’s disease Positive Go to A Toxic presentation Nontoxic presentation Standard computed tomography Ileocolonoscopy with biopsy* Move to nontoxic presentation once stabilized Diagnosis confirmed Diagnosis still uncertain Cross-sectional imaging to determine extent of disease† Cross-sectional imaging† Diagnosis still uncertain Capsule endoscopy budesonide (Entocort EC) are an option for disease affecting the ileum and/or proximal colon and may be preferred because of their unique delivery specifically to that area.2 Budesonide undergoes significant firstpass metabolism in the liver, resulting in improved tolerability.26 Because corticosteroids do not maintain remission, adverse effects are common, and because perforating complications are higher in patients who take corticosteroids, they are most often used to treat symptom flare-ups while patients transition to more effective therapies. IMMUNOMODULATORS Algorithm for diagnosing Crohn’s disease. Thiopurines and methotr … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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