Primary Nursing Diagnosis

Alteration in nutrition: Less than body requirements related to anorexia, diarrhea, and decreased absorption of the intestines

OUTCOMES. Nutritional status: Food and fluid intake; Nutrient intake; Biochemical measures; Body mass; Energy; Bowel elimination; Endurance

INTERVENTIONS. Nutrition management; Nutrition therapy; Nutritional counseling and monitoring; Fluid and electrolyte management; Medication management; Enteral tube feeding; Intravenous therapy; Total parenteral nutrition administration

H PLANNING AND IMPLEMENTATION Collaborative

MEDICAL. Much of the medical management centers on medications. During acute exacerbations, bowel "rest" is important to promote healing; bowel rest can be achieved by placing the patient NPO with the administration of total parenteral nutrition to supply the required fluids, nutrients, and electrolytes. Once the acute episode has subsided and symptoms are relieved, a diet high in protein, vitamins, and calories is prescribed. The patient's diet should be balanced, and supplements of fiber may be beneficial for colonic disease; low-roughage diet is usually indicated for patients with obstructive symptoms. In addition, a low-residue, milk-free diet is generally well tolerated.

SURGICAL. Surgery, though not a primary intervention, may be necessary for patients who develop complications such as bowel perforation, abscess, intestinal obstruction, fistulae, or hemorrhage and for those who do not respond to conservative management such as nutritional and drug therapy. Unfortunately, there is a 60% recurrence of the disease process after surgical intervention. Multiple resections also may lead to short bowel syndrome, defined as malabsorption of fluids, electrolytes, and nutrients, which leads to nutritional deficiencies. The syndrome occurs when less than 150 cm of functional small bowel remains.

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