U Assessment

HISTORY. Patients initially report insidious symptoms such as mild, nonbloody diarrhea (three to five semi-soft stools per day), fatigue, anorexia, and vague, intermittent abdominal pain. As the disease progresses, they complain of more severe, constant abdominal pain that typically localizes in the right lower quadrant, weight loss, more severe fatigue, and moderate fever. Some patients may also report skin breakdown in the perineal and rectal areas.

PHYSICAL EXAMINATION. Because CD is a chronic disease that affects the GI system and causes anorexia and multiple episodes of diarrhea, common problems are malnutrition and dehydration. Inspect for hair loss, dry skin, dry and sticky mucous membranes, poor skin turgor, muscle weakness, and lethargy. Also, inspect the patient's perianal area for signs of fistula formation.

Palpate the patient's abdomen for pain, tenderness, or distension. Generally, pain localizes in the right lower quadrant, but note the location, intensity, type, and duration of discomfort. Auscultate the patient's abdomen for bowel sounds. Often, hyperactive sounds will be noted during an acute inflammatory episode.

254 Crohn's Disease

PSYCHOSOCIAL. The effects of chronic illness and debilitating symptoms, along with frequent hospitalizations, often result in psychological problems and social isolation. Assess the coping mechanisms, as well as the patient's support system.

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