Crohn disease is an idiopathic, chronic inflammatory process affecting any part of the gut from the mouth to the anal opening. Most individuals with the condition often experience manifested relapses and remission. The manifestations of Crohn disease include abdominal pain and diarrhea, rectal bleeding, fever, weight loss nausea, vomiting bone loss among others. Psychological symptoms such as depression, anxiety, and difficulties in coping may also manifest (Cleyen et al., 2016). The disease is believed to be a result of an imbalance between pro-inflammatory and anti-inflammatory mediators. About 30 percent of cases involve the small bowel, 20 percent involve the colon, and about 45 percent involves the small bowel and the colon.
Ulcerative colitis, on the other hand, is also one of the inflammatory bowel diseases. Unlike Crohn disease which affects any part of the gut, ulcerative colitis involves only the large bowels (Rossen et al., 2015). The predominant manifestations in ulcerative colitis are rectal bleeding, frequent stools, tenesmus, and purulent discharge from the rectum among others. Its exact etiology is unknown, but the condition appears to be polygenic and multifactorial (Cleyen et al., 2016). There are proposed causes that include environmental factors, immune dysfunction, and genetic risks. Children of low birth weight born of mothers who have ulcerative colitis also have a higher predisposition to Ulcerative Colitis (Rossen et al., 2015).
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The teaching plan for patients with inflammatory bowel diseases involves; teaching on the reasons why patients are non-adherent to medication, increasing acceptance of patients who have the condition and getting to know the patient's learning needs. A five-step lesson plan provides very effective teaching for the patients. First, the anticipatory set, then the introduction of new material, a guided practice, and independent practice and finally closure. In the anticipatory set, engage the patient and allow him or her to tell you the last time they learned something new and what worked best in their learning. For patients who like writing everything down, provide a pen and paper (Rossen et al., 2015). Allow the patient to be comfortable in their setting and ensure maximum attentiveness.
For inflammatory bowel diseases, the introduction of new material is vital since the conditions are poorly understood. Treatment plans, diet, manifestations, and complications may be discussed in this section. In recent years, there has been the development of biologic anti-tumor necrosis factor agents for the management of Crohn's disease that has improved the induction and maintenance of clinical remission in patients with moderate and severe illness especially in the patients who are corticosteroid dependent. It would also be crucial to explaining that medical therapy may fail, and in that instance, surgical resection of the inflamed bowel may be indicated (Rossen et al., 2015). Most patients with Crohn's disease can be treated on the outpatient basis, and inpatient care is required in cases of serious complications such as obstruction, perforation, bleeding which manifest with severe abdominal pain and melena stool or hematochezia.
The next step in patient teaching would be guided practice. It involves activities that illustrate that the patient has understood the skills and concepts (Cleyen et al., 2016). This is done when the patient is allowed to work on the subjects discussed with the guidance of the health care provider. Responses to the dosing and time to take medications, the modes of action of the treatments, complications, and manifestations of the disease should be assessed with help from the healthcare provider giving the teaching. The fourth step is the independent practice. It is done while still in the setting or the teaching environment. It may involve written or verbal feedback. The patient should be allowed to do the practice alone to assess the quality of education and comprehension of the topic. Finally, closure is vital to make sure all is understood.
References
Cleynen, I., Boucher, G., Jostins, L., Schumm, L. P., Zeissig, S., Ahmad, T., ... & Brant, S. R. (2016). Inherited determinants of Crohn's disease and ulcerative colitis phenotypes: a genetic association study. The Lancet , 387(10014), 156-167.
Rossen, N. G., Fuentes, S., van der Spek, M. J., Tijssen, J. G., Hartman, J. H., Duflou, A., ... & Zoetendal, E. G. (2015). Findings from a randomized controlled trial of fecal transplantation for patients with ulcerative colitis. Gastroenterology, 149(1), 110-118.
