A nurse is caring for a 12-year-old client who has sickle cell disease.

Exhibits

Complete the following sentence by using the lists of options.

The nurse should anticipate a provider prescription for

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due to the child's

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.

• Crohn's disease: The client’s presentation of hematochezia, abdominal pain, fever, anorexia, elevated CRP, hypoalbuminemia, anemia, and positive stool leukocytes points toward Crohn’s, an inflammatory bowel disease with systemic and intestinal involvement.

• Encourage a high-protein diet: Chronic inflammation and malabsorption in Crohn’s disease contribute to weight loss and muscle wasting, so a high-protein diet supports tissue repair and nutritional repletion.

• Record dietary intake: Careful documentation helps identify food triggers, ensures adequate caloric and protein intake, and provides a baseline for evaluating nutritional support interventions.

• Hemoglobin level: Clients with Crohn’s are prone to gastrointestinal blood loss, putting them at risk for anemia; trending hemoglobin values helps track disease activity and bleeding severity.

• Albumin level: Hypoalbuminemia in Crohn’s reflects both malnutrition and protein-losing enteropathy; monitoring this value provides insight into nutritional status and disease progression.

Rationale for Incorrect Choices

• Appendicitis: Appendicitis usually presents with localized right lower quadrant pain, rebound tenderness, and leukocytosis without chronic systemic signs like anemia or hypoalbuminemia, which are more consistent with Crohn’s disease.

• Peptic ulcer disease: Ulcers typically cause epigastric pain and possible melena, but they do not explain systemic inflammation, positive stool leukocytes, or low albumin seen in this case.

• Celiac disease: Celiac often presents with diarrhea, bloating, and steatorrhea, but this client’s hematochezia, fever, and elevated CRP are more consistent with inflammatory bowel disease.

• Administer an enema: This intervention is contraindicated in clients with bowel inflammation due to risk of worsening irritation or triggering perforation.

• Provide a gluten-free diet: While effective in celiac disease, it does not address the inflammation and malabsorption specific to Crohn’s disease.

• Prepare for surgery: Surgery is not the first-line intervention in Crohn’s unless complications like obstruction or perforation occur; conservative management is prioritized initially.

• Abrupt decrease in pain level: This is concerning for ruptured appendix and peritonitis, which are not primary features of Crohn’s disease progression.

• Abdominal rigidity: This is a sign of peritonitis, usually from perforation, which is not the presenting concern for this client with Crohn’s disease.

• Presence of steatorrhea: Steatorrhea is more typical of celiac disease or pancreatic insufficiency rather than Crohn’s, which more commonly presents with bloody stools.

A. Pale, oily stools: Celiac disease causes malabsorption due to an immune response to gluten, leading to steatorrhea. The stools are typically pale, foul-smelling, and oily because of impaired fat absorption.

B. Redcurrant, jelly-like stools: This type of stool is characteristic of intussusception, a condition where part of the intestine telescopes into itself, causing bleeding and mucus, not celiac disease.

C. Increased hemoglobin level: Children with celiac disease often experience iron deficiency anemia due to malabsorption, which lowers hemoglobin levels. An increase in hemoglobin would not be expected.

D. Hematemesis: Vomiting blood is not a typical finding in celiac disease. It is more commonly associated with upper gastrointestinal bleeding from ulcers or esophageal varices.