A nurse is teaching an adolescent how to manage his cystic fibrosis. Which of the following statements by the adolescent indicates an understanding of the teaching?

Condition Most Likely Experiencing: Crohn's disease

Actions to Take:

1. Record dietary intake
2. Provide a gluten-free diet.

Parameters to Monitor:

1. Albumin level.
2. Hemoglobin level.

Rationale:

Crohn’s Disease- Positive stool occult blood and positive leukocytes suggest intestinal inflammation and bleeding, which are characteristic of Crohn’s disease. Elevated C-reactive protein (CRP) (3.2 mg/dL) and WBC count (13,000/mm³) indicate inflammation and infection, common in Crohn’s disease flare-ups. Low albumin (3.4 g/dL) suggests malabsorption and protein loss, which occurs in Crohn’s disease due to chronic inflammation and poor nutrient absorption.

Appendicitis – Usually presents with localized right lower quadrant (RLQ) pain, fever, nausea, vomiting, and abdominal rigidity. The patient does not have classic signs of appendicitis.

Peptic Ulcer Disease (PUD) – Typically associated with H. pylori infection (negative in this case) and does not usually cause elevated CRP and WBC.

Celiac Disease – Would not cause elevated inflammatory markers (CRP, WBC) or stool occult blood.·

Record dietary intake.Nutritional deficiencies (e.g., low albumin) are common in Crohn’s disease. Keeping a food diary helps identify trigger foods that exacerbate symptoms.

Provide a gluten-free diet. While gluten-free diets are primarily for celiac disease, some Crohn’s disease patients may benefit from avoiding gluten and other inflammatory foods. Low-residue, high-protein diets are often recommended to reduce intestinal irritation and promote healing.

Administer an enema. Contraindicated in Crohn’s disease, as enemas can worsen inflammation and irritate the bowel.

Prepare for surgery. Surgery is not the first-line treatment for Crohn’s disease. It is only considered for severe complications (e.g., strictures, fistulas, or perforation).

Albumin level. Low albumin suggests malabsorption and protein loss, which should be monitored to assess nutritional status.

Hemoglobin level. Anemia (Hgb 11 g/dL, Hct 33%) suggests chronic blood loss from inflammation. Monitoring hemoglobin helps assess disease progression and response to treatment.

Abrupt decrease in pain level. This would be a concern for bowel perforation rather than an indicator of improvement in Crohn’s disease.

Abdominal rigidity. Not a typical assessment parameter for Crohn’s disease, but more relevant for appendicitis or peritonitis

A. "I will offer my child 20 grams of carbohydrates every 2 hours." During illness, children with diabetes should continue to eat, but it's more important to focus on maintaining adequate fluid intake and monitoring blood glucose levels. Carbohydrate intake may vary depending on the child's appetite and glucose levels, but 20 grams of carbohydrates every 2 hours may not be necessary for every child.

B. "I will increase the amount of fluids I offer my child." During illness, it is crucial to maintain hydration in children with diabetes to prevent dehydration, which can be exacerbated by fever, vomiting, or diarrhea. Fluids help maintain glucose stability and prevent complications such as diabetic ketoacidosis (DKA).

C. "I will withhold my child's dose of insulin when his appetite is poor.” Insulin should not be withheld even if the child's appetite is poor, as this can lead to hyperglycemia and diabetic ketoacidosis (DKA). Insulin needs should be adjusted based on blood glucose levels, not appetite.

D. "I will monitor my child's blood glucose levels every 8 hours." Blood glucose levels should be monitored more frequently, especially during illness. Typically, it's recommended to check every 2-4 hours to ensure the child’s blood glucose is within a safe range and to detect any changes that require adjustment in insulin therapy.