A nurse is preparing to teach about dietary management to a client who has Crohn’s disease and an enteroenteric fistula. Which of the following nutrients should the nurse instruct the client to decrease in their diet? A. Calories B. Protein C. Potassium D. Fiber
The correct answer and explanation is:
The correct answer is D. Fiber.
Explanation:
Crohn’s disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. One of its complications includes the formation of fistulas, such as an enteroenteric fistula, which is an abnormal connection between two segments of the intestine. This condition can lead to malabsorption, diarrhea, and nutritional deficiencies.
Dietary management in Crohn’s disease, especially with complications like fistulas, focuses on minimizing irritation and trauma to the gut while ensuring adequate nutrition.
Why decrease fiber?
- Fiber, especially insoluble fiber, adds bulk to the stool and stimulates bowel movements.
- In Crohn’s disease, the inflamed and damaged intestinal walls are sensitive and may narrow (strictures). High-fiber foods can irritate the gut lining and worsen symptoms like abdominal pain, cramping, and diarrhea.
- In the presence of an enteroenteric fistula, the intestines are already compromised. High fiber can increase stool volume and passage, leading to irritation and increased output through the fistula, worsening fluid and nutrient losses.
- Therefore, a low-fiber diet (low-residue diet) is recommended during active flare-ups or when fistulas are present to reduce mechanical irritation and allow the intestines to heal.
Why not the other nutrients?
- A. Calories: Patients with Crohn’s disease often have increased caloric needs due to chronic inflammation, malabsorption, and weight loss. Calories should not be decreased; instead, adequate or increased caloric intake is encouraged.
- B. Protein: Protein needs are usually increased to promote tissue repair and healing, especially in inflammatory or fistula conditions. A high-protein diet is often recommended.
- C. Potassium: Electrolyte imbalances, including potassium loss, are common due to diarrhea and fistula drainage. Potassium should be maintained or supplemented if needed, not decreased.
Summary:
For a client with Crohn’s disease and an enteroenteric fistula, reducing fiber intake is essential to prevent further intestinal irritation and manage symptoms effectively, while calories, protein, and potassium should be maintained or increased according to the client’s needs.