Personal Impact Paper
Addonica Jackson
NUR/427
July 8, 2014
Debra Ayer

Personal Impact Paper Crohn's disease (CD) is a chronic inflammatory bowel disease affecting any part of the gastrointestinal tract from the mouth to the anus, although the ileum, colon and perineum are most commonly involved (Hart, A. & Ng, S., 2011). CD is more widespread among adolescents and young adults between the ages of 15 - 35. According to Mayo Clinic Staff, "Researchers believed that a number of factors, such as heredity and a malfunctioning immune system, play a role in the development of Crohn's disease." In CD the patient develops inflammation to the wall of the bowel that causes scarring or the inflammation can penetrate through the wall of the bowel and causes a fistula. Some symptoms of CD are persistent diarrhea, abdominal pain and cramps, rectal bleeding, decrease appetite, weight loss and constipation. In order to protect the patient's privacy I will use the initial AJ. I obtained verbal permission from AJ and her mom to interview her. I chose CD because over the past 6 months I have seen the great financial, personal and social impact CD has on AJ and her family. This paper will also address AJ's learning process and educational experience regarding CD. It will also outline the change motivators AJ used and recommend theories of learning and motivation. AJ, a 21 year old nursing student was experiencing frequent bouts of abdominal pain, loose stool and hyperactive bowel sounds in January 2013. After several visits to the doctor AJ stated "I was diagnosed with Irritable bowel syndrome." The physician placed her on Donnatal every six hours around the clock. While taking the prescribed medication she continues to have recurrent abdominal pain and loose stool, her mom who is a nurse requested a Gastrointestinal (GI) consult for her daughter. After 8 months of recurrent IBS, AJ was able to be examined by a GI physician who ordered several studies, upper GI and small bowel series and a colonoscopy. While performing the colonoscopy, the physician was unable to get the scope into the small bowel because there was too may strictures, I was sent home on a bland diet and steroids. AJ very tearful recalls December 30, 2013 experiencing vomiting, fever, abdominal pain and diarrhea, "I was taken to the ER by my mom. CT scan of the abdomen was done and result shows a bowel obstruction and I was diagnosed with Crohn's disease. AJ stated "I was admitted for seven days, during a hospital stay I was placed on nothing by mouth, had to receive the medications intravenously." Some of the medications I recalled were antibiotics, steroid, fluids and morphine. After three days, "I started to have watery stool and was advanced to a full liquid diet." In March 2014, I started to experience fever, abdominal pain and vomiting again, went to the ER and was admitted again for six days, my hemoglobin was very low and so I started on Hemax, Merpopurine (6MP), Zofran and Morphine. In April 2014, I was placed on Humira pen twice monthly. AJ explains that Humira pen is a form of oral chemotherapy drug that is used to treat Crohn's disease. This disease has caused a great financial strain on my parents. Even though my parents have insurance there was a large out of pocket deductible thathad to be met before I was covered with 80%. My parents had to make lots of sacrifices to get the Humira pen, for the first 30 days supply they had to pay $1000.00, and then the second month $900.00, not to mention the many hospital bills and diagnostic tests. After five months of being diagnosed with CD my parents finally met their out of pocket deductible, which they now pay $400.00 for the Humira. While in the hospital I was encouraged to dis enroll from my mom's insurance and apply for Medicaid. My mom did not dis enroll me, but she did apply for Medicaid that was denied. AJ spoke about the changes CD has on her personal life. I was 11 months away from graduating nursing school, being an A average student my grades went down to a C average. Being hospitalized twice, I almost dropped out of nursing school. I had a part time job that I tried to maintain but had to resign. She spoke about her social life, was very depressed and withdrawn. AJ stated "I would lock away in my room for days, I felt like my youth was just swept from under my feet." She stated how she was scared to go around friends because of the gurgling and rolling sounds of her stomach and not able to eat regular food. AJ said living with CD is very scary, unexpected flare ups and unexpected pain. It affects your confidence. She also stated that one afternoon I was in my room crying and my mom walked in, "I told her leave me alone I just want to die." My mom feeling so helpless called my physician and asked to refer me to a psychologist. I told her I would not go to any psychologist. My turnaround came about when a Social Worker from my mom's job visited me. After talking and encouraging me, she then invited me to go horseback riding with her. I took up her offer and started looking forward to going weekly. From then on I started inviting my friends over and going out occasionally with them. As I progresses through the interview, AJ discusses her learning process and educational experience. She stated, I studied Crohn's Disease in the nursing program but could not believe I would be diagnosed with this disease. Having some knowledge about the disease and having a mom who is a nurse at first helped me to understand the disease process. I further utilize the internet to research the disease, I collected brochures, speak to others who are also living with CD. I wanted to learn as much as possible so I could lead a normal life. During several hospitalizations the physicians explained the disease and lifestyle adjustments. Blooms Taxonomy learners recognize or put elements together to form a new structure or pattern (Bloom, B., 1956). AJ explains that my motivation and change came when "I decided that I would not allow this disease to take control of my life." Motivation is a term that describes forces acting on or within an organism that initiate,

direct, and maintain behavior. Motivation also explains differences in the intensity and direction

of behavior. In the teaching-learning situation, motivation addresses the willingness of the

learner to embrace learning. The term readiness describes evidence of motivation at a particular

time (Redman, 2007). AJ was depressed and fearful very early in the diagnosis but after speaking

with her mom's social worker, other patients living with CD and seeing the support of her family

she became very optimistic about her situation. AJ became very involved in following

instructions and teachings received upon discharge and also from her primary physician. She has

changed her diet to a low residue diet. The idea is to increase the time food spends travelling

through the digestive tract, increasing the chance that nutrients will be absorbed, and reducing

incidence of diarrhea (Keifer, D. 2012). Since there is no known cure for Crohn's disease, AJ

was instructed on stress management, maintaining a low residue diet, adequate rest, and

medication regimen. AJ reported how supportive her family and friends are with disease and

diet. she emphasized how her mom would pureed the seasoning, cooked the vegetables very soft

and avoid any food that would triggers a flare up. Since AJ is well knowledgeable about her

disease and treatments, she was provided with other online resources she can utilize. AJ is now

motivated, and encouraging others online suffering or newly diagnosed with Crohn's Disease.

References

Kiefer, D. (March, 02, 2012). Crohn's Disease. the low residue diet for crohn's disease, 3. Retrieved from http://healthline.com/health/crohn's-disease/low-residue-diet
Mayoclinic.org. (1998-2014). diseases-conditions/Crohn's-disease. Retrieved from ttp://www.mayoclinic.
University of Phioenix (2014). Blooms Affective Domain. Retrieved from University of Phoenix NUR/427 website.