Question

TM is a 38 year old male with ulcerative colitis admitted to the medical unit at the hospital for acute exacerbation of the disease. This is his second admission in the last six months. TM says he is frustrated with this disease. In the last week TM has had 15-20 diarrhea episodes a day. He needs to hurry to the bathroom often throughout the day and night. He reports sleeping only an hour at a time at night and trouble staying awake at work. He also reports nausea and vomiting in the last three days along with increasing abdominal pain. His bowel movement at time of admission appears loose, bloody and has a large amount of mucous. His vital signs include: BP 98/64, HR 96, RR 22, T 100.8˚F (38.2˚C), O2Sat 98% on RA. He is 5’8” and weighs 125 lbs.

1. Which assessment values are indicative of ulcerative colitis?

The physician orders the following labs: CBC w/differential, Chem panel, stool analysis.

2. What abnormalities do you expect and why?

The nurse assigns the nursing diagnosis of Deficient Fluid Volume related to diarrhea as evidenced by reported diarrhea, hypotension and elevated pulse. 3. What assessments will the nurse perform to monitor TM’s fluid status?

Answer 1

1. CBC and stool analysis values are indicative of ulcerative colitis.

• CBC counts will determine whether the patient is anemic or not.
• Stool analysis will rule out the type of stools, usually the stools will be diarrhea like having bright red, pink or tarry.
• Other laboratory markers such as C reactive protein test is also done to determine UC or ulcerative colitis.

2. The abnormalities are,

• Abdominal pain due to severe diarrhea.
• Dehydration due to fluid loss from the body.
• Fever of 100.8 ^oF due to infection in the stomach.
• Nausea and vomiting due to poor absorption.
• Hypotension due to dehydration status.
• Tachycardia or elevated pulse due to dehydration or decreased fluid volume.

3. A dehydration assessment can be done to rule out whether the patient is dehydrated or not.

• In that a "skin pinch test" can be done by pinching a portion of the patient's skin in the fore hand and if the skin drops back very slowly then it is indicative of dehydration.
• BP monitoring can be done, if patient has hypotension then it is also suggestive of dehyration.
• Monitor the weight of the patient daily to rule out any weight loss.
• Serum electrolyte tests also helps in rule out the fluid status of the patient.