Question

S.D. is a 17 year old Somali female presenting to the primary care office with fever and diarrhea. She states she has had similar episodes over the past few years, but none as severe as the present episode. She does not weigh herself consistently, so she is not aware of weight loss or gain, but states that her clothes are looser than normal.

Vital Signs:

●      Temperature 37.2C

●      Pulse 102

●      Respiration 16

●      BP 102/62

●      O2 saturation 99% on Room Air

●      Height 64 inches

●      Weight 102 pounds

Physical Exam:

●      General appearance - thin female in no acute distress

●      Head, Eyes, Ears, Nose, Throat (HEENT) - mucous membranes are dry

●      Skin - warm and dry centrally, hands and feet cool to touch, delayed skin recoil

●      Respiratory - lungs clear to auscultation

●      Cardiac - regular rhythm, no murmur; pulses normal with brisk capillary refill

●      Abdomen - scaphoid appearance, hyperactive bowel sounds

●      Rectal exam - stool is guaiac positive

Laboratory results:

●      CBC

○      microcytic, hypochromic anemia

○      thrombocytopenia

●      Stool

○      positive WBCs

Case Study Questions:

Answer the questions and statements related to the case study. You must include a minimum of three references to support your responses. The references may only be from online library.

1.     Does this young woman have Crohn’s Disease or Ulcerative Colitis? Support your response with rationales.

2.     Calculate her BMI. Is this a normal finding? Support your response with rationales.

3.     What clinical findings indicate dehydration? Support your response with rationales.

4.     What is the treatment plan for this patient in the acute care setting? Support your response with rationales.

5.     Are there any cultural considerations when caring for this patient? Support your response with rationales.

6.     Develop a three day diet plan to implement for this patient after she is discharged from the hospital.

7.     How would the treatment and diet plan differ if the patient was Hispanic?

Answer 1

1. Yes, this young woman has possible chances of having Crohn's disease or ulcerative colitis. The rationale behind this is she is showing similar symptoms of Inflammatory Bowel disease such as fever, diarrhea, fatigue, weight loss, anemia, hyperactive bowel sounds, positive WBCs in the stool.

2. BMI formula

Weight in pounds X 703 /( height in inches)²

The woman weighs 102 pounds.

(64 inches)² = 4096.

Then, applying BMI formula,

102 x 703 / 4096 = 17.5

The BMI of 17.5 indicates she is underweight.

3. Dry mouth, Dry skin, delayed skin recoil, fatigue, muscle weakness are the clinical findings of the dehydration.

4. The initial treatment in the acute care settings is to rehydrate the patient by starting Intravenous fluid and gives essential fluid orally(ORS). Prescribe appropriate antibiotics and antidiarrheal medicines.

5. Somali immigrants are a high risk of malnutrition, anemia, infectious disease like diarrhea. They give more preference to the spirituality. Give support to the family when giving care. Establish a good rapport with the patient. Get permission to touch her as the females are highly sensitive. Always use right hand to offer food and medications. Try to use an easy language or keep an interpreter.

6. Diet plan

	Day 1	Day 2	Day 3
Breakfast	1 cup cereal, 6oz orange juice	2 slice bread toast, tea, 1 tablespoon butter	Toasted white bread with banana.
Lunch	2 slice white bread, 1 cup chicken soup	2 rice crackers, 1 cup vanilla yogurt, 1/2 apple.	chicken soup, or rice with applesauce.
Dinner	1/2 cup rice, 1/2 cup fruit salad.	2 slice bread roast, 1 tablespoon peanut butter.	Dried blueberries, 6 oz orange juice.

7. Explain the Hispanic patient in detail before treatment starts. Be punctual in time. They have more cultural values and always look for alternative treatment. They will consider a lot of fruits and vegetables in the diet. Cheese, fish, turkey, egg, the chicken should be included in the diet. They use more of soy and olive oil in the diet.