Question

Nancy Dove, age 30, has had episodes of diarrhea and cramping abdominal pain for 8 months. Recently she developed bloody stools, fatigue, and weight loss. Her mother had ulcerative colitis. On physical exam, you find normal vital signs and her cardiac and neurological assessments are normal as well. Her bowel sounds are normal, her abdomen is flat and she has diffuse tenderness to the abdomen but no rebound tenderness. You review her labs. She is positive for occult blood (there is blood in her stool). Her CBC shows anemia. Her stool sample is negative for C. Diff toxin but she does have positive WBCs in the stool. She has just returned from having a colonoscopy and the report indicates she has inflammation and multiple small bleeding ulcers throughout the rectum and sigmoid colon, the biopsy results read: Ulcerative Colitis. Her working diagnoses are now Mild Anemia and Ulcerative Colitis.

1. Inflammatory bowel disease involve genetic predispositions and abnormal ____ cell reactions to intestinal ____________.
   1. B, microflora
   2. T, microflora
   3. B, nutrients
   4. T, nutrients
2. Why did the physician test for rebound tenderness?
3. Why is it important to monitor Ms. Dove’s red blood cell count?
4. What patient education would you provide to Ms. Dove about her diagnosis of UC and anemia?
5. What complications can occur with UC and how can Ms. Dove try to avoid these complications?

Answer 1

1)Why did the physician test for rebound tenderness?

Rebound tenderness is indicative of peritonitis which can be found in Ulcerative colitis.Rebound tenderness is checked by physician by pushing the abdomen and ask the patient whether they have pain. If they have pain, it is rebound tenderness.

2)Why is it important to monitor Ms. Dove’s red blood cell count?

Since the patient has bloody stools, there are chances of having anaemia due to blood loss.In order to prevent and treat anaemia, red blood cell count should be monitored.

3)What patient education would you provide to Ms. Dove about her diagnosis of UC and anemia?

Explain about the disease condition,

Explain about the management,

Importance of well balanced diet,avoid diet that exacerbate the symptoms,Avoid diary products.

Encourage to avoid medicines that worsen the symptoms such as NSAIDS.

Importance of iron rich diet to prevent anaemia. 4)What complications can occur with UC and how can Ms. Dove try to avoid these complications?

Bleeding, perforation,toxic megacolon, dehydration, osteoporosis.

Monitor haemoglobin level.

Encourage iron rich diet.

Monitor signs of dehydration.

Monitor the signs of infection.