Group Handout Case Study

Inflammatory Bowel Disease

Patient Profile
M.K. is a 22-year-old male who comes to the health care provider for complaints of frequent
diarrhea and abdominal pain. He had appendicitis with appendectomy at age 9. He currently
takes no medications.

Subjective Data
• Frequently has abdominal pain and diarrhea

Objective Data
Physical Examination:
• Temperature 99.9° F, pulse 78, respirations 16, blood pressure 114/62
• Height 5’3”, weight 100 lb, BMI 17.7 kg/m2

Diagnostic Studies
Lab values:
• WBC: 11,600/µL
• RBC: 3.4 million/µL
• Hematocrit: 33%
• Hemoglobin: 10 g/dL
• Platelets: 190,000/µL
• ESR: 34 mm/hr
• Sodium: 132 mEq/L
• Potassium: 3.2 mEq/L
• HCO3: 25.4 mEq/L
• Chloride: 99.5 Eq/L
• Fecal occult blood tests negative

Discussion Questions
Question: Describe the assessment you need to perform to determine what may be occurring
with M.K.
The assessment need to perform to determine what may be occurring with M.K
are:
• The complete blood count should be done.
• It is important to analyse the weight of the patient and intervene about any
weight loss recently.
• The location of the pain should be assessed along with the description
such as intensity of pain.
• Evaluate the vital signs.
• Monitor the respiratory rate.
• It is important to analyse the blood report of the patient. Check for
symptoms which could be related to anemia.

Question: Based on M.K.’s clinical manifestations and lab results, the health care provider
suspects inflammatory bowel disease. Why?
Inflammatory bowel disease is thought to be due to a disproportionate immune
response within the bowel. The mojor types are Crohn's disease and ulcerative
Colitis. The symptoms include abdominal cramps, fever, diarrhoea with mucoid or
bloody stools which is present in this patient. Since the patient has multiple
episodes, it is unlikely to be of infectious etiology. The WBC counts are elevated
along with ESR and this too points to an inflammatory condition.

Question: What additional diagnostic studies may be ordered to confirm this diagnosis?
Complete blood count and ESR are already done. The patient will also need vit
B12 assay, iron studies, stool culture to rule out chronic infections. Imaging
studies including USG abdomen, CT and endoscopy will also help reach a
diagnosis. Endoscopy is the most important among these.

Question: M.K. has a colonoscopy, which is normal, with no signs of disease or inflammation.
He continues to have frequent abdominal pain and diarrhea and a 5-lb weight loss over the next
two weeks. The health care provider then orders a capsule endoscopy. What is the rationale
behind ordering a capsule endoscopy?
The patient might be suffering from Crohn's disease which can have 'skip
lesions'. This means that parts of diseased bowel may be alternatively present
alongside normal bowel. This can be missed in routine endoscopy which only
explores the large bowel.
Question: The capsule endoscopy results show areas of inflammation interspersed with areas
of healthy tissue in the terminal ileum. These findings are characteristic of what disease?
Skip lesions are a feature of Crohn's disease.

Question: Based on the diagnostic results, what is the most likely cause of M.K.’s anemia?
Anemia is most likely due to chronic blood loss which leads to an iron
deficient state.
Question: The health care provider prescribes mesalamine (Pentasa) for M.K.’s inflammatory
bowel disease. What does this medication do and how will it be administered?
Meslamine is usually give orally along with meals in Crohn's. Off-laber rectal
route is also done. It reduces the bowel inflammation.

Question: What are the goals of nutritional therapy for patients with inflammatory bowel
disease?Ensure adequate protein, calorie and micronutrient deficiences. Give the bowel
time to heal and avoid trigger foods.

Question: Describe three teaching points you could use to assist M.K. in improving his
nutritional status.Avoid trigger foods that the patient has noticed to worsen his illness. .
Eat regular meals. Ensure adequate protein and calorie intake. Take supplements to
counter malabsorption. Avoid alcohol, caffeineted drinks and foods that are high in fiber.

Care plan
Nursing Diagnostic PES (the student will create two nursing diagnostics one needs to be acute or actual
and the other one could be risk for)
Nursing diagnostic :Acute Pain
Outcome/Goals:Report pain is relieved/controlled.

Diagnostic 1:Risk for infection

Diagnostic 2
Interventions Inspect incision and dressings. Note characteristics of drainage from wound (if inserted),
presence of erythema.Watch closely for possible surgical complications.
Diagnostic 1

Diagnostic 2

Evaluation

Diagnostic 1 Risk for Deficient Fluid Volume

Diagnostic 2 inflammatory bowel disease with undernourishment

Patient Report

The student will write his or her patient report and share it with the nurse coming in. Please very
descriptive.

Twenty two year old young man whose name is MK presented with complaints of frequent
diarrhoea and abdominal pain, for last few days, which is associated with fever.He also give a
history of appendicectomy at the age of 9. His personal and family history is uneventful. He is
adequately immunized for his age.

On physical examination his body temperature was 99.9°F, and his height is 5'3" and weight is
100lb, his BMI is 17.7kg/m2, which implies he is under nourished.
His vitals are pulse rate 78 per minute regular rhythm and normal volume, respiratory rate is 16/
min, regular breathing abdominothoracic type, his blood pressure is 114/64 in right upper limb in
sitting position. No pallor, clubbing, cyanosis or pedal edema.

Systemic examination of cardiovascular system, inspection of chest revealed no dilated veins or

any scars, first and second heart sound heard in all cardiac areas, no murmur ascultated. Then
examination of respiratory system on inspection bilateral equal movements of chest, not
tachypnoeic, on ascultation there is bilateral equal air entry on both lungs with no added sound.

Gastrointestinal system examination , on inspection there is normal abdominal movement with

respiration, there is a scar in the right illiac fossa, no dilated veins.

On palpation of abdomen there is diffuse abdominal pain, not localized to any of the quadrant,
bowel sounds present on ascultation.

Central nervous system examination , the patient is conscious and alert, inspection showed no
muscle wasting or ptosis , motor power of both side upper and lower limb is 5/5, no focal
neurological defecit.

Diagnosis: inflammatory bowel disease with undernourishment

His complete blood count was done it showed elevated total count, hematocrit, reduced
hemoglobin , decreased serum sodium and potassium, and normal platelet count. Fecal occult
blood test is negative.