CASE #7 R.G. Presents with Inflammatory Bowel Disease Description: R.G. was a co

Question

CASE #7

R.G. Presents with Inflammatory Bowel Disease

Description:

R.G. was a colicky baby, even though she was breastfed. Her mother decided to continue to breast feed up to 8 months because she was accepting very few solids. As a toddler and preschooler, RG would fuss and refuse to eat some days for no apparent reason. She often complained of abdominal pains and cramps as she grew up and her parents tried to identify the reason for her pain. They thought she was lactose intolerant like some close relatives. By avoiding milk products, RGs products in her diet. They also gave her a low fiber diet by limiting whole grain breads and cereals. Although she had no appetite and was rater thin, she was still growing normally. Her parents were Jewish and both were tall and thin. Her intermittent abdominal pain and diarrhea continued into her teens and her doctor diagnosed her with irritable bowel syndrome and lactose intolerance and she was treated for iron and vitamin B12 deficiency anemia. In high school, she began to have sporadic diarrhea when she ate fatty foods and was stressed during examination periods. She began to develop joint pain and very fatigued which led her to drop ballet and become isolated from friends. She became sad and her school performance dropped. The next year she had more frequent episodes of diarrhea, lost more weight and felt depressed. It worsened to include skin rash, mouth ulcers, periodontal disease, and fever. She almost stopped eating as not to trigger bouts of pain. She mostly had soup and gingerale, with occasional plain white pasta or rice. Upon complaining of unbearable appendicitis like abdominal pain she went to the emergency room.

Question:

1. What is your assessment of her clinical condition from the signs and symptoms she had previously and those she developed during high school? Explain why.

Explanation / Answer

Inflammatory Bowel Disease involves the inflammation of all part of your digestive tract.

Assessment:

i) Nutritional Health:

*inadequate nutritional intake(malnourished):like lactose intolerence,low fibre diet,taking limited whole grains and cereals, reduced appetite(because of abdominal pain), vitamin B12 deficiency( as there is malapsorption of vitamins,impaired absorption of fat,folic acid and iron), taking only soft and liquid diet

* abdominal pain: as ulceration and inflammation affect the normal movement of content through digestive tract.

* body built: thin, low BMI, unintended weight loss

*oral examination: ulcers in mouth,(as inflammation affect the oral cavity's tissue mostly seen in crohn's disease of IBD), swollen and bleeding gums due to ulcer(periodontal disease)

*integumentary system: skin rashes present( may be caused by nutritional deficiency or due to ulcerative colitis as it causes inflammation within your body or may be due to medications used to treat ulcerative colitis)

*Elimination Pttern: frequent episodes of diarrhea( becase of impaired intestinal mobility due to infaection)

*vital sign: temperature:fever

*joint pain (as bacterial and parasitic infection may cause inflammation and there is also vitamin D deficiency which is caused by impaired fat absorption and this viamin is fat soluble )

*psychological assessment: facial expression:sad,fatigued because of pain ,depressed,unsatisfactory school performance

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