Mrs. Greenway is 25-years-old and is complaining of bloody diarrhea. She claims

Question

Mrs. Greenway is 25-years-old and is complaining of bloody diarrhea. She claims that she was in good health “except for the last three months when this condition started” (referring to the bloody diarrhea). In the past three months, Mrs. Greenway has had three instances of bloody diarrhea, where it would last for a few days and resolve. Her husband claims that her appetite is “just not what it used to be” while she tells you she has been “feeling more tired than usual.” She says she has a stressful job and has been getting occasional headaches for which she takes one 200 mg Advil for. Her husband adds that she “smokes one pack of cigarettes a day” to relieve her stress. Mrs. Greenway reports abdominal tenderness upon palpation. The physician suspects that Mrs. Greenway has inflammatory bowel disease. From your pharmacology class, you know that some of the treatments Mrs. Greenway may receive include anti-diarrhea, immunosuppressive agents and corticosteroids.

1.Name the two types of inflammatory bowel disease and discuss the differences between the two types and their characteristics including diarrhea, rectal bleeding and areas involved.

2. What additional information would you like to obtain regarding the bleeding episodes? Explain your answer.

3. What laboratory work or diagnostic tests would you like to investigate further in this patient? Why?

4. Describe the differences between an ileostomy and a colostomy and what is expected after surgery?

5.. What are the treatment (surgical or/and non-surgical) options for Mrs. Greenway? Explain your answer

6. Discuss at least 3 initial nursing interventions that you would start if Mrs. Greenway was to be hospitalized.

Explanation / Answer

1)Two types of Inflammatory bowel disease:a)Ulcerativie coliits b)Crohn's Disease.

Ulcerative colitis Crohn's Disease

i)All /some part of large intestine Any part of digestive system

ii)Etiology:Unknown Unknown

iii)Some protection from Smoking Smoking is the common reason

iv)Risk with NSAID'S Risk with NSAID'S

v)Rectal bledding:Bloody stool with Tenesmus Less common

vi)Nausea and vomiting less common More often with Nausea and Vomiting

vii)areas:Rectum and Colon Entire digestive system(Mouth to rectum).

2)In Ulcerative colitis the stool contain blood and also Tenesums are common and the episodes of bleeding leads to many health isseues while in Crohn"s disease it is less and some times occurs.In UC blood can visible with the naked eyes and normal person can be afraid in this situation.

3)Labtest and diagnostic evaluation are very important factor to acess the IBD.commonly we use endoscpy and Barium studies and X rays.Other investigation includes Colonoscopy and Endoscopy are most important tools to access the degree and percentage of disese extend.Routine blood test help to find out the related symptoms in patient,

4)The surgery medically preferable is Ileostomy and Colostomy:

Ostomy means:Artifical opening on the abdominal wall.Difference are:

ileostomy colostomy

i)ileum(last part od small intesine)connects to abdominal Colon connect to abdominal wall

ii)Temporary when heal and we can reconnect may be temporary or permanent.

iii)Lower right side of stomach Lower left side of stomach.

5)Treatment

Non surgical(medical):Anti inflammatory Drugs:(reduce inflammation),Corticosteroids combinatation is very effective in many cases.

Immuno supression agents:Help to supress the immune system and produce more inflmmation chemicals help to reduce the pain and symptoms.

Antibiotics : Based on the infecion.

Anti diarrehal drugs:Help to control the diarreha and reduce the itching in the rectal area

Pain relivers,iron supplement,calcium vitamin supplements are also added for the better outcome.

b)Surgical:Ulcerative colitis:Proctocolectomty Entire removal of Colon and rectum.can cure the disease

Crohn's disease:Surgey is not offen consider.Surgeey dosen't cure

6)Nursing Interventions:

*Diarreha:Observe and record stool frequecency characteristics,percipating factors.

Promote bed rest and bedside commode

Remove stool and deodrize the room after removal.

Restart Oral intake:Clear liquids to solild foods based on the outcome.

*Imbalances Nutritional status less than body requirment:

Daily weight mointer

Recommend rest before meals

Provide Oral hygiene

Serve food in a good atmosphere

Record the intake

Encourage the patient to verbilze the feelngs

Diet from:Clear fluid---Bland diet---low residue----high protein----high caloriec----non spicy----low fiber,

*Acute pain:

Encourage patient to verbalize pain

Assess the pain according to the pain scale(0-10)

Monitor the factors that aggrevate the disease

Comfortable position and comfortable measures

Provide Stiz bath

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