What is the primary focus of nursing care for a patient experiencing a mild exacerbation of ulcerative colitis?

B) Monitor symptoms and ensure medication adherence

A) Encourage increased physical activity

B) Monitor symptoms and ensure medication adherence

C) Restrict fluid intake to prevent diarrhea

D) Advise a high-protein diet to improve anemia

Based on the initial assessment findings, which intervention should the nurse prioritize for a patient experiencing a mild exacerbation of ulcerative colitis?

B) Educate the patient on dietary modifications to manage symptoms

A) Administer intravenous fluids to prevent dehydration

B) Educate the patient on dietary modifications to manage symptoms

C) Prepare the patient for immediate surgical intervention

D) Obtain a stool culture to check for infection

What is the primary purpose of initiating a low-residue diet for a patient with bowel irritation?

C) To enhance nutrient absorption

Which laboratory test result indicates a positive response to treatment in a patient with ulcerative colitis and anemia?

B) Elevated liver enzyme levels

C) Reduced fecal calprotectin levels

D) Increased frequency of bowel movements

A patient with ulcerative colitis is on mesalamine therapy. Which laboratory result indicates the medication is well-tolerated?

C) Increased fecal calprotectin

What is the primary goal of maintaining the patient's current treatment regimen for ulcerative colitis?

C) To sustain symptom management and prevent complications

A) To prevent the development of liver dysfunction

B) To ensure the patient gains weight rapidly

C) To sustain symptom management and prevent complications

D) To increase the patient's heart rate to normal levels

Which vital sign measurement of the patient indicates stability and normal physiological function?

C) Respiratory rate of 22 breaths per minute

D) Oral temperature of 101.2°F

Which dietary recommendation is most appropriate to enhance iron absorption for a patient experiencing fatigue related to low hemoglobin levels?

B) Consume vitamin C-rich foods with iron-rich meals

C) Increase intake of calcium supplements

A patient with ulcerative colitis reports increased fatigue despite stable bowel habits and a stable diet. Which intervention should the nurse prioritize based on the recent laboratory findings?

B) Educate the patient on increasing dietary iron intake

A) Increase the patient's mesalamine dosage

B) Educate the patient on increasing dietary iron intake

C) Suggest the patient increase fluid intake to improve symptoms

D) Recommend the patient engage in more physical activity to boost energy levels

ulcerative colitis - Nursing Case Study

Pathophysiology

• Primary mechanism: Ulcerative colitis is an inflammatory bowel disease characterized by chronic inflammation of the colon's inner lining, mainly due to an abnormal immune response where the body's immune system attacks the colon's tissues, mistaking them for harmful invaders.

• Secondary mechanism: This immune response leads to the release of pro-inflammatory cytokines, causing damage to the epithelial cells of the colon, resulting in ulcers and continuous inflammation, which disrupts the normal absorption and movement of the bowel.

• Key complication: Persistent inflammation and ulceration can lead to complications such as bleeding, diarrhea, and an increased risk of colon cancer over time if left untreated.

Patient Profile

Demographics:

25-year-old female, teacher

History:

• Key past medical history: Diagnosed with ulcerative colitis 6 months ago, no other significant medical history

• Current medications: Mesalamine 2.4g daily

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Mild abdominal discomfort

• Key symptoms: Occasional diarrhea, slight abdominal pain, minimal blood in stool

• Vital signs: Blood pressure 118/76 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F (37°C)

Section 1

Initial Assessment Findings:

Upon initial assessment, the patient, a 25-year-old female teacher with a history of ulcerative colitis, presents with stable vitals: blood pressure of 118/76 mmHg, heart rate of 72 bpm, respiratory rate of 16 breaths per minute, and a temperature of 98.6°F (37°C). She reports experiencing mild abdominal discomfort, occasional diarrhea, slight abdominal pain, and minimal blood in her stool. Her physical examination reveals a soft abdomen with mild tenderness on palpation in the left lower quadrant, but no rebound tenderness or guarding, indicating that there is no acute abdomen or severe inflammation at this time.

Laboratory tests were conducted to further evaluate her condition. Her complete blood count shows a slight decrease in hemoglobin levels at 11.5 g/dL, which may suggest mild anemia likely due to the minimal bleeding noted in the stool. The white blood cell count is within normal limits at 7,500 cells/mcL, indicating no acute infection. C-reactive protein (CRP) is slightly elevated at 8 mg/L, reflecting some ongoing inflammation consistent with her ulcerative colitis. Electrolyte levels, including sodium and potassium, are within normal ranges, suggesting that her hydration status is adequate despite occasional diarrhea.

These findings indicate that the patient is experiencing a mild exacerbation of her ulcerative colitis, but remains in an early, stable stage. The focus for nursing care will be on monitoring her symptoms, ensuring medication adherence, and providing education on dietary modifications to manage her symptoms effectively. The nursing staff will also schedule a follow-up appointment with her gastroenterologist to evaluate the need for any adjustments in her treatment plan, aiming to prevent progression and manage her current symptoms efficiently.

Section 2

Response to Interventions:

Following the initial assessment, the nursing team initiated a care plan focused on symptom management and patient education. The patient was started on a low-residue diet to reduce bowel irritation and was educated on the importance of maintaining adequate hydration to compensate for fluid loss due to diarrhea. She was also reminded of the importance of adhering to her prescribed medication regimen, which includes oral mesalamine to help control inflammation.

Over the next few days, the patient demonstrated a good understanding of dietary modifications and reported adherence to her medication schedule. During daily assessments, she reported a slight reduction in abdominal discomfort and a decrease in the frequency of diarrhea. Her bowel movements became more formed, and there was no further observation of blood in her stool. Despite these improvements, she continued to experience mild fatigue, which the nursing staff attributed to her lower hemoglobin levels.

Vital signs remained stable with blood pressure at 116/74 mmHg, heart rate at 70 bpm, and respiratory rate at 16 breaths per minute. A repeat complete blood count was ordered to monitor her hemoglobin levels, which showed a slight improvement to 11.8 g/dL. The patient was encouraged to incorporate iron-rich foods into her diet, and the nursing staff discussed the potential use of oral iron supplements with her healthcare provider. The patient expressed relief at her improving symptoms and was optimistic about managing her condition more effectively with the support of the healthcare team. A follow-up appointment with her gastroenterologist was confirmed to reassess her treatment plan and ensure continued progress.

Section 3

New Diagnostic Results:

A week following her initial improvement, the patient returned for her scheduled follow-up appointment. During this visit, the healthcare team conducted a series of routine diagnostic tests to evaluate her progress and ensure no new complications had arisen. A complete blood count was repeated, revealing a further increase in hemoglobin levels to 12.2 g/dL, indicating a positive response to dietary modifications and potential iron supplementation. Additionally, a fecal calprotectin test was ordered to assess intestinal inflammation, which showed a mild elevation but remained within the expected range for her current stage of ulcerative colitis.

The patient's liver function tests were also reviewed to monitor for any potential side effects of mesalamine therapy. Results indicated normal liver enzyme levels, suggesting that the medication was well-tolerated. The patient reported a continued decrease in the frequency of her bowel movements, down to two to three times daily, with no further blood observed. Her abdominal discomfort had subsided significantly, and she felt more energetic, likely due to the gradual improvement in her anemia.

These results prompted the healthcare team to consider maintaining her current treatment regimen, emphasizing ongoing monitoring and patient education. The importance of routine follow-ups and adherence to both dietary recommendations and medication was reiterated. The patient was encouraged to contact her healthcare provider should she experience any changes in symptoms, such as increased abdominal pain or rectal bleeding, to address potential complications promptly. The visit concluded with reassurance of her progress and a reminder to schedule another follow-up in three months to continue monitoring her condition.

Section 4

Three months later, the patient arrived for her scheduled follow-up appointment, expressing optimism about her continued progress. During the initial assessment, the nurse observed the patient appeared well-nourished and in good spirits. Her vital signs were stable, with a blood pressure of 118/76 mmHg, heart rate of 72 bpm, respiratory rate of 16 breaths per minute, and an oral temperature of 98.4°F. The patient reported maintaining her bowel movement frequency at two to three times daily, with no blood present, and noted further improvement in her energy levels, which allowed her to resume daily activities more comfortably.

A repeat complete blood count showed hemoglobin levels had increased to 12.8 g/dL, further supporting the effectiveness of the dietary modifications and iron supplementation. The fecal calprotectin test was repeated, showing a slight decrease in levels compared to the last visit, indicating a gradual reduction in intestinal inflammation. Liver function tests remained within normal limits, confirming continued tolerance to mesalamine therapy. The patient voiced a better understanding of her condition and expressed confidence in her ability to manage her symptoms with the current treatment plan.

Based on these findings, the healthcare team decided to maintain the patient's current treatment regimen, emphasizing the importance of ongoing symptom monitoring and adherence to dietary and medication recommendations. The patient was reminded of potential signs of complications, such as increased abdominal pain or rectal bleeding, and was encouraged to report any changes promptly. The visit concluded with scheduling another follow-up in six months, aiming to ensure sustained management of her ulcerative colitis and prevent complications as she continues her journey towards better health.

Section 5

Three months later, the patient returned for her scheduled follow-up appointment, reporting a slight increase in fatigue over the past few weeks, despite no changes in her bowel habits or diet. During the initial assessment, the nurse noted that the patient appeared slightly more fatigued than during her previous visit but remained in good spirits. Her vital signs were stable, with a blood pressure of 116/74 mmHg, heart rate of 74 bpm, respiratory rate of 16 breaths per minute, and an oral temperature of 98.6°F. The patient maintained her bowel movement frequency at two to three times daily, with no blood present.

To investigate the cause of the increased fatigue, the healthcare provider ordered a repeat complete blood count, which revealed a slight decrease in hemoglobin levels to 11.9 g/dL. This change indicated a possible need to reassess the patient's dietary intake and iron supplementation. Additionally, a serum iron test showed levels at the lower end of the normal range, suggesting that the current supplementation might need adjustment. The fecal calprotectin test continued to show a gradual decrease, confirming that intestinal inflammation was still under control. Liver function tests remained within normal limits, indicating continued tolerance to mesalamine therapy.

In response to these findings, the healthcare team decided to adjust the patient's iron supplementation and provide dietary counseling to enhance iron absorption. The patient was educated on consuming vitamin C-rich foods alongside iron-rich meals to improve absorption. The team emphasized the importance of monitoring fatigue levels and maintaining communication with the healthcare provider if symptoms persisted. A follow-up appointment was scheduled in three months to reassess the patient's status, ensuring that her ulcerative colitis remained well-managed and that any underlying causes of fatigue were addressed effectively.