Unit 5 Case Study: Inflammatory Bowel Disease. 1000w. due 6-11-22. 5 references
Mrs. Z is a 34-year-old female who come in with a complaint of diarrhea accompanied by abdominal pain. Onset of the symptom was about 4 days ago. She reports thinking she is running a fever but has not taken her temperature. She concerned that she is starting to feel weak.
When asked how about the characteristics and the number of bowel movements a day, she reports increased number of BMs over the last few months. In the last few days she reports averaging about 10 small volume watery stools with varying amounts of blood daily.
She denies recent travel and reportedly has not been on any antibiotics in the past few weeks.
In reviewing her record, you notice that her health history is positive for history of ulcerative colitis. She has not been on any medications for this over the last few years as she had not been symptomatic.
Mrs. Z is on an oral contraceptive. She takes slippery elm capsules and has for the last several years. She reports that she has been taking 2 to 3 doses of Benefiber prebiotic fiber for the last couple days.
Objective data:
BP 116/70 sitting, 100/66 standing; P 92; Temp 100.1
Abdomen – active bowel sounds all 4 quadrants, mild tenderness with palpation
Otherwise her exam is unremarkable for pertinent positives or negatives.
Labs – WBC 14,000; Hgb 11.9; Hct 35.7; Sodium 133; Potassium 3.3
Instructions:
Please prepare and submit a paper 3-4 pages [total] in length (not including APA formatted title and references pages) answering the questions below. Please support your position with examples.
· What pharmacologic therapy would you prescribe for Mrs. Z?
· How will you evaluate the effectiveness of this therapy?
· What patient education would you provide for Mrs. Z relative to the pharmacologic agent you prescribed?
· Are there any pharmacogenetic considerations related to what you prescribed for the patient?
· Are there any alternative therapies or over-the-counter agents that might be of value to Mrs. Z?
· What, if any, lifestyle changes would you recommend?
Inflammatory bowel disease (IBD) can
affect structures or segments along the
gastrointestinal tract. The term includes both
acute and chronic disorders.
Acute and chronic IBD can result in nutritional
deficits, altered bowel elimination, infection,
pain, and fluid or electrolyte imbalances. The
nurse needs to be knowledgeable about acute
and chronic IBD in order to collaborate with the
client and the interprofessional team in treating
and managing these disorders.
ACUTE IN FLAMMATOR Y BOWEL DISEASE
Appendicitis
Inflammation of the appendix
●● Caused by an obstruction of the lumen or opening of
the appendix.
●● Fecaliths, or hard pieces of stool, can be the initial cause
of the obstruction.
●● Adolescents and young adults are at increased risk.
●● Refer to the NURSING CARE OF CHILDREN REVIEW MODULE,
CHAPTER 23: GASTROINTESTINAL STRUCTURAL AND
INFLAMMATORY DISORDERS.
Peritonitis
Inflammation of the peritoneum results from infection
of the peritoneum due to puncture (surgery or trauma),
rupture of part of the gastrointestinal tract (diverticulitis,
peptic ulcer disease, appendicitis, bowel obstruction), or
infection from continuous ambulatory peritoneal dialysis.
Gastroenteritis
Inflammation of the stomach and small intestine
●● Triggered by infection (either bacterial or viral).
●● Vomiting and frequent, watery stools place the client at
increased risk for fluid and electrolyte imbalance and
impaired nutrition.
CHRONIC IN FLAMMATOR Y
BOWEL DISEASE
Ulcerative colitis and Crohn’s disease are characterized by
frequent stools, cramping abdominal pain, exacerbations,
and remissions.
Ulcerative colitis
Edema and inflammation primarily in the rectum and
rectosigmoid colon
●● In severe cases, it can involve the entire length of the
colon. Mucosa and submucosa become hyperemic
(increase in blood flow), and the colon will become
edematous and reddened. It can lead to abscess formation.
●● Edema and thickened bowel mucosa can cause partial
bowel obstruction. Intestinal mucosal cell changes
can lead to colon cancer or insufficient production of
intrinsic factor, resulting in insufficient absorption of
vitamin B12 (pernicious anemia).
●● Classified as either mild, moderate, severe, and fulminant.
Crohn’s disease
Inflammation and ulceration of the gastrointestinal tract,
often at the distal ileum
●● All bowel layers can become involved; lesions are
sporadic. Fistulas are common.
●● Can involve the entire GI tract from the mouth to the anus.
●● Malabsorption and malnutrition can develop when
the jejunum and ileum become involved. Requires
supplemental vitamins and minerals, possibly including
vitamin B12 injections.
Diverticulitis
Diverticulitis is inflammation and infection of the bowel
mucosa caused by bacteria, food, or fecal matter trapped
in one or more diverticula (pouch‑like herniations in
the intestinal wall). Diverticulitis is not to be confused
with diverticulosis, which is the presence of many small
diverticula in the colon without inflammation.
●● Not all clients who have diverticulosis
develop diverticulitis.
●● Diverticula can perforate and cause peritonitis, and/or
severe bleeding.
ASSESSMENT
Etiology of ulcerative colitis and Crohn’s disease is
unknown but possibly due to a combination of genetic,
environmental, and immunological causes.
RIS K FACTORS
Genetics: Ulcerative colitis and Crohn’s disease
Culture: Caucasians (ulcerative colitis), Jewish heritage
(ulcerative colitis and Crohn’s disease), and African
Americans (diverticular disease)
Sex and age: The incidence of ulcerative colitis peaks at
adolescence to young adulthood (more often in females)
and older adulthood (more often in males). Crohn’s disease
usually develops in adolescents and young adults, but can
occur at any age. Diverticulitis occurs more often in older
adults and affects males more frequently than females.
Tobacco use: Crohn’s disease
EXPECTE D FINDINGS
Ulcerative colitis
●● Abdominal pain/cramping: often left‑lower quadrant pain
●● Anorexia and weight loss
PHYSICAL ASSESSMENT FINDINGS
●● Fever
●● Diarrhea: up to 15 to 20 liquid stools/day
●● Stools containing mucus, blood, or pus
●● Abdominal distention, tenderness, and/or firmness
upon palpation
●● High‑pitched bowel sounds
●● Rectal bleeding
Crohn’s disease
●● Abdominal pain/cramping: often right‑lower quadrant pain
●● Anorexia and weight loss
PHYSICAL ASSESSMENT FINDINGS
●● Fever
●● Diarrhea: five loose stools/day with mucus or pus
●● Abdominal distention, tenderness and/or firmness
upon palpation
●● High‑pitched bowel sounds
●● Steatorrhea
Diverticulitis
●● Acute onset of abdominal pain often in left‑lower quadrant
●● Nausea and vomiting
PHYSICAL ASSESSMENT FINDINGS
●● Fever
●● Chills
●● Tachycardia
●● Abdominal distention
LA BORATOR Y TESTS
Ulcerative colitis
Hematocrit and hemoglobin: Decreased
Erythrocyte sedimentation rate (ESR): Increased
WBC: Increased
C‑reactive protein: Increased
Albumin: Decreased
Stool for occult blood: Can be positive
K+, Na, Mg, Ca, and Cl: Decreased
Crohn’s disease
Hematocrit and hemoglobin: Decreased
ESR: Increased
WBC: Increased
C‑reactive protein: Increased
Albumin: Decreased
Folic acid and B12: Decreased
Anti‑glycan antibodies: Increased
Stool for occult blood: Can be positive
Urinalysis: WBC
K+, Mg, and Ca: Decreased
Diverticulitis
Hematocrit and hemoglobin: Decreased
ESR: Increased
WBC: Increased
Stool for occult blood: Can be positive
DIAGNOSTIC PROCE DURES
Magnetic resonance enterography: Used with all IBD
CLIENT EDUCATION: Maintain NPO for 4 to 6 hr prior to
the exam. You might be asked to drink a contrast medium
prior to the test.
Ulcerative colitis
Sigmoidoscopy or colonoscopy: Can diagnose
ulcerative colitis
Barium enema: Helpful to distinguish ulcerative colitis
from other disease processes
CT scan or MRI: Can identify the presence of abscesses
Stool examination: For the presence of parasites
or microbes
Crohn’s disease
Endoscopy
●● Newer diagnostic tools used, such as video
capsule endoscopy
●● Proctosigmoidoscopy: Performed to identify
inflamed tissue
●● Colonoscopy and sigmoidoscopy: A lighted, flexible
scope inserted into the rectum to visualize the rectum
and large intestine
Abdominal ultrasound, x‑ray, and CT scan: CT scans can
show bowel thickening.
Barium enema: Barium is inserted into the rectum as a
contrast medium for x‑rays. This allows for the rectum
and large intestine to be visualized, and is used to
diagnose ulcerative colitis. A barium enema can show the
presence of diverticulosis and is contraindicated in the
presence of diverticulitis due to the risk of perforation.
NURSING ACTIONS: Monitor postprocedure for
manifestations of bowel perforations (rectal bleeding, firm
abdomen, tachycardia, hypotension).
FINDINGS
●● Small intestine ulcerations and narrowing is consistent
with Crohn’s disease.
●● Ulcerations and inflammation of the sigmoid colon and
rectum is significant for ulcerative colitis.
CLIENT EDUCATION
●● Remain NPO as required, and perform bowel preparation.
●● There can be possible abdominal discomfort and
cramping during the barium enema.
PATIENT‑CENTERED CARE
NURSING CARE
Ulcerative colitis and Crohn’s disease
●● The client should receive instructions regarding the
usual course of the disease process.
●● The client should receive instructions regarding
medication therapy and vitamin supplements.
●● Monitor by colonoscopy due to the increased risk of
colon cancer.
●● Assist the client in identifying foods that
trigger manifestations.
●● Monitor for electrolyte imbalance, especially potassium.
Diarrhea can cause a loss of fluids and electrolytes.
●● Monitor I&O, and assess for dehydration.
●● Educate the client to eat high-protein, high-calorie,
low-fiber foods.
CLIENT EDUCATION
●● Seek emergency care for indications of bowel obstruction
or perforation (fever, severe abdominal pain, vomiting).
●● For extreme or long exacerbations, NPO status and
administration of total parenteral nutrition promotes
bowel rest while providing adequate nutrition.
●● Avoid caffeine and alcohol.
●● Take a multivitamin that contains iron.
●● Small, frequent meals can reduce the occurrence
of manifestations.
●● Dietary supplements that are high in protein and low in
fiber (elemental and semi‑elemental products, canned
nutrition beverages) can be used.
●● Weigh 1 or 2 times weekly.
●● Use of vitamin supplements and B12 injections, if needed.
Diverticulitis
●● For severe manifestations (severe pain, high fever), the
client is hospitalized, NPO, and receives nasogastric
suctioning, IV fluids, IV antibiotics, and opioid
analgesics for pain.
●● Instruct the client who has mild diverticulitis about
self‑care at home. The client should take medications as
prescribed (antibiotics, analgesics, antispasmodics) and
get adequate rest.
●● Provide the client with instructions to promote normal
bowel function and consistency. (Avoid laxatives and the
use of enemas. Drink adequate fluids.)
CLIENT EDUCATION
●● Consume a clear liquid diet until manifestations subside.
●● Progress to a low‑fiber diet once solid foods are tolerated
without other manifestations. Slowly advance to a
high‑fiber diet as tolerated when inflammation resolves.
●● Avoid seeds or indigestible material (nuts, popcorn,
seeds), which can block diverticulum.
●● Avoid foods or drinks that can irritate the bowel. (Avoid
alcohol. Limit fat to 30% of daily calorie intake.)
ME DICATIONS FOR ULCERATI VE
COLITIS , CRO HN’S DISEASE
5‑aminosalicylic acid: Anti‑inflammatory
Reduces inflammation of the intestinal mucosa and
inhibits prostaglandins
Sulfonamides: Sulfasalazine
●● These medications are contraindicated if the client has a
sulfa allergy.
●● Sulfasalazine is given orally.
●● Adverse effects include nausea, fever, and rash.
●● Can take up to 2 to 4 weeks for therapeutic effects.
NURSING ACTIONS
◯◯ Monitor CBC, and kidney and hepatic function.
◯◯ Monitor for the development of agranulocytosis,
hemolytic anemia, and macrocytic anemia.
CLIENT EDUCATION
◯◯ Take the medication with a full glass of water
after meals.
◯◯ Avoid sun exposure.
◯◯ Increase fluid intake to 2 L/day.
◯◯ This medication can cause urine, skin, and
contact lenses to have a yellow‑orange color.
◯◯ Notify the provider if nausea, vomiting, anorexia,
sore throat, rash, bruising, or fever occur.
◯◯ Take medication as directed. The usual maintenance
dose of sulfasalazine is 2 to 4 g/day.
◯◯ Take a folic acid supplement.
Nonsulfonamides
●● Mesalamine
●● Balsalazide
●● Olsalazine (for clients intolerant to sulfasalazine,
rarely used)
●● The adverse effects are not as serious as sulfasalazine.
●● These medications can be contraindicated if the client
has a salicylate or sulfa allergy.
NURSING ACTIONS: Monitor for kidney toxicity.
CLIENT EDUCATION: Report headache or gastrointestinal
problems (abdominal discomfort, diarrhea).
Corticosteroids
Reduces inflammation and pain
●● For rectal inflammation, topical steroids can be
administered by a retention enema.
●● Used to induce remission.
●● Not for long‑term use due to adverse effects.
●● Prolonged use can lead to adrenal suppression,
osteoporosis, risk of infection, and cushingoid
syndrome. Use corticosteroids in low doses to minimize
adverse effects.
●● Can slow healing.
MEDICATIONS
●● Prednisone
●● Prednisolone
●● Hydrocortisone
●● Budesonide
NURSING ACTIONS
●● Monitor blood pressure.
●● Reduce systemic dose slowly.
●● Monitor electrolytes and glucose.
CLIENT EDUCATION
●● Take the oral dose with food.
●● Avoid discontinuing dose suddenly.
●● Report unexpected increase in weight or other
indications of fluid retention.
●● Avoid crowds and other exposures to infectious diseases.
●● Report evidence of infection (Crohn’s disease can mask
infection).
Immunosuppressants
Mechanism of action in treatment of IBD is unknown.
MEDICATIONS
●● Cyclosporine
●● Methotrexate
●● Azathioprine
●● Mercaptopurine
NURSING ACTIONS
●● Monitor for pancreatitis and neutropenia.
●● Can take up to 6 months to see therapeutic effects.
●● Not used as monotherapy.
●● Reserved for refractory disease due to toxicity.
CLIENT EDUCATION
●● Avoid crowds and other chances of exposures to
infectious diseases, and report evidence of infection.
●● Monitor for indications of bleeding, bruising, or infection.
Immunomodulators
●● Suppresses the immune response
●● Inhibits tumor necrosis factor, an antibody found in
Crohn’s disease
MEDICATIONS
●● Infliximab
●● Adalimumab (self‑administered by subcutaneous injection)
●● Natalizumab (can cause progressive multi‑focal
leukoencephalopathy, a deadly brain infection)
●● Certolizumab
NURSING ACTIONS
●● Follow directions for IV use with care and in accordance
with facility policy; can require pretreatment to reduce
infusion reactions.
●● Many adverse effects are possible, including chills,
fever, hypotension/hypertension, dysrhythmias, and
blood dyscrasias.
●● Monitor liver enzymes, coagulation studies, and CBC.
CLIENT EDUCATION
●● Avoid crowds and other exposures to infectious diseases,
and report evidence of infection. There is a risk for
development or reactivation of tuberculosis.
●● Monitor and report evidence of bleeding, bruising, or
infection, and transfusion or allergic reaction.
Antidiarrheals
Suppress the number of stools
●● Used to decrease risk of fluid volume deficit and
electrolyte imbalance. They also reduce discomfort.
●● Use of antidiarrheals can lead to toxic megacolon (massive
dilation of the colon with a risk of the development of
gangrene and peritonitis). Use cautiously.
MEDICATIONS
●● Diphenoxylate and atropine
●● Loperamide
NURSING ACTIONS
●● Observe for manifestations of toxic megacolon that
can result in gangrene and peritonitis (hypotension,
fever, abdominal distention, decrease or absence of
bowel sounds).
●● Observe for indications of respiratory depression,
especially in older adult clients.
CLIENT EDUCATION: Due to the central nervous system
effects, avoid hazardous activities until the response to
the medication is established.
ME DICATION FOR DIVERTICULITIS
Antimicrobials
Treat infection (decrease inflammation in Crohn’s disease,
used to treat abscesses or fistulas)
●● Discontinue ciprofloxacin for tendon pain. Can cause
tendon rupture.
●● Decreased dose should be used for clients who have
impaired kidney function.
MEDICATIONS
●● Ciprofloxacin
●● Metronidazole
●● Sulfamethoxazole‑trimethoprim
NURSING ACTIONS: Monitor kidney and hepatic studies.
CLIENT EDUCATION
●● Can cause a superinfection; observe for manifestations
of thrush or vaginal yeast infection.
●● Urine can darken (expected, harmless effect).
●● Monitor for manifestations of CNS effects (numbness
of extremities, ataxia, and seizures), and notify the
provider immediately.
THERA PEUTIC PROCE DURES
Clients who do not have success with medical treatment or
who have complications (bowel perforation, colon cancer)
are candidates for surgery.
Ulcerative colitis: Colectomy with or without ileostomy
Crohn’s disease
●● Laparoscopic stricturoplasty to increase the diameter of
the bowel for bowel strictures
●● Surgical repair of fistulas or in response to other
complications related to the disease (perforation)
Diverticulitis (dependent on problem)
●● Required for rupture of the diverticulum that results in
peritonitis, bowel obstruction, uncontrolled bleeding,
or abscess
●● Colon resection with or without colostomy
PREOPERATIVE CARE
●● Preoperative care is similar to other abdominal surgeries.
●● If the creation of a stoma is planned, collaborate with an
enterostomal therapy nurse regarding care related to
the stoma.
●● Administer antibiotic bowel prep (neomycin), if prescribed.
●● Administer cleansing enema or laxative, if prescribed.
POSTOPERATIVE CARE
●● Postoperative care is similar to care for clients who have
other types of abdominal surgery.
●● The client should be NPO and have a nasogastric tube to
suction, unless the surgery was performed laparoscopically.
●● An ileostomy can drain as much as 1,000 mL/day.
Prevent fluid volume deficit. Replace fluid loss with IV
fluids if the client is NPO. Oral hydration is slowly
introduced in 1 to 2 days.
CARE AFTER DISCHARGE: Refer the client who has an ostomy
to an enterostomal therapist and an ostomy support group.
INTER PRO FESSIONAL CARE
●● Refer the client for nutritional counseling.
●● The client might benefit from complementary therapy
(biofeedback, massage, yoga).
●● Recommend community support groups or a mental
health referral for assistance with coping
Complications of ulcerative colitis, Crohn’s disease, and
diverticulitis include bleeding and fluid and electrolyte
imbalance. Peritonitis can occur due to perforation of the
bowel. Abscess formation can occur as a complication of
diverticular disease and Crohn’s disease.
Peritonitis
●● A life-threatening inflammation of the peritoneum and
lining of the abdominal cavity
●● Often caused by bacteria in the peritoneal cavity
ASSESSMENT FINDINGS
●● Rigid, board‑like abdomen (hallmark indication)
●● Abdominal distention
●● Nausea, vomiting
●● Rebound tenderness
●● Tachycardia
●● Fever
●● Early manifestation in older adult clients: decreased
mental status, confusion
NURSING ACTIONS
●● Place the client in Fowler’s or semi‑Fowler’s position to
promote drainage of peritoneal fluid and improve lung
expansion.
●● Monitor respiratory status and administer oxygen
as prescribed. Turn, cough, deep breathe. Provide
mechanical ventilation if needed.
●● Maintain and monitor nasogastric suction.
●● Keep the client NPO.
●● Monitor fluid and electrolyte status.
●● Monitor for hypovolemia.
●● Administer hypertonic IV fluids and broad-spectrum
antibiotics as prescribed.
●● Collaborate with case management to determine home
care and wound management needs.
●● If surgery is performed:
◯◯ Closely monitor postoperative vital signs.
◯◯ Monitor I&O every hour immediately after surgery.
◯◯ Monitor surgical dressing for bleeding.
◯◯ If the client requires wound irrigation postoperatively,
use sterile technique, and monitor irrigation intake
and output to prevent fluid retention.
CLIENT EDUCATION
●● Maintain adequate rest and resume home activity slowly,
as tolerated. No heavy lifting for at least 6 weeks.
●● Monitor for evidence of return infection. Notify the
provider immediately.
Bleeding due to deterioration of the bowel
NURSING ACTIONS
●● Observe for indications of rectal bleeding (black, tarry
stools; bright red blood).
●● Monitor vital signs.
●● Check laboratory values, especially hematocrit,
hemoglobin, and coagulation factors.
CLIENT EDUCATION
●● Report rectal bleeding.
●● Understand the importance of bed rest.
Fluid and electrolyte imbalance
Occurs due to loss of fluid through diarrhea, vomiting, and
nasogastric suctioning.
NURSING ACTIONS
●● Monitor laboratory values, and provide
replacement therapy.
●● Monitor weight.
●● Assess for indications of fluid volume deficit (loss or
absence of skin turgor).
CLIENT EDUCATION
●● Record and report the number of loose stools.
●● Maintain adequate fluid intake.
●● Follow the prescribed diet.
Abscess and fistula formation
Occurs due to the destruction of the bowel wall, leading to
an infection
NURSING ACTIONS
●● Monitor fluid and electrolytes.
●● Observe for manifestations of dehydration (decreased
urine output, fever, hypotension, tachycardia, dizziness).
●● Provide a diet high in protein and calories (at least
3,000 calories/day), and low in fiber.
●● Administer a vitamin supplement.
●● Consult with an enterostomal therapist to develop a
plan to prevent skin breakdown and promote
wound healing.
●● Monitor for evidence of infection, which can indicate
abdominal abscesses or sepsis.
●● Ensure the function of drainage devices if used.
Toxic megacolon
Occurs due to inactivity of the colon. Massive dilation of
the colon occurs, and the client is at risk for perforation.
NURSING ACTIONS
●● Maintain nasogastric suction.
●● Administer IV fluids and electrolytes.
●● Administer prescribed medications (antibiotics,
corticosteroids).
●● Prepare the client for surgery (usually an ileostomy)
if the client does not begin to show improvement
within 72 hr.
SUBJECTIVE
Mrs. Z came into the clinic with a complaint of diarrhea combined with abdominal pain;
she is a 34-year-old female with a history of ulcerative colitis. The first appearance of her
symptoms started about four days ago, and she reported she might be having a fever but not
taking her temperature. She felt very uneasy about starting to be weak, so when asked to
illustrate the characteristics and frequency of bowel movements a day, she reported they had
been having a rise in bowel movements over the last couple of months. She stated that she had
no recent travel experiences and she had not been taking any antibiotics in the recent past. She
reported that she never had to take any medications because he did not experience signs and
symptoms of exacerbations. Mrs. Z takes an oral contraceptive daily as her birth control and has
been taking slippery elm capsules for numerous years. She also declares that she just took
Benefiber prebiotic fiber pills not so long ago; she takes them in two to three doses daily.
OBJECTIVE
Mrs. Z’s vital signs are blood pressure is 116/70 in a sitting position, 100/66 in a standing
position, a pulse of 92, and a Temperature of 100.1. The patient has active bowel sounds in all
four quadrants of the abdomen with mild tenderness during palpation, which means she has an
unremarkable exam for pertinent positives or negatives. The patient’s laboratory exam results are
white blood cells of 14,000, hemoglobin of 11.9, hematocrit of 35.7, sodium of 133, and
potassium of 3.3.
ASSESSMENT
The patient is experiencing inflammatory bowel disease due to her reported loose stools
with abdominal pain, running a fever, and an increased number of bowel movements over the
last month. The digestive system's most common complications are inflammation, and chronic inflammatory bowel disease affects the digestive tract of any part from the mouth to the anus
(Cai et al., 2021). According to several studies, it is an idiopathic disorder that causes
inflammation of mucosa that results in ulceration, edema, bleeding, and fluid and electrolyte loss
(Enomoto et al., 2021). To properly diagnose this disease, a complete blood count and stool test
are needed to test for signs of intestinal inflammation, colonoscopy to inspect large and small
intestines, endoscopic ultrasound to examine the digestive tract for ulcers and swelling, flexible
sigmoidoscopy to check the inside of the rectum and anus, CT scan or MRI to observe for signs
of inflammation or abscess, upper endoscopy to view the digestive tract from the mouth to the
beginning of the small intestine, and capsule endoscopy where patient swallow a small camera
which it captures images as it moves through the digestive tract (Guan, 2019). The two main
treatment goals of this specific disorder are to achieve remission and obviate flare-ups so there is
no cure for it, only to relieve the symptoms and heal the mucosa, which means care for the
patient can be medical or surgical, or both (Cai et al., 2021). The medical approach includes
symptomatic care and mucosal healing, which can be managed in an outpatient setting. It
becomes a practical approach that results in a decreased surgery rate (Cai et al., 2021).
THERAPEUTIC
The pharmacological approach is currently an essential invention for inflammatory bowel
disease treatment. Distinguishing the first line of medication therapy will adapt depending on the
seriousness of the signs and symptoms. There are several guidelines to indicate the severity of it
and to choose what medication would be appropriate (Cai et al., 2021). The medicines are
aminosalicylates, antibiotics, corticosteroids, and immunomodulators (Cai et al., 2021). This
patient will be placed in a mild to moderate range of medication therapy based on her labs,
exams, and reported symptoms which would be aminosalicylates (Cai et al., 2021). The specific drug under aminosalicylate she will be taking is sulfasalazine 500 mg twice daily. The initial
approach of it is to start at a total strength dose of 4.8g in a day for induction of remission and
reduce it to a maintenance dose of 2.4g a day, but a study found that an increased incidence of
adverse effects with it (Feuerstein & Tripathi, 2019). She will also be given steroids like
prednisone 40 mg daily and tapered off in a month to ease the risk of long-term side effects,
which were studied that works well in controlling diarrhea exacerbated by the disease (Cai et al.,
2021).
Evaluating the effectiveness of the therapy will be based on the subjective and objective
where the patient reports the relief of the symptoms. It is necessary to assess the patient
continuously through follow-up to ensure the information collected is reliable. Daily review is
also needed when the patient is on corticosteroids, which have long-term adverse effects. Clinical
assessment and laboratory work were initiated to determine the disease’s severity and progress
(Guan, 2019). Prolonged diarrhea results in electrolyte imbalances; therefore, routine workups
like complete blood count are ordered.
EDUCATION
It is essential to start medication reconciliation to verify all listed medications to avoid
errors of omission, incorrect doses, duplication, and drug-to-drug interactions. With that being
said, the patient may continue taking slippery elm supplements. The patient is currently on an
oral contraceptive, so she has no plans to get pregnant; this supplement is not recommended for
pregnant or breastfeeding women. Patients may use over-the-counter medication like
acetaminophen for the pain to treat ulcerative colitis but make sure to avoid NSAIDs like
ibuprofen to avoid stomach distress. It is also necessary to regard smoking and drinking alcohol;
it may help faster relieve symptoms and lessen the risk of relapse (Cai et al., 2021). Patients may also need to find ways to reduce stress, like exercise or yoga; it may lessen the flare-ups (Cai et
al., 2021).
CONSULTATION/COLLABORATION
The patient will be referred to a gastroenterologist to further assist with continuous monitoring
and colorectal screening to rule out colon cancer.
This
