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Inflammatory Bowel Disease Case Study (45 min)

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Ms. Hale is a 19 year old female who presents to the Emergency Department (ED) reporting bloody diarrhea. She reports that she has been told she has Irritable Bowel Syndrome (IBS) in the past, and sometimes has bloody stools, but this is the first time she’s seen this much blood

Critical Thinking Check
Bloom's Taxonomy: Application

What further history questions would you ask Ms. Hale?

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Ms. Hale reports she has 5-10 bowel movements daily, she has had 3 already this morning. She reports she’s used to that, especially if she eats greasy foods. She says “I had just accepted that I would never poop normally, but I’ve never seen that amount of blood before. It was crazy!”. She reports a weight loss of 10 lbs in the last 4 months.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What additional nursing assessments need to be performed?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What diagnostic tests would you expect the provider to order? Why?

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Ms. Hale’s vital signs are stable. The provider found frank blood on a digital rectal exam. Ms. Hale received a colonoscopy, which showed a bleeding ulcer in her transverse colon, which was cauterized, but no other signs of bleeding.  The provider believes this may have been an isolated incident due to irritation caused by the patients greasy food diet and IBS. He orders for her to be discharged home.

Critical Thinking Check
Bloom's Taxonomy: Application

What discharge instructions should be included for Ms. Hale?

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Ms. Hale returns to the ED 2 days later complaining of bright red blood in her stools – two yesterday and five already today. She reports severe lower abdominal pain, nausea and vomiting. 

Critical Thinking Check
Bloom's Taxonomy: Analysis

What further diagnostic testing should be done at this time?

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The nurse notes open sores in Ms. Hale’s mouth and Ms. Hale also begins reporting epigastric pain.

An endoscopy, repeat colonoscopy, and CT scan show severe thickening of the mucosa in the small and large intestine, with some ulcerations in the duodenum and ileocecal junction, in addition to the previous one seen in the transverse colon.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What do you believe might be the issue for Ms. Hale?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

Is Ms. Hale presenting with signs of Ulcerative Colitis or Crohn’s Disease? Explain.

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A Gastroenterology specialist officially diagnoses Ms. Hale with Inflammatory Bowel Disease, and explains that these symptoms can sometimes be misdiagnosed until they become severe.  Specifically, he diagnoses her with Crohn’s Disease and explains how it affects the entire GI tract. He will write for new medications and discharge her home tomorrow, as long as she is stable.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What medications would you expect Ms. Hale to be discharged with? Why?

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