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
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.
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.
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.
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.
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.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell