Case study with guided questions
Eleanor Brown has been admitted to hospital with complications of ulcerative colitis. Eleanor, now 48 years old, was diagnosed with ulcerative colitis when she was 31 years old. Over the years she has had numerous admissions to hospital for acute episodes of ulcerative colitis. Eleanor’s ulcerative colitis has been managed with a combination of diet, medication (infliximab) and medical monitoring.
Eleanor has been experiencing an acute exacerabation of ulcerative colitis over the last two weeks. She has had up to fourteen episodes of diarrhoea with blood and pus per day with severe pain in her lower abdomen. She has been experiencing a sensation of abdominal bloating and cramping pain. Eleanor states that she been feeling too ill to eat and drink much and she has lost nine kilograms in the last two weeks. She also states that she is feeling fatigued and has been unable to complete daily activities.
A colonoscopy performed four years ago revealed that Elenaor has developed a large number of pseudopolyps in her descending and sigmoid colon. Due to her current exacerbation of ulcerative colitis, Eleanor’s gastroenterologist ordered an MRI scan of Eleanor’s abdomen because of the risk of perforation and haemorrhage of her bowel. The MRI scan revealed that Eleanor had now developed pancolitis. The gastroenterological surgeon has recommeded that Eleanor has a total colectomy and construction of an ileostomy.
On examination, Eleanor has a painful and distended abdomen. Her skin is dry, pale and cool to touch with poor turgor. Eleanor’s capillary refill is slow and she has flat neck veins. She states she has had reduced urinary output over recent weeks.
Observations on admission:
Blood pressure: 90/50 mm/Hg
Pulse rate: 120 beats/minute
Respiratory rate: 25 breaths/ minute
Temperature: 38.4C
Sa02: 97 % in room air
Weak peripheral pulses
Weight: 54 kilograms
Height: 165cm
Urinalysis:
specific gravity: 1040
dark coloured urine
no other abnormalities
Initial pathology results:
Haemoglobin: 86g/L (normal range 117-157g/L)
Haematocrit: 52% (normal range 35-47%)
White cell count ( WBC): 16780/mm3 ( normal range 3500-1100/mm3)
Erythrocyte sedimenation rate (ESR) : 31.3mm/hour ( normal range 0-20mm/hour)
C-reactive protein (CRP) : 33.6mg/dl (normal range 20mg/dl)
Albumen: 22.8g/L ( normal range 35-50g/L)
Medical Officer ordered the following:
Morphine 15mg intramuscularly (IMI) QID PRN
Metoclopramide ( Maxolon) 10mg IMI TDS
1000mls Hartman’s solution over 6 hours
Methylprednisolone 20 mg IVI TDS
Nil by Mouth.
Questions
Question 1. (Suggested word limit 400 ) Describe the structural and functional changes in the disease process that led to Eleanor’s weight loss? Students answers must be supported by relevant academic references. References are not included in the word limit.
Question 2. (suggested word limit 300) Explain the pain pathway and how Morphine alters the consicious perception of pain. Students must support their answers with relevant academic references. References are not included in the word limit.
Question 3. (suggested word limit 200) Identify the clinical manifestations that may indicate the deterioration of Eleanor’s ulcerative colitis condition and explain why these may occur. Students answers must be supported by academic references. References are not included in the word limit.
Question 4. (suggested word limit 150) Explain the characteristics of the intravenous fluid that was ordered for Eleanor and the rationale for the administration of the IV fluid relating to Eleanor’s specific fluid balance. Students answers must be supported with academic references.
APA referencing style 20 references (2015-2019)
Note- not older than 2015