Abdominal bloating and cramping pain


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 exacerbation 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 pseudo polyps inher 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 recommended 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 sedimentation 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.

Question 1. (10 marks. 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. (5 Marks suggested word limit 200)

Explain the pain pathway and how Morphine alters the conscious perception of pain.

Students must support their answers with relevant academic references. References are not included in the word

limit.

Question 3. (2.5 Marks 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. (2.5 Marks suggested word limit 200)

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

Language use Sentences are clearly constructed, and expression and meaning are clear. There is no spelling, grammatical or punctuation errors. Referencing and in text citations The APA referencing style is used correctly for both in -text citations and the reference list. At least three academic references including a journal article are utilised. References must be current and within the last five (5) years.

references. References are not included in the word limit.

Please note there is a word limit of 1000 words. Academic references will not be included in the assessment word

limit.

Students should note that if the word limit is exceeded by more than 10% the marker will stop marking.

 Case study marking Criteria:

Question 1: Accurately, clearly and comprehensively describes the structural and functional changes in the disease process that led to Eleanor’s weight loss.

Question 2: Accurately, clearly and comprehensively describes the pain pathway and how Morphine alters the conscious perception of pain.

Question 3: Accurately, clearly and comprehensively identifies the clinical manifestations that indicates the deterioration of Eleanor’s ulcerative colitis.

Question 4: Accurately, clearly and comprehensively explains the characteristics of the IV fluid ordered for Eleanor and the rationale for the administration of the IV fluid relating to Eleanor’s specific fluid balance.

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