Sunday 24 June 2012

Case Study

Case Study

Mr. Smokey Robinson is a 30 year old man who was admitted to the hospital from home with frequent bloody diarrhea over several days, sharp abdominal pain, and generalized weakness. During the health history interview, he reported suffering from chronic hemorrhoids and diarrhea and uses over-the-counter hydrocortisone cream at home. He also reported frequent joint pain, especially in the lower back.

Mr. Robinson has a history of smoking 20 cigarettes a day for 15 years. He lives in Sudbury, an urban city in Northern Ontario. He is single and works as a construction worker and reports disliking his job. He does not engage in physical activity outside of his work due to low energy and usually grabs a bite to eat at fast food restaurants on his way to and from work.

While in hospital, he underwent an endoscopy of the small intestine, a colonoscopy of the entire colon to look for lesions, and a barium study of the gut. Test results revealed the "string sign" - a constriction at the terminal ileum of the small intestine, a "cobblestone" appearance of the gut due to lesions and fibrosis with "skips" of normal tissue in between. His blood tests showed anemia and he was given 2 units of blood upon admission.

  1. He was diagnosed with Crohn disease while in hospital. Which of his signs and symptoms are consistent with this diagnosis?
    • sharp abdominal pain
    • frequent bloody diarrhea
    • hemorrhoids
    • joint pain, especially in the lower back
    • constriction at the junction between the small intestine and the large intestine
    • lesions causing a cobblestone appearance to the guy
    • areas of normal tissue, as if the lesions "skipped" a section of the gut
    • anemia (from gastric bleeding)
  2. He was started on aminosalicylates which is an antiinflammatory drug. He tells you that he knows someone who also has Crohn disease but that person is taking 3 different medications and wonders why he is receiving different treatments. What do you tell him?

    Treatment for IBD is individualized to the patient and the symptoms that they are experiencing.
  3. What are your priority assessments for him while he is in the hospital?
    • Abdominal assessments: firm, rigid, tender abdomen may be from bowel obstruction or perforation; hyperactive bowel sounds may be from diarrhea; hypoactive bowel sounds may indicate constipation
    • Monitor for dehydration and electrolyte imbalance: poor skin turgor, dry mucous membranes, elevated BUN, low potassium/sodium
    • Signs and symptoms of infections
    • Pain: ensure patient's pain is managed
  4. Mr. Robinson tells you that he "brought this on himself" for not exercising and not eating well and says, "It must be all this stress at work that gave me these ulcers." What do you tell him?

    Stress and diet have not been shown to be causative for IBD, but it may worsen a pre-existing condition.

1 comment:

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