Unit 5 Case Study: Inflammatory Bowel Disease. 1000w. due 6-11-22. 5 references

Mrs. Z is a 34-year-old female who come in with a complaint of diarrhea accompanied by abdominal pain.  Onset of the symptom was about 4 days ago.  She reports thinking she is running a fever but has not taken her temperature.  She concerned that she is starting to feel weak. 

When asked how about the characteristics and the number of bowel movements a day, she reports increased number of BMs over the last few months.  In the last few days she reports averaging about 10 small volume watery stools with varying amounts of blood daily.

She denies recent travel and reportedly has not been on any antibiotics in the past few weeks. 

In reviewing her record, you notice that her health history is positive for history of ulcerative colitis.  She has not been on any medications for this over the last few years as she had not been symptomatic.

Mrs. Z is on an oral contraceptive.  She takes slippery elm capsules and has for the last several years.  She reports that she has been taking 2 to 3 doses of Benefiber prebiotic fiber for the last couple days.

Objective data:

BP 116/70 sitting, 100/66 standing; P 92; Temp 100.1

Abdomen – active bowel sounds all 4 quadrants, mild tenderness with palpation

Otherwise her exam is unremarkable for pertinent positives or negatives.

Labs – WBC 14,000; Hgb 11.9; Hct 35.7; Sodium 133; Potassium 3.3

Instructions:

Please prepare and submit a paper 3-4 pages [total] in length (not including APA formatted title and references pages) answering the questions below.  Please support your position with examples.

· What pharmacologic therapy would you prescribe for Mrs. Z?

· How will you evaluate the effectiveness of this therapy?

· What patient education would you provide for Mrs. Z relative to the pharmacologic agent you prescribed?

· Are there any pharmacogenetic considerations related to what you prescribed for the patient?

· Are there any alternative therapies or over-the-counter agents that might be of value to Mrs. Z?

· What, if any, lifestyle changes would you recommend?

Inflammatory bowel disease (IBD) can

affect structures or segments along the

gastrointestinal tract. The term includes both

acute and chronic disorders.

Acute and chronic IBD can result in nutritional

deficits, altered bowel elimination, infection,

pain, and fluid or electrolyte imbalances. The

nurse needs to be knowledgeable about acute

and chronic IBD in order to collaborate with the

client and the interprofessional team in treating

and managing these disorders.

ACUTE IN FLAMMATOR Y BOWEL DISEASE

Appendicitis

Inflammation of the appendix

●● Caused by an obstruction of the lumen or opening of

the appendix.

●● Fecaliths, or hard pieces of stool, can be the initial cause

of the obstruction.

●● Adolescents and young adults are at increased risk.

●● Refer to the NURSING CARE OF CHILDREN REVIEW MODULE,

CHAPTER 23: GASTROINTESTINAL STRUCTURAL AND

INFLAMMATORY DISORDERS.

Peritonitis

Inflammation of the peritoneum results from infection

of the peritoneum due to puncture (surgery or trauma),

rupture of part of the gastrointestinal tract (diverticulitis,

peptic ulcer disease, appendicitis, bowel obstruction), or

infection from continuous ambulatory peritoneal dialysis.

Gastroenteritis

Inflammation of the stomach and small intestine

●● Triggered by infection (either bacterial or viral).

●● Vomiting and frequent, watery stools place the client at

increased risk for fluid and electrolyte imbalance and

impaired nutrition.

CHRONIC IN FLAMMATOR Y

BOWEL DISEASE

Ulcerative colitis and Crohn’s disease are characterized by

frequent stools, cramping abdominal pain, exacerbations,

and remissions.

Ulcerative colitis

Edema and inflammation primarily in the rectum and

rectosigmoid colon

●● In severe cases, it can involve the entire length of the

colon. Mucosa and submucosa become hyperemic

(increase in blood flow), and the colon will become

edematous and reddened. It can lead to abscess formation.

●● Edema and thickened bowel mucosa can cause partial

bowel obstruction. Intestinal mucosal cell changes

can lead to colon cancer or insufficient production of

intrinsic factor, resulting in insufficient absorption of

vitamin B12 (pernicious anemia).

●● Classified as either mild, moderate, severe, and fulminant.

Crohn’s disease

Inflammation and ulceration of the gastrointestinal tract,

often at the distal ileum

●● All bowel layers can become involved; lesions are

sporadic. Fistulas are common.

●● Can involve the entire GI tract from the mouth to the anus.

●● Malabsorption and malnutrition can develop when

the jejunum and ileum become involved. Requires

supplemental vitamins and minerals, possibly including

vitamin B12 injections.

Diverticulitis

Diverticulitis is inflammation and infection of the bowel

mucosa caused by bacteria, food, or fecal matter trapped

in one or more diverticula (pouch‑like herniations in

the intestinal wall). Diverticulitis is not to be confused

with diverticulosis, which is the presence of many small

diverticula in the colon without inflammation.

●● Not all clients who have diverticulosis

develop diverticulitis.

●● Diverticula can perforate and cause peritonitis, and/or

severe bleeding.

ASSESSMENT

Etiology of ulcerative colitis and Crohn’s disease is

unknown but possibly due to a combination of genetic,

environmental, and immunological causes.

RIS K FACTORS

Genetics: Ulcerative colitis and Crohn’s disease

Culture: Caucasians (ulcerative colitis), Jewish heritage

(ulcerative colitis and Crohn’s disease), and African

Americans (diverticular disease)

Sex and age: The incidence of ulcerative colitis peaks at

adolescence to young adulthood (more often in females)

and older adulthood (more often in males). Crohn’s disease

usually develops in adolescents and young adults, but can

occur at any age. Diverticulitis occurs more often in older

adults and affects males more frequently than females.

Tobacco use: Crohn’s disease

EXPECTE D FINDINGS

Ulcerative colitis

●● Abdominal pain/cramping: often left‑lower quadrant pain

●● Anorexia and weight loss

PHYSICAL ASSESSMENT FINDINGS

●● Fever

●● Diarrhea: up to 15 to 20 liquid stools/day

●● Stools containing mucus, blood, or pus

●● Abdominal distention, tenderness, and/or firmness

upon palpation

●● High‑pitched bowel sounds

●● Rectal bleeding

Crohn’s disease

●● Abdominal pain/cramping: often right‑lower quadrant pain

●● Anorexia and weight loss

PHYSICAL ASSESSMENT FINDINGS

●● Fever

●● Diarrhea: five loose stools/day with mucus or pus

●● Abdominal distention, tenderness and/or firmness

upon palpation

●● High‑pitched bowel sounds

●● Steatorrhea

Diverticulitis

●● Acute onset of abdominal pain often in left‑lower quadrant

●● Nausea and vomiting

PHYSICAL ASSESSMENT FINDINGS

●● Fever

●● Chills

●● Tachycardia

●● Abdominal distention

LA BORATOR Y TESTS

Ulcerative colitis

Hematocrit and hemoglobin: Decreased

Erythrocyte sedimentation rate (ESR): Increased

WBC: Increased

C‑reactive protein: Increased

Albumin: Decreased

Stool for occult blood: Can be positive

K+, Na, Mg, Ca, and Cl: Decreased

Crohn’s disease

Hematocrit and hemoglobin: Decreased

ESR: Increased

WBC: Increased

C‑reactive protein: Increased

Albumin: Decreased

Folic acid and B12: Decreased

Anti‑glycan antibodies: Increased

Stool for occult blood: Can be positive

Urinalysis: WBC

K+, Mg, and Ca: Decreased

Diverticulitis

Hematocrit and hemoglobin: Decreased

ESR: Increased

WBC: Increased

Stool for occult blood: Can be positive

DIAGNOSTIC PROCE DURES

Magnetic resonance enterography: Used with all IBD

CLIENT EDUCATION: Maintain NPO for 4 to 6 hr prior to

the exam. You might be asked to drink a contrast medium

prior to the test.

Ulcerative colitis

Sigmoidoscopy or colonoscopy: Can diagnose

ulcerative colitis

Barium enema: Helpful to distinguish ulcerative colitis

from other disease processes

CT scan or MRI: Can identify the presence of abscesses

Stool examination: For the presence of parasites

or microbes

Crohn’s disease

Endoscopy

●● Newer diagnostic tools used, such as video

capsule endoscopy

●● Proctosigmoidoscopy: Performed to identify

inflamed tissue

●● Colonoscopy and sigmoidoscopy: A lighted, flexible

scope inserted into the rectum to visualize the rectum

and large intestine

Abdominal ultrasound, x‑ray, and CT scan: CT scans can

show bowel thickening.

Barium enema: Barium is inserted into the rectum as a

contrast medium for x‑rays. This allows for the rectum

and large intestine to be visualized, and is used to

diagnose ulcerative colitis. A barium enema can show the

presence of diverticulosis and is contraindicated in the

presence of diverticulitis due to the risk of perforation.

NURSING ACTIONS: Monitor postprocedure for

manifestations of bowel perforations (rectal bleeding, firm

abdomen, tachycardia, hypotension).

FINDINGS

●● Small intestine ulcerations and narrowing is consistent

with Crohn’s disease.

●● Ulcerations and inflammation of the sigmoid colon and

rectum is significant for ulcerative colitis.

CLIENT EDUCATION

●● Remain NPO as required, and perform bowel preparation.

●● There can be possible abdominal discomfort and

cramping during the barium enema.

PATIENT‑CENTERED CARE

NURSING CARE

Ulcerative colitis and Crohn’s disease

●● The client should receive instructions regarding the

usual course of the disease process.

●● The client should receive instructions regarding

medication therapy and vitamin supplements.

●● Monitor by colonoscopy due to the increased risk of

colon cancer.

●● Assist the client in identifying foods that

trigger manifestations.

●● Monitor for electrolyte imbalance, especially potassium.

Diarrhea can cause a loss of fluids and electrolytes.

●● Monitor I&O, and assess for dehydration.

●● Educate the client to eat high-protein, high-calorie,

low-fiber foods.

CLIENT EDUCATION

●● Seek emergency care for indications of bowel obstruction

or perforation (fever, severe abdominal pain, vomiting).

●● For extreme or long exacerbations, NPO status and

administration of total parenteral nutrition promotes

bowel rest while providing adequate nutrition.

●● Avoid caffeine and alcohol.

●● Take a multivitamin that contains iron.

●● Small, frequent meals can reduce the occurrence

of manifestations.

●● Dietary supplements that are high in protein and low in

fiber (elemental and semi‑elemental products, canned

nutrition beverages) can be used.

●● Weigh 1 or 2 times weekly.

●● Use of vitamin supplements and B12 injections, if needed.

Diverticulitis

●● For severe manifestations (severe pain, high fever), the

client is hospitalized, NPO, and receives nasogastric

suctioning, IV fluids, IV antibiotics, and opioid

analgesics for pain.

●● Instruct the client who has mild diverticulitis about

self‑care at home. The client should take medications as

prescribed (antibiotics, analgesics, antispasmodics) and

get adequate rest.

●● Provide the client with instructions to promote normal

bowel function and consistency. (Avoid laxatives and the

use of enemas. Drink adequate fluids.)

CLIENT EDUCATION

●● Consume a clear liquid diet until manifestations subside.

●● Progress to a low‑fiber diet once solid foods are tolerated

without other manifestations. Slowly advance to a

high‑fiber diet as tolerated when inflammation resolves.

●● Avoid seeds or indigestible material (nuts, popcorn,

seeds), which can block diverticulum.

●● Avoid foods or drinks that can irritate the bowel. (Avoid

alcohol. Limit fat to 30% of daily calorie intake.)

ME DICATIONS FOR ULCERATI VE

COLITIS , CRO HN’S DISEASE

5‑aminosalicylic acid: Anti‑inflammatory

Reduces inflammation of the intestinal mucosa and

inhibits prostaglandins

Sulfonamides: Sulfasalazine

●● These medications are contraindicated if the client has a

sulfa allergy.

●● Sulfasalazine is given orally.

●● Adverse effects include nausea, fever, and rash.

●● Can take up to 2 to 4 weeks for therapeutic effects.

NURSING ACTIONS

◯◯ Monitor CBC, and kidney and hepatic function.

◯◯ Monitor for the development of agranulocytosis,

hemolytic anemia, and macrocytic anemia.

CLIENT EDUCATION

◯◯ Take the medication with a full glass of water

after meals.

◯◯ Avoid sun exposure.

◯◯ Increase fluid intake to 2 L/day.

◯◯ This medication can cause urine, skin, and

contact lenses to have a yellow‑orange color.

◯◯ Notify the provider if nausea, vomiting, anorexia,

sore throat, rash, bruising, or fever occur.

◯◯ Take medication as directed. The usual maintenance

dose of sulfasalazine is 2 to 4 g/day.

◯◯ Take a folic acid supplement.

Nonsulfonamides

●● Mesalamine

●● Balsalazide

●● Olsalazine (for clients intolerant to sulfasalazine,

rarely used)

●● The adverse effects are not as serious as sulfasalazine.

●● These medications can be contraindicated if the client

has a salicylate or sulfa allergy.

NURSING ACTIONS: Monitor for kidney toxicity.

CLIENT EDUCATION: Report headache or gastrointestinal

problems (abdominal discomfort, diarrhea).

Corticosteroids

Reduces inflammation and pain

●● For rectal inflammation, topical steroids can be

administered by a retention enema.

●● Used to induce remission.

●● Not for long‑term use due to adverse effects.

●● Prolonged use can lead to adrenal suppression,

osteoporosis, risk of infection, and cushingoid

syndrome. Use corticosteroids in low doses to minimize

adverse effects.

●● Can slow healing.

MEDICATIONS

●● Prednisone

●● Prednisolone

●● Hydrocortisone

●● Budesonide

NURSING ACTIONS

●● Monitor blood pressure.

●● Reduce systemic dose slowly.

●● Monitor electrolytes and glucose.

CLIENT EDUCATION

●● Take the oral dose with food.

●● Avoid discontinuing dose suddenly.

●● Report unexpected increase in weight or other

indications of fluid retention.

●● Avoid crowds and other exposures to infectious diseases.

●● Report evidence of infection (Crohn’s disease can mask

infection).

Immunosuppressants

Mechanism of action in treatment of IBD is unknown.

MEDICATIONS

●● Cyclosporine

●● Methotrexate

●● Azathioprine

●● Mercaptopurine

NURSING ACTIONS

●● Monitor for pancreatitis and neutropenia.

●● Can take up to 6 months to see therapeutic effects.

●● Not used as monotherapy.

●● Reserved for refractory disease due to toxicity.

CLIENT EDUCATION

●● Avoid crowds and other chances of exposures to

infectious diseases, and report evidence of infection.

●● Monitor for indications of bleeding, bruising, or infection.

Immunomodulators

●● Suppresses the immune response

●● Inhibits tumor necrosis factor, an antibody found in

Crohn’s disease

MEDICATIONS

●● Infliximab

●● Adalimumab (self‑administered by subcutaneous injection)

●● Natalizumab (can cause progressive multi‑focal

leukoencephalopathy, a deadly brain infection)

●● Certolizumab

NURSING ACTIONS

●● Follow directions for IV use with care and in accordance

with facility policy; can require pretreatment to reduce

infusion reactions.

●● Many adverse effects are possible, including chills,

fever, hypotension/hypertension, dysrhythmias, and

blood dyscrasias.

●● Monitor liver enzymes, coagulation studies, and CBC.

CLIENT EDUCATION

●● Avoid crowds and other exposures to infectious diseases,

and report evidence of infection. There is a risk for

development or reactivation of tuberculosis.

●● Monitor and report evidence of bleeding, bruising, or

infection, and transfusion or allergic reaction.

Antidiarrheals

Suppress the number of stools

●● Used to decrease risk of fluid volume deficit and

electrolyte imbalance. They also reduce discomfort.

●● Use of antidiarrheals can lead to toxic megacolon (massive

dilation of the colon with a risk of the development of

gangrene and peritonitis). Use cautiously.

MEDICATIONS

●● Diphenoxylate and atropine

●● Loperamide

NURSING ACTIONS

●● Observe for manifestations of toxic megacolon that

can result in gangrene and peritonitis (hypotension,

fever, abdominal distention, decrease or absence of

bowel sounds).

●● Observe for indications of respiratory depression,

especially in older adult clients.

CLIENT EDUCATION: Due to the central nervous system

effects, avoid hazardous activities until the response to

the medication is established.

ME DICATION FOR DIVERTICULITIS

Antimicrobials

Treat infection (decrease inflammation in Crohn’s disease,

used to treat abscesses or fistulas)

●● Discontinue ciprofloxacin for tendon pain. Can cause

tendon rupture.

●● Decreased dose should be used for clients who have

impaired kidney function.

MEDICATIONS

●● Ciprofloxacin

●● Metronidazole

●● Sulfamethoxazole‑trimethoprim

NURSING ACTIONS: Monitor kidney and hepatic studies.

CLIENT EDUCATION

●● Can cause a superinfection; observe for manifestations

of thrush or vaginal yeast infection.

●● Urine can darken (expected, harmless effect).

●● Monitor for manifestations of CNS effects (numbness

of extremities, ataxia, and seizures), and notify the

provider immediately.

THERA PEUTIC PROCE DURES

Clients who do not have success with medical treatment or

who have complications (bowel perforation, colon cancer)

are candidates for surgery.

Ulcerative colitis: Colectomy with or without ileostomy

Crohn’s disease

●● Laparoscopic stricturoplasty to increase the diameter of

the bowel for bowel strictures

●● Surgical repair of fistulas or in response to other

complications related to the disease (perforation)

Diverticulitis (dependent on problem)

●● Required for rupture of the diverticulum that results in

peritonitis, bowel obstruction, uncontrolled bleeding,

or abscess

●● Colon resection with or without colostomy

PREOPERATIVE CARE

●● Preoperative care is similar to other abdominal surgeries.

●● If the creation of a stoma is planned, collaborate with an

enterostomal therapy nurse regarding care related to

the stoma.

●● Administer antibiotic bowel prep (neomycin), if prescribed.

●● Administer cleansing enema or laxative, if prescribed.

POSTOPERATIVE CARE

●● Postoperative care is similar to care for clients who have

other types of abdominal surgery.

●● The client should be NPO and have a nasogastric tube to

suction, unless the surgery was performed laparoscopically.

●● An ileostomy can drain as much as 1,000 mL/day.

Prevent fluid volume deficit. Replace fluid loss with IV

fluids if the client is NPO. Oral hydration is slowly

introduced in 1 to 2 days.

CARE AFTER DISCHARGE: Refer the client who has an ostomy

to an enterostomal therapist and an ostomy support group.

INTER PRO FESSIONAL CARE

●● Refer the client for nutritional counseling.

●● The client might benefit from complementary therapy

(biofeedback, massage, yoga).

●● Recommend community support groups or a mental

health referral for assistance with coping

Complications of ulcerative colitis, Crohn’s disease, and

diverticulitis include bleeding and fluid and electrolyte

imbalance. Peritonitis can occur due to perforation of the

bowel. Abscess formation can occur as a complication of

diverticular disease and Crohn’s disease.

Peritonitis

●● A life-threatening inflammation of the peritoneum and

lining of the abdominal cavity

●● Often caused by bacteria in the peritoneal cavity

ASSESSMENT FINDINGS

●● Rigid, board‑like abdomen (hallmark indication)

●● Abdominal distention

●● Nausea, vomiting

●● Rebound tenderness

●● Tachycardia

●● Fever

●● Early manifestation in older adult clients: decreased

mental status, confusion

NURSING ACTIONS

●● Place the client in Fowler’s or semi‑Fowler’s position to

promote drainage of peritoneal fluid and improve lung

expansion.

●● Monitor respiratory status and administer oxygen

as prescribed. Turn, cough, deep breathe. Provide

mechanical ventilation if needed.

●● Maintain and monitor nasogastric suction.

●● Keep the client NPO.

●● Monitor fluid and electrolyte status.

●● Monitor for hypovolemia.

●● Administer hypertonic IV fluids and broad-spectrum

antibiotics as prescribed.

●● Collaborate with case management to determine home

care and wound management needs.

●● If surgery is performed:

◯◯ Closely monitor postoperative vital signs.

◯◯ Monitor I&O every hour immediately after surgery.

◯◯ Monitor surgical dressing for bleeding.

◯◯ If the client requires wound irrigation postoperatively,

use sterile technique, and monitor irrigation intake

and output to prevent fluid retention.

CLIENT EDUCATION

●● Maintain adequate rest and resume home activity slowly,

as tolerated. No heavy lifting for at least 6 weeks.

●● Monitor for evidence of return infection. Notify the

provider immediately.

Bleeding due to deterioration of the bowel

NURSING ACTIONS

●● Observe for indications of rectal bleeding (black, tarry

stools; bright red blood).

●● Monitor vital signs.

●● Check laboratory values, especially hematocrit,

hemoglobin, and coagulation factors.

CLIENT EDUCATION

●● Report rectal bleeding.

●● Understand the importance of bed rest.

Fluid and electrolyte imbalance

Occurs due to loss of fluid through diarrhea, vomiting, and

nasogastric suctioning.

NURSING ACTIONS

●● Monitor laboratory values, and provide

replacement therapy.

●● Monitor weight.

●● Assess for indications of fluid volume deficit (loss or

absence of skin turgor).

CLIENT EDUCATION

●● Record and report the number of loose stools.

●● Maintain adequate fluid intake.

●● Follow the prescribed diet.

Abscess and fistula formation

Occurs due to the destruction of the bowel wall, leading to

an infection

NURSING ACTIONS

●● Monitor fluid and electrolytes.

●● Observe for manifestations of dehydration (decreased

urine output, fever, hypotension, tachycardia, dizziness).

●● Provide a diet high in protein and calories (at least

3,000 calories/day), and low in fiber.

●● Administer a vitamin supplement.

●● Consult with an enterostomal therapist to develop a

plan to prevent skin breakdown and promote

wound healing.

●● Monitor for evidence of infection, which can indicate

abdominal abscesses or sepsis.

●● Ensure the function of drainage devices if used.

Toxic megacolon

Occurs due to inactivity of the colon. Massive dilation of

the colon occurs, and the client is at risk for perforation.

NURSING ACTIONS

●● Maintain nasogastric suction.

●● Administer IV fluids and electrolytes.

●● Administer prescribed medications (antibiotics,

corticosteroids).

●● Prepare the client for surgery (usually an ileostomy)

if the client does not begin to show improvement

within 72 hr.

SUBJECTIVE

Mrs. Z came into the clinic with a complaint of diarrhea combined with abdominal pain;

she is a 34-year-old female with a history of ulcerative colitis. The first appearance of her

symptoms started about four days ago, and she reported she might be having a fever but not

taking her temperature. She felt very uneasy about starting to be weak, so when asked to

illustrate the characteristics and frequency of bowel movements a day, she reported they had

been having a rise in bowel movements over the last couple of months. She stated that she had

no recent travel experiences and she had not been taking any antibiotics in the recent past. She

reported that she never had to take any medications because he did not experience signs and

symptoms of exacerbations. Mrs. Z takes an oral contraceptive daily as her birth control and has

been taking slippery elm capsules for numerous years. She also declares that she just took

Benefiber prebiotic fiber pills not so long ago; she takes them in two to three doses daily.

OBJECTIVE

Mrs. Z’s vital signs are blood pressure is 116/70 in a sitting position, 100/66 in a standing

position, a pulse of 92, and a Temperature of 100.1. The patient has active bowel sounds in all

four quadrants of the abdomen with mild tenderness during palpation, which means she has an

unremarkable exam for pertinent positives or negatives. The patient’s laboratory exam results are

white blood cells of 14,000, hemoglobin of 11.9, hematocrit of 35.7, sodium of 133, and

potassium of 3.3.

ASSESSMENT

The patient is experiencing inflammatory bowel disease due to her reported loose stools

with abdominal pain, running a fever, and an increased number of bowel movements over the

last month. The digestive system's most common complications are inflammation, and chronic inflammatory bowel disease affects the digestive tract of any part from the mouth to the anus

(Cai et al., 2021). According to several studies, it is an idiopathic disorder that causes

inflammation of mucosa that results in ulceration, edema, bleeding, and fluid and electrolyte loss

(Enomoto et al., 2021). To properly diagnose this disease, a complete blood count and stool test

are needed to test for signs of intestinal inflammation, colonoscopy to inspect large and small

intestines, endoscopic ultrasound to examine the digestive tract for ulcers and swelling, flexible

sigmoidoscopy to check the inside of the rectum and anus, CT scan or MRI to observe for signs

of inflammation or abscess, upper endoscopy to view the digestive tract from the mouth to the

beginning of the small intestine, and capsule endoscopy where patient swallow a small camera

which it captures images as it moves through the digestive tract (Guan, 2019). The two main

treatment goals of this specific disorder are to achieve remission and obviate flare-ups so there is

no cure for it, only to relieve the symptoms and heal the mucosa, which means care for the

patient can be medical or surgical, or both (Cai et al., 2021). The medical approach includes

symptomatic care and mucosal healing, which can be managed in an outpatient setting. It

becomes a practical approach that results in a decreased surgery rate (Cai et al., 2021).

THERAPEUTIC

The pharmacological approach is currently an essential invention for inflammatory bowel

disease treatment. Distinguishing the first line of medication therapy will adapt depending on the

seriousness of the signs and symptoms. There are several guidelines to indicate the severity of it

and to choose what medication would be appropriate (Cai et al., 2021). The medicines are

aminosalicylates, antibiotics, corticosteroids, and immunomodulators (Cai et al., 2021). This

patient will be placed in a mild to moderate range of medication therapy based on her labs,

exams, and reported symptoms which would be aminosalicylates (Cai et al., 2021). The specific drug under aminosalicylate she will be taking is sulfasalazine 500 mg twice daily. The initial

approach of it is to start at a total strength dose of 4.8g in a day for induction of remission and

reduce it to a maintenance dose of 2.4g a day, but a study found that an increased incidence of

adverse effects with it (Feuerstein & Tripathi, 2019). She will also be given steroids like

prednisone 40 mg daily and tapered off in a month to ease the risk of long-term side effects,

which were studied that works well in controlling diarrhea exacerbated by the disease (Cai et al.,

2021).

Evaluating the effectiveness of the therapy will be based on the subjective and objective

where the patient reports the relief of the symptoms. It is necessary to assess the patient

continuously through follow-up to ensure the information collected is reliable. Daily review is

also needed when the patient is on corticosteroids, which have long-term adverse effects. Clinical

assessment and laboratory work were initiated to determine the disease’s severity and progress

(Guan, 2019). Prolonged diarrhea results in electrolyte imbalances; therefore, routine workups

like complete blood count are ordered.

EDUCATION

It is essential to start medication reconciliation to verify all listed medications to avoid

errors of omission, incorrect doses, duplication, and drug-to-drug interactions. With that being

said, the patient may continue taking slippery elm supplements. The patient is currently on an

oral contraceptive, so she has no plans to get pregnant; this supplement is not recommended for

pregnant or breastfeeding women. Patients may use over-the-counter medication like

acetaminophen for the pain to treat ulcerative colitis but make sure to avoid NSAIDs like

ibuprofen to avoid stomach distress. It is also necessary to regard smoking and drinking alcohol;

it may help faster relieve symptoms and lessen the risk of relapse (Cai et al., 2021). Patients may also need to find ways to reduce stress, like exercise or yoga; it may lessen the flare-ups (Cai et

al., 2021).

CONSULTATION/COLLABORATION

The patient will be referred to a gastroenterologist to further assist with continuous monitoring

and colorectal screening to rule out colon cancer.

This