NUR 190 PATHOPHYSIOLOGY REMEDIATION GI CASE STUDY A 34 year old female is admitted who reports abdominal pain and

diarrhea. She is very pale and emaciated. Her admitting diagnosis is rule out Crohns disease. 1. What specific questions should the nurse ask her as part of the admission history? Have you had a fever lately? Have you lost any weight? If so, how much and in what time period? How long have you been having abdominal pain? Is there anything that relieves this pain? Is there anything that exacerbates this pain? How long have you had diarrhea? Is it immediately after you eat? Have you felt as though you were dehydrated? Headache, nausea, etc.? 2. What objective data should the nurse collect? There is sometimes a mass that is felt in the right iliac fossa that occurs with Crohns disease. Assessment of stool could also be collected to rule out infectious diarrhea. Diagnostic studies also provide information about disease severity and complications. A CBC typically shows iron-deficiency anemia from blood loss. An elevated WBC count may be an indication of toxic megacolon or perforation. Decreases in serum sodium, potassium, chloride, bicarbonate, and magnesium levels are due to fluid and electrolyte losses from diarrhea and vomiting. 3. What information will be helpful regarding the clients social history? Why? If the client has had an infection or an autoimmune disorder would be important to ask the client while performing an assessment. This information could help with the diagnosis or finding of a cause for the patient. 4. What nursing measures are important to prevent the complication of dehydration? Patients with significant fluid and electrolyte losses or malabsorption may need enteral feedings, such as elemental diets. Supplement iron may be necessary to prevent or treat iron-deficiency anemia resulting from chronic blood loss. 5. What other nursing interventions should the nurse anticipate providing? Diet is important in these patients. The goals of diet management are to provide adequate nutrition without exacerbating symptoms, to correct and prevent malnutrition, to replace fluid and electrolyte losses, and to prevent weight loss. *Source- Medical-Surgical Nursing assessment and management of clinical problems (Lewis, Dirksen, Heitkemper, Bucher, Camera)