Case Study: GI
Concordia University, St. Paul
NUP 353: Nursing Role In The Acute Care Setting
TM is a 38 year old male with ulcerative colitis admitted to the medical unit at the hospital for acute exacerbation of the disease. This is his second admission in the last six months. TM says he is frustrated with this disease. In the last week TM has had 15-20 diarrhea episodes a day. He needs to hurry to the bathroom often throughout the day and night. He reports sleeping only an hour at a time at night and trouble staying awake at work. He also reports nausea and vomiting in the last three days along with increasing abdominal pain. His bowel movement at time of
admission appears loose, bloody and has a large amount of mucous. His vital signs include: BP
1. Which assessment values are indicative of ulcerative colitis?
T.M. is showing many clinical manifestations of an ulcerative colitis exacerbation in the
severe disease stage (Harding et al., 2020) . He has had 15-20 diarrhea episodes each day
for the past week. He must rush to get to the bathroom many times during the day and
night. This is keeping him awake at night, which is affecting his work. The bowel
movement he had upon admission was bloody, loose, and contained a lot of mucous. A
weight of 125 lbs is below average for a male that is 5'8". He is experiencing nausea,
vomiting, abdominal pain, fever (100.8), increased respirations (22), a high heart rate
(98), and his BP is a little on the lower side (98/64). These are all different nursing
assessments for someone suffering with IBD (Harding et al., 2020)
The physician orders the following for TM: Methylprednisolone (Solu-Medrol) 100mg IV Q6H D5W in 0.9% NaCl with 40 mEq KCl at 125 mL/hr, NPO except for PO meds, diphenoxylate/atropine (Lomotil) 2.5 mg PO q4hr prn, olsalazine (Dipentum) 500 mg PO bid
2. Tell about each of these orders. What is the indication? What side effects ought the nurse be observing for? What other nursing implications ought the nurse keep in mind?
A. Methylprednisolone (Solu-Medrol) 100mg IV Q6H:
a. Indication: Methylprednisolone is a corticosteroid used to decrease inflammation
and should be given in a short amount of time due to side effects associated with
long-term use. This is indicated primarily for acute exacerbations of ulcerative
colitis, but can be used for relief of nausea.
b. Side effects:
- Anorexia
- Decrease wound healing - Adrenal suppression - Muscle wasting - Osteoporosis - Infection - Hypersensitivity - Persistent abdominal pain
- Black tarry stools that can indicate a GI bleed
- Moon face/buffalo hump and fluid retention with long term use
- Hypokalemia - Peptic ulceration
- Thromboembolism
- Weight loss or gain
c. Nursing implications:
- Monitor daily weights as it is the best indicator of fluid volume
- Monitor I's and O's
- Assess for any signs of adrenal insufficiency such as hypotension, weight loss
weakness, anorexia, lethargy, confusion, and