Advanced Health Assessment: Ulcerative Colitis Patient

The client is a 47-year-old male ulcerative colitis (UC) patient admitted to the emergency room with extreme abdominal pain. He does not have prescription or medical insurance and has not taken his medication for several months.

Relevant Additional Subjective Information

Sources contend that inflammatory bowel disease (IBD) patients are often embarrassed to discuss their symptoms with their physicians or nurses (Hibi et al., 2020). To optimize individual treatment, therefore, physicians and nurses may have to actively query their patients about all possible symptoms (Hibi et al., 2020).

To adequately capture the history of present illness (HPI), therefore, the nurse will include information on whether the patient has experienced any other symptoms of UC, including diarrhoea, fecal incontinence, nausea and vomiting, diarrhoea associated with mucus or blood, constipation, and tenesmus, among others. Understanding the full range of symptoms would provide the nurse with a clearer view of the extent of the disease and the impact on the patients overall quality of life. It may also be appropriate to provide details about the patients pain, such as its locality or whether it begins from one end of the abdomen and moves to another (McDowell, Farooq & Haseeb, 2022). UC presents with pain in the lower left quadrant, while Crohn disease presents with pain in the lower right quadrant (McDowell et al., 2022). Thus, obtaining information about the location of the patients pain would provide a subjective basis for determining whether or not to test for Crohn disease.

The nurse may also need to document information on the patients exposure to environmental and genetic risk factors. They need to indicate where the patient lives, and whether or not the patient smokes cigarettes, has a history of gastroenteritis, has undergone hormone replacement therapy, and so on. Furthermore, it may be appropriate to document whether the patients family has a history of UC, which predisposes them to the disease (Ungaro et al., 2016). This information would help the nurse contextualize...

Consequently, it would provide a more effective means to advice on proper disease management.

It may also be appropriate for the nurse to obtain information on the patients medication history. Aminosalicylates are the first-line treatment for mild to moderate UC, while corticosteroids are used for moderate to severe cases or where aminosalicylates prove ineffective (McDowell et al., 2022). Patients who fail to respond to corticosteroid therapy may be exposed to immune-modifying agents (anti-TNF agents)...

…bowel syndrome (Ungaro et al., 2016; McDowell et al., 2022). Like UC, Crohn disease is a form of inflammatory bowel disease (McDowell et al., 2022). However, the two differ based on their depth in the bowel wall and location (McDowell et al., 2022). UC affects the colonic mucosa, while Crohn disease most often affects the rectum although it may also spread to the entire colon and terminal ileum (McDowell et al., 2022). However, the presenting patient is unlikely to be suffering from Crohn disease because then, the chief complaint would have been abdominal pain accompanied by occult blood and/or rectal prolapse, rather than isolated abdominal pain.

Appendicitis is a condition resulting from an inflamed appendix, and which often causes severe abdominal pain on the right side of the belly button. However, appendicitis presents with chills, fever, vomiting, and nausea. The presenting client does not complain of any of these. Finally, irritable bowel syndrome is a common large intestine disorder that is characterized by diarrhea, bloating gas, constipation, abdominal pain, and cramping. However, the condition is easily managed through lifestyle changes and managing ones diet, and will rarely cause severe symptoms requiring ER admission. Moreover, the condition affects the large intestine and is associated with rectal bleeding, which the presenting client does not experience. Thus, ulcerative…