Case Study 48 Inflammatory Bowel
Disease with Small Bowel
Obstruction
C.W., a 36-year-old woman, was admitted several days ago with a diagnosis of recurrent
inflammatory bowel disease (IBD) and possible small bowel obstruction (SBO). C.W. is married,
and her husband and 11-year-old son are supportive, but she has no extended family in-state. She
has had IBD for 15 years and has been taking mesalamine (Asacol) for 15 years and prednisone
40 mg/day for the past 5 years. She is very thin; at 5 feet 2 inches she weighs 86 pounds and has
lost 40 pounds over the past 10 years. She has an average of 5 to 10 loose stools per day. C.W.'s
life has gradually become dominated by her disease (anorexia; lactase deficiency; profound
fatigue; frequent nausea and diarrhea; frequent hospitalizations for dehydration; and recurring,
crippling abdominal pain that often strikes unexpectedly). The pain is incapacitating and relieved
only by a small dose of diazepam (Valium), oral electrolyte solution (Pedialyte), and total bed
rest. She confides in you that sexual activity is difficult: “It always causes diarrhea, nausea, and
lots of pain. It's difficult for both of us.” She is so weak she cannot stand without help. You
indicate complete bed rest on the nursing care plan.
1. Identify six priority problems for C.W.
1. SBO can be life threatening (perforation, peritonitis, sepsis, shock).
2. FVD (affects all body systems, perfusion)
3. Debilitating pain.
4. Imbalanced Nutrition; < Body Requirements;
5. R/F (or actual) Impaired Skin Integrity
6. Stress & Anxiety (Making problems worse)
7. Activity Intolerance
8. Interrupted Family Processes
2. Considering C.W.'s weakness, chronic diarrhea, and lower-than-desired body
weight, what nursing interventions need to be implemented to minimize skin
breakdown?
1. IV fluids
2. CBC, Metabolic Panel
3. Nutrition Assessment
4. Low Residue Diet
5. Possible parental nutrition supplementation
6. Perianal care, skin barrier
Case Progress:
C.W.'s condition deteriorates on the third day after admission; she experiences intractable
abdominal pain and unrelenting nausea and vomiting. C.W. is taken to the operating room
for probable SBO and is readmitted to your unit from the post-anesthesia care unit.
During surgery, 38 inches of her small bowel were found to be severely stenosed with
two areas of visible perforation. Much of the remaining bowel is severely inflamed and
friable. A total of 5 feet of distal ileum and 2 feet of colon have been removed, and a
This study source was downloaded by 100000817935606 from CourseHero.com on 02-01-2022 07:28:55 GMT -06:00
https://www.coursehero.com/file/16728434/Case-Study-IBD/
Disease with Small Bowel
Obstruction
C.W., a 36-year-old woman, was admitted several days ago with a diagnosis of recurrent
inflammatory bowel disease (IBD) and possible small bowel obstruction (SBO). C.W. is married,
and her husband and 11-year-old son are supportive, but she has no extended family in-state. She
has had IBD for 15 years and has been taking mesalamine (Asacol) for 15 years and prednisone
40 mg/day for the past 5 years. She is very thin; at 5 feet 2 inches she weighs 86 pounds and has
lost 40 pounds over the past 10 years. She has an average of 5 to 10 loose stools per day. C.W.'s
life has gradually become dominated by her disease (anorexia; lactase deficiency; profound
fatigue; frequent nausea and diarrhea; frequent hospitalizations for dehydration; and recurring,
crippling abdominal pain that often strikes unexpectedly). The pain is incapacitating and relieved
only by a small dose of diazepam (Valium), oral electrolyte solution (Pedialyte), and total bed
rest. She confides in you that sexual activity is difficult: “It always causes diarrhea, nausea, and
lots of pain. It's difficult for both of us.” She is so weak she cannot stand without help. You
indicate complete bed rest on the nursing care plan.
1. Identify six priority problems for C.W.
1. SBO can be life threatening (perforation, peritonitis, sepsis, shock).
2. FVD (affects all body systems, perfusion)
3. Debilitating pain.
4. Imbalanced Nutrition; < Body Requirements;
5. R/F (or actual) Impaired Skin Integrity
6. Stress & Anxiety (Making problems worse)
7. Activity Intolerance
8. Interrupted Family Processes
2. Considering C.W.'s weakness, chronic diarrhea, and lower-than-desired body
weight, what nursing interventions need to be implemented to minimize skin
breakdown?
1. IV fluids
2. CBC, Metabolic Panel
3. Nutrition Assessment
4. Low Residue Diet
5. Possible parental nutrition supplementation
6. Perianal care, skin barrier
Case Progress:
C.W.'s condition deteriorates on the third day after admission; she experiences intractable
abdominal pain and unrelenting nausea and vomiting. C.W. is taken to the operating room
for probable SBO and is readmitted to your unit from the post-anesthesia care unit.
During surgery, 38 inches of her small bowel were found to be severely stenosed with
two areas of visible perforation. Much of the remaining bowel is severely inflamed and
friable. A total of 5 feet of distal ileum and 2 feet of colon have been removed, and a
This study source was downloaded by 100000817935606 from CourseHero.com on 02-01-2022 07:28:55 GMT -06:00
https://www.coursehero.com/file/16728434/Case-Study-IBD/
