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Case Study : The patient is an 11-year-old girl who has been complaining of intermittent right lower quadrant pain and diarrhea for the past year.

Discussion: Quadrant Pain and Diarrhea

Inflammatory Bowel Disease

Case Study

The patient is an 11-year-old girl who has been complaining of intermittent right lower

quadrant pain and diarrhea for the past year. She is small for her age. Her physical

examination indicates some mild right lower quadrant tenderness and fullness.

Studies Results

Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL)

Hematocrit (Hct), 28% (normal: 31%-43%)

Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL)

Meckel scan, No evidence of Meckel diverticulum

D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL)

120 min: 6 mg/dL (normal: >20 mg/dL)

Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in

glucose)

Small bowel series, Constriction of multiple segments of the small intestine

Diagnostic Analysis

The child’s small bowel series is compatible with Crohn disease of the small intestine.

Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose

tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has

vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive

regimen, and her condition improved significantly. Unfortunately, 2 years later she

experienced unremitting obstructive symptoms and required surgery. One year after surgery,

her gastrointestinal function was normal, and her anemia had resolved. Her growth status

matched her age group. Her absorption tests were normal, as were her B12 levels. Her

immunosuppressive drugs were discontinued, and she is doing well.

Critical Thinking Questions

1. Why was this patient placed on immunosuppressive therapy?

2. Why was the Meckel scan ordered for this patient?

3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s

Disease? (always on boards)

4. What is prognosis for patients with IBD and what are the follow up recommendations for

managing disease?

note:
reference at least two updated, and APA format, with plagiarism rate 0%, if possible attach%

Once the doctor was available, I had him review the medication order and guidelines per the drug as I felt he had made an error. Turns out that the doctor was wrong and that the patient indeed did not need the treatment that day. Our textbook states that we as nurses in a health care setting must work closely with physicians, pharmacist and other clinic staff. I believe that I utilized my resources as an LPN and made the right choice by getting a second opinion even though I still did not agree with her response. As a nurse, it is acceptable to not agree with someone but you need to explain your reasoning for something as the other nurse did not provide an acceptable reason for me.

Reference

Catalano, J. (2015). Nursing Now! Today’s Issues, Tomorrow’s Trends. Philadelphia. F.A Davis Company

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