Question: Fatima Is A 36-year-old Female Admitted Several Days Ago With A Diagnosis Of Recurrent Inflammatory Bowel Disease And Possible Small Bowel Obstruction Fatima And Her Partner Maria Have One Adopted Daughter, Age 10. Her Family, Aside From A Couple Aunts And Uncles, Reside In Portugal. She Has Had IBD For Many Years And Usually Takes Mesalamine And Prednisone …

Fatima is a 36-year-old female admitted several days ago with a diagnosis of recurrent inflammatory bowel disease and possible small bowel obstruction Fatima and her partner Maria have one adopted daughter, age 10. Her family, aside from a couple aunts and uncles, reside in Portugal. She has had IBD for many years and usually takes mesalamine and prednisone daily. She is qu thin, at 5’2″, weighing 921bs. Since the onset of her IBD, she has lost over 50 pounds. Fatima averages 5-10 loose stools per day. She has been unable to work due to her symptom including anorexia, lactase deficiency, profound fatigue, ongoing nausea and diarrhea. This is her 5th hospitalization in the past two years for dehydration and recurring severe abdominal pain. The pain is severe enough to warrant taking a dose of diazepam, and hopefully some electrolyte solution (Pedialyte), and total bed rest. She notes her relationship with Maria has become strained, as the ongoing symptoms of her IBD have affected her ability to hold a job and care actively for their 10 year old. Often, Fatim has to call Maria to pick up their daughter from school and take her to all her after school activities such as dance, Tai Kwon Do, and Portuguese language lessons. Maria is becoming resentful, and Fatima is not feeling supported. Yesterday, Fatima’s pain worsened with constant nausea and vomiting. She was taken to the operating room. She had 38″ of her small bowel removed as it was quite stenosed and had visible perforated areas. Most of the remaining bowel is inflamed and friable. She had a temporary ileostomy established, a Jackson-Pratt drain to bulb suction in the RLQ, and the wound is slightly opened but packed with ribbon gauze. She has two peripheral IV’s, a NG tu to low suction, and a Foley catheter in place. Today, her VS are 112/72, 86/min regular, 24/n 38.2°C. She has absent sounds. She has mild nausea, no vomiting. She rates her abdominal at 7/10. Breath sounds are clear, decreased to both bases. The stoma is red, moist, and sma amount serosanguinous drainage in the collection bag. Meds Orders: NPO, NG to low suction, ice chips PRN Monitor I and o V NS at 100cc/hr Morphine 5mg IV via mini bag Q4h PRN Ondansetron 4mg IV Q6H Dietitician for TPN orders