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Ulcerative Colitis Mini Case Study

Ulcerative Colitis Mini Case Study. Krista Blackwell Sodexo Mid-Atlantic Dietetic Internship January 6, 2014. Overview. Ulcerative Colitis MNT in IBD Case Study History and Physical Medication and Labs Assessment Diagnoses Goals and Intervention Monitoring and Evaluation Education

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Ulcerative Colitis Mini Case Study

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  1. Ulcerative ColitisMini Case Study Krista Blackwell Sodexo Mid-Atlantic Dietetic Internship January 6, 2014

  2. Overview • Ulcerative Colitis • MNT in IBD • Case Study • History and Physical • Medication and Labs • Assessment • Diagnoses • Goals and Intervention • Monitoring and Evaluation • Education • Article Review • Resources

  3. Ulcerative Colitis • A form of IBD that effects the colon and rectum • Causes: Genetic, environment, and “irritant” • Inflammatory and abnormal immune response • Dx made with sigmoidoscopy

  4. Side Effects • Protein losses • Electrolyte disturbances • Dehydration • Anorexia • Malabsorption • Altered GI transit • Increased secretions • Diarrhea • Fever • Weight loss • Anemia • Food intolerances • Malnutrition • GI and/or rectal bleed • Growth failure

  5. Healthy Colon vs. Ulcerative Colitis

  6. MNT in IBD • Goals: Reduce inflammation, alleviate symptoms, correct dehydration and nutritional deficiencies • Individualized treatment • Acute phase/ flare up: Low-fiber • Remission: High protein (1.0-1.5 g/kg), nutrient-dense diet, 2 quarts of water daily

  7. MNT in IBD • Avoid: Diarrhea-causing foods, extreme temperatures, carbonated beverages, alcohol, caffeine, spicy foods, lactose • Small frequent meals, eat slowly and chew well • MVI with minerals: Thiamine, Vit E, iron, zinc, Ca, K, folic acid

  8. Case Study: History and Physical • CP is a 26 year old female • PMHx: Dx with ulcerative colitis in 2011 • CP reported having multiple episodes of bloody diarrhea • Distended abdomen and abdominal cramping • NKA

  9. Chief Complaint • Nov. 2nd: CP presented with bloody bowel movements and fatigue, was put under observation and given Solu-Medrol and prednisone and d/c Nov. 3 • Nov. 6th: CP vomited her first dose of prednisone • Nov. 9th: Early this morning, CP had one bloody BM an hour and presented to the ED and was admitted to SGAH for further evaluation and monitoring

  10. Medical Diagnoses • Ulcerative Colitis (Dx in 2011) • Rectal bleeding • Hemorrhage of the anus and rectum • Hypokalemia • Anemia

  11. Social History • CP is a 26 year-old Caucasian female • Lives at home in Rockville, MD with her parents • Manager at GAP • Works long hours • Limited access to food

  12. Home Medications

  13. Hospital Medications

  14. Anthropometric Data • Ht: 157cm (62”) • Wt 11/9/13: 46.5 kg (102.3lb) • Wt 11/3/13: 53.6 kg (118lb) • UBW: 50kg (110lb) • IBW: 50 kg (110lb) • %IBW: 93% • % wt change: 5% wt loss over 1 week • BMI: 18.86

  15. Laboratory Data

  16. Nutrition Assessment • Diet Order: Clear Liquid • Intake: Fair • Risk Level: Moderate • Reason for visit: Diet Education • Summary of visit • 8lb wt loss since last hospital admission on 11/3 • Pt’s nausea subsided, able to consume clear liquid diet and the doctor will be advancing her to full liquids • Tries to drink adequate fluids, usually about 3-4 bottles of water a day • No BM since hospital admission • Provided pt with diet education for ulcerative colitis/ inflammatory bowel disease

  17. Nutrition Prescription • Estimated Energy Needs: 1388-1500kcal • (MSJ 1.2-1.3) • Estimated Protein Needs: 38-47g (0.8-1.0 g/kg) • Estimated Fluid Needs: 1500 mL (1mL/kcal) • Micronutrient Needs: MVI with minerals

  18. Nutrition Diagnoses • Nutrition Diagnoses I: Involuntary weight loss R/T ulcerative colitis AEB 5% wt loss over 1 week • Diagnoses II: Food and nutrition-related knowledge deficit R/T lack of prior exposure to nutrition-related information AEB no formal prior education while experiencing acute colitis symptoms

  19. Goals • Pt consume adequate energy intake: At least 75% of meals within the next 3-4 days. • Pt maintain current weight and prevent further weight loss • Patient to demonstrate knowledge of diet guidelines through menu selections prior to discharge

  20. Interventions • Nutrition Education: Provided pt with information about a low fiber diet for the next few weeks and how to slowly reincorporate fiber into the diet • Food and Nutrition Delivery/ Meals and Snacks: As tolerated and as medically feasible, suggest advancing to a low fiber diet • MVI with minerals

  21. Monitoring and Evaluation • Monitor po intake • Monitor pt’s wt trends • RD to monitor understanding of information presented

  22. Discharge Summary • Discharged Nov. 13 • Diagnoses: • Ulcerative Colitis flare • Rectal bleeding secondary to ulcerative colitis flare: Diarrhea and rectal bleed resolved • Anemia, which is stable • Acute dehydration • Hypokalemia, which is resolved • Discharge medications: Prednisone and protonix • Pt to follow up with GI doctor in 2 days

  23. Nutrition Care in Adult IBD Nutrition Issues in Gastroenterology, June 2012Authors: Amar S. Naik and Nanda Venu • Nutrition Assessment • Identifying deficiencies and malnourished pts • Goals • Diet in IBD • Common Deficiencies: Fe, Zinc, Mg, Vit B12, Folate, Vit D and Ca • Omega 3s • Enteral and Parenteral Nutrition

  24. Remission Induction and Maintenance Effect of Probiotics on Ulcerative Colitis: A meta-analysis World Journal of Gastroenterology, April 2010Authors: Li-Xuan Sang, Bing Chang, Wen-Liang Zhang, Xiao-Mei Wu, Xiao-Hang Li, Min Jiang • Aim: To evaluate the induction of remission and maintenance effects of Probiotics for UC • 13 randomized controlled trials from MEDLINE, EMBASE, Cochrane Controlled Trials Register • Evaluates probiotic’s curative effects for treating UC based on existing random control trials

  25. Remission Induction and Maintenance Effect of Probiotics on Ulcerative Colitis: A meta-analysis • Results: Further research is needed including variations of bacterial species, applied dosage, treatment timing, and course of treatment • Results were not consistent

  26. Resources • Mahan, K.., Escott-Stump, S, Raymond, J. Krause’s Food and the Nutrition Care Process. 3rd ed. Elsevier Saunders. 2012 • Width, Mary; Reinhard, Tonia. The Clinical Dietitian’s Essential Pocket Guide. Lippincott Williams & Wilkins. 2009. • Naik, Amar S., Venu, Nanda. “Nutrition Care in Adult Inflammatory Bowel Disease.” Nutrition Issues in Gastroenterology, series #106. June 2012. • Sang, Li-Xuan., Chang, Bing., Zhang, Wen-Liang., Wu, Xiao-Mei., Li, Xiao-Hang., Jiang, Min. “Remission induction and maintenance effect of probiotics on ulcerative colitis: A meta-analysis”. World Journal of Gastroenterology. April 2010.

  27. Thank you!

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