Reference no: EM133603736
Assignment:
A Young Woman with Ulcerative Colitis
1. A female age 25, is from a low-income family with a mother who is very ambitious for her only daughter. Shirley tried hard to excel and was an "A" student in college which she attended with the aid of scholarships and part-time jobs. A hectic schedule and her desire to do well in both school and work put great pressure on her. After graduation she went to work for an interior decorator and was very successful, although demanding clients and an erratic schedule kept up a high level of stress.
She recently has begun her own business and has many worries about obtaining and pleasing customers, making a reputation, and finances. Before leaving home in the morning, she tries to have fruit or juice, cereal with milk, toast and coffee, because her other meals are unpredictable. Often she skips lunch because of work pressures. Sometimes she goes out to lunch with a client or business associate. Frequently when she gets home at night, she is so tired she grabs anything handy from the refrigerator and sometimes skips dinner completely. Her business requires much night work.
For some time she has been losing weight. She is always tired and her joints ache. The appearance of a bloody diarrhea prompts her to see her physician.
On examination she appears pale, nervous, and somewhat dehydrated. Her height is 165 cm (65 in.) and her weight, 50 kg (110 lb); hemoglobin, 11 Hgb; hematocrit, 35%. She is hospitalized for further evaluation. The physician arrives at a diagnosis of ulcerative colitis and anemia, while tests also reveal lactose intolerance.
A diet high in protein and calories, low in fiber, and restricted in lactose is ordered, plus a vitamin and mineral supplement. Corticosteroids are prescribed.
A. What factors in Shirley's background and life-style may have contributed to the ulcerative colitis?
B. Shirley is very apprehensive and has many questions and complaints. At mealtime she is afraid to eat for fear that her symptoms will be aggravated. How might health care team members assist and support Shirley, whom some consider a "difficult" patient?
C. What practical suggestions might you make to help Shirley reduce the level of stress in her life?
D. Shirley likes milk and dairy products and wonders if she can have them. How might you answer?
E. She knows that milk is a good source of protein and calcium and is concerned about getting enough of these nutrients in her lactose-restricted diet. What might you suggest?
F. She has always been weight conscious and although she has lost weight, she is concerned about getting fat on a high-calorie diet. What might you tell her?
G. She will sometimes have to go to restaurants for business lunches. What suggestions might you give for ordering?
H. What are possible nutritional side effects of corticosteroids?