Scenario: A 47-year-old man with Ulcerative Colitis (UC) has been admitted to the emergency room with extreme abdominal pain. He explains that he has not taken his medications for the last few months and does not have any medical or prescription insurance.

The following health assessment information is required for a diagnosis of UC:

• Medical history: The patient’s medical history should be reviewed to assess for any risk factors for UC, such as a family history of UC, Jewish ethnicity, and smoking. The patient should also be asked about his symptoms, including the onset, duration, severity, and quality of the abdominal pain; the presence of diarrhea, rectal bleeding, and mucus in the stool; and any associated symptoms such as fever, weight loss, and fatigue.
• Physical examination: The physical examination should focus on the abdomen, where the patient may have tenderness, distention, and guarding. The rectum should also be examined for signs of inflammation and bleeding.
• Laboratory tests: Laboratory tests that may be helpful in diagnosing UC include:
  • Complete blood count (CBC): A CBC may show signs of anemia, which can be caused by blood loss from the inflamed colon.
  • Electrolyte levels: Electrolyte levels may be low in patients with UC due to diarrhea and vomiting.
  • C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): These tests are markers of inflammation and may be elevated in patients with UC.
  • Stool culture: A stool culture may be ordered to rule out infection as a cause of the patient’s symptoms.
• Imaging studies: Imaging studies such as a colonoscopy and/or flexible sigmoidoscopy may be performed to visualize the colon and rectum and look for signs of inflammation and ulceration.

Response of an Advanced Practice Nurse

As an advanced practice nurse, I would respond to this scenario in the following way:

1. Assess the patient’s pain and provide appropriate analgesia. The patient’s pain should be assessed using a standardized pain scale, such as the Numeric Rating Scale (NRS). Once the patient’s pain has been assessed, I would provide appropriate analgesia, such as intravenous morphine or fentanyl.
2. Order the necessary laboratory tests and imaging studies. I would order a CBC, electrolyte levels, CRP, ESR, and stool culture to assess for anemia, electrolyte imbalances, inflammation, infection, and other potential complications of UC. I would also order a colonoscopy and/or flexible sigmoidoscopy to visualize the colon and rectum and look for signs of inflammation and ulceration.
3. Start the patient on appropriate medications. Once the patient has been diagnosed with UC, I would start him on appropriate medications, such as mesalamine, corticosteroids, or biologic medications. The specific medications that I would choose would depend on the severity of the patient’s disease and his response to previous treatments.
4. Educate the patient about his disease and its management. I would educate the patient about UC, including the causes, risk factors, symptoms, and treatment options. I would also teach the patient how to manage his disease at home, including how to take his medications, how to manage his diet, and how to identify and prevent complications.
5. Refer the patient to appropriate resources. I would refer the patient to a specialist in inflammatory bowel disease (IBD) for ongoing care and management. I would also refer the patient to a social worker or other support resources to help him cope with his disease and its impact on his life.

Evidence-Based Practice Guidelines

The following evidence-based practice guidelines are applicable to the care of patients with UC:

• American Gastroenterological Association (AGA) Institute Clinical Guideline on the Management of Ulcerative Colitis: This guideline provides recommendations for the diagnosis, treatment, and monitoring of patients with UC.
• Crohn’s and Colitis Foundation: This website provides a wealth of information on UC, including information on diagnosis, treatment, and management.

Ethical Considerations

The following ethical considerations are applicable to the care of patients with UC:

• Autonomy: Patients have the right to make their own decisions about their healthcare. As an advanced practice nurse, I would respect the patient’s autonomy and involve him in all decision-making related to his care.
• Beneficence: I would act in the best interest of the patient by providing him with the highest quality of care possible. I would also consider the patient’s individual needs and preferences when making treatment decisions.
• Justice: I would provide the patient with the same