NSG2ANB: A Multidisciplinary Approach to Ulcerative Colitis Management

This assignment focuses on the acute nursing care of a patient, Bob Jackson, suffering from ulcerative colitis. It addresses the management of symptoms such as lower abdominal pain, bloody stools, and diarrhea through various medications, including Celebrex, corticosteroids, and antibiotics, detailing their mechanisms of action and potential side effects. The report emphasizes a multidisciplinary approach, highlighting the crucial role of a registered dietician in managing the patient's dietary needs to alleviate symptoms and improve overall health. The dietician's interventions include recommending dietary adjustments, supplements like iron and folic acid, and probiotics to support the intestinal immune system and manage bone mass loss associated with ulcerative colitis. The assignment concludes by underscoring the importance of holistic care and multidisciplinary collaboration in effectively treating ulcerative colitis and improving the patient's quality of life. Desklib provides a platform for students to access similar solved assignments and past papers for their studies.

Running head: ACUTE NURSING
ACUTE NURSING
Name of the Student
Name of the University
Author Note

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Introduction
The assignment is about bob Jackson, who had been suffering from a chronic
abdominal disorder and whose symptoms are more like ulcerative colitis. Some of the clinical
issues manifested by Bob Jackson are-Lower abdominal pain in the left quadrant, stools
containing with blood, diarrhea, pain in the rectal region and joint pain due to arthritis and
joint swelling.
This paper would describe some of the mode of actions of the medicines that will be
used for Bob and the rationale behind their use. Bob Jackson required a multidisciplinary
approach to treat the symptoms and second part of the assignment will discuss about the role
of a registered dietician managing the dietary health of Bob Jackson.
Question 1
Treatment of pain can be challenging for people with ulcerative colitis as many of the
painkillers might cause flare up of the disease. New studies have found that Celebrex does
not pose long-term risk. According to some of the studies painkillers such as ibuprofen and
naproxen has been linked to ulcerative colitis flare ups (Setia, Nehru & Sanyal, 2014) .It is a
COX-2 inhibitor that is a non- steroidal anti-inflammatory drugs. Cox -2- enzyme is the one
that is responsible for the production of the prostaglandins that causes pain in arthritis.
Celebrex specifically inhibits COX-2 but does not affect the COX- 1 enzyme (Setia, Nehru &
Sanyal, 2014).
Corticosteroids can also be administered orally or intravenously and these
medications can be used to reduce the inflammation in the intestinal lining. These steroids

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cannot be used for long term, as the patients might become steroid independent (Li et al.,
2015). Since paracetamol is a weak inhibitor of the prostaglandins. Although the effects of
the paracetamol is much like selective cox -2 – inhibitors but , paracetamol might not be
suitable for Bob, as Bob has reported a dull abdominal pain with intensity ranging from 6-8
out of 10, which indicates towards moderate to severe pain (Jóźwiak-Bebenista & Nowak,
2014).
Endone tablets can also be given to Bob as a painkiller as its action is similar to the
opioid analgesics. The active ingredients of endone is oxycodone hydrochloride and it affects
the way how a body reacts to the pain. However, it binds to the receptor, inhibits the adenylyl
cyclase and the hyperpolarization of the neurons, and thus reduces the excitability.
Since the intestinal micro biota plays an important role in the development of chronic
ulceritis, antibiotics can have impact by decreasing the concentration of the bacteria residing
in the gut lumen and modifying the concentration of the intestinal micro flora for favoring the
beneficial bacteria (Nitzan, Elias, Peretz & Saliba, 2016). Hence, antibiotics might be used
for the treatment of the progression of the disease. Antibiotics like metronidazole can be used
(Nitzan, Elias, Peretz & Saliba, 2016).
However, there are several side effects in relation to administration of the painkillers like
allergic symptoms or difficulty in breathing, dizziness or disorientation.
Question 2
A multidisciplinary team is normally created to as abdominal pain and diarrhea
requires an array of treatment. The importance of the multidisciplinary team is that it
emphasizes to the patient all aspects of pain experience and contribution from each members

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of the pain management team (Bitton et al., 2014). The team member that has been chosen
for the discussion and who is also a part of the multidisciplinary team is a registered dietician.
The activated receptors interferes with the pain signals that are transmitted through the
central nervous system.
A clinical dietician is the one that promotes nutrition to the patient in the hospitals as
per their disease conditions and the nutritional requirements, due to this they are often taken
as members of multidisciplinary teams. It is evident from the case study that Bob Jackson had
been suffering from ulcerative colitis (Triantafillidis, Vagianos & Papalois, 2015).Various
dietary and nutritional factors have been found to be the etiological factors for ulcerative
colitis. Management of the gastrointestinal disorders largely depends upon the dietary
supplements prescribed by registered dieticians. This referral has been chosen for Bob, as
dietary habits and food choices often play an important role in the treatment and the
prevention of the gastrointestinal disorders.
According to Triantafillidis, Vagianos & Papalois, (2015), exclusion of lactose or
other disaccharides from the diet has been proven effective for the individuals with diarrhea.
Conversely, the intake of the citrus fruits, the fruit juices and vegetables have been found to
lower the risk of the development of ulcerative colitis. Abdominal pain, discomfort, diarrhea
deeply affects the quality of life of millions of people. According to Limdi, Aggarwal &
McLaughlin, (2015), a healthy diet plan can be helpful to treat the eating habits of the
patients and helps them to maintain a healthy life style. Based on the latest scientific findings,
dietary fibers, probiotics and non-absorbable antibiotics targeting the gut have some impact
upon the patients with abdominal disorders. Mikocka-Walus et al. (2017), have stated that
there are certain foods that exacerbate the diarrheal symptoms. Bob Jackson had been

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suffering from osteoarthritis and joint pain, this can be related to the fact that patient having
ulcerative colitis displays and increased loss of the bone mass. Hence a dietician can plan the
diet of the patient accordingly, such as implementation the of iron and folic acid supplements
in the diet plan. The deficiency of the folic acids can be linked to increased risk of colitis-
associated carcinogenesis. Recommending with probiotics can increase the stimulation of the
intestinal immune system, greater permeability of the intestinal mucosa. Hence, sufficient
calorie and protein intake recommended by a registered nurse can be helpful in managing the
symptoms of ulcerative colitis in Bob Jackson.
Conclusion
In conclusion, it can be said that since pain management is an important aspect of
treating ulcerative colitis symptoms, medicines like paracetamol, Endone, celebrex can be
used in treating severe pain in the patient. Antibiotics and corticosteroids are the
recommended medications for the treatment of ulcerative colitis. However, it is
recommended to look after the contraindications of each of the medications. Since, treatment
of the clinical issues of Bob required a multidisciplinary approach and diet plays an important
role in managing gastrointestinal disorders, hence the role of the dieticians has been discussed
supported by some literary evidence. As per the age of Bob Jackson, he required a holistic
care approach to cope up with the pain and other issues.

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References
Bitton, A., Buie, D., Enns, R., Feagan, B. G., Jones, J. L., Marshall, J. K., ... & Panaccione,
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Toronto consensus statements. The American journal of gastroenterology, 107(2),
179. https://www.nature.com/articles/ajg2011386
Jóźwiak-Bebenista, M., & Nowak, J. Z. (2014). Paracetamol: mechanism of action,
applications and safety concern. Acta poloniae pharmaceutica, 71(1), 11-23.
https://europepmc.org/abstract/med/24779190
Li, J., Wang, F., Zhang, H. J., Sheng, J. Q., Yan, W. F., Ma, M. X., ... & Zheng, P. (2015).
Corticosteroid therapy in ulcerative colitis: clinical response and predictors. World
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Nitzan, O., Elias, M., Peretz, A., & Saliba, W. (2016). Role of antibiotics for treatment of
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