The client presents with severe rectal bleeding. 16 diarrheal stools a day, severe abdominal pain, tenesmus and dehydration. Because of these symptoms the nurse should be alert for other problems associated with what disease?

1. A

   Crohn's disease

2. B

   Ulcerative colitis

3. C

   Diverticulitis

4. D

   Peritonitis

Appeared in: OSSSC Nursing Officer-2023

Explanation

• The symptom cluster of severe bloody diarrhea, high stool frequency (16/day), abdominal pain, and tenesmus is the hallmark presentation of a severe ulcerative colitis flare.
• Tenesmus, the feeling of incomplete evacuation, specifically points to significant inflammation of the rectum (proctitis), which is a universal feature of ulcerative colitis at onset.
• In ulcerative colitis, inflammation is typically limited to the mucosal layer of the colon, which becomes friable and ulcerated, leading to the characteristic severe bleeding.
• According to the Truelove-Witts criteria, having six or more bloody stools per day is classified as severe ulcerative colitis, and this patient has 16.

Why Other Options Were Wrong

• Option A: While Crohn's disease is an inflammatory bowel disease, it less commonly presents with severe, profuse rectal bleeding. Diarrhea is often non-bloody, and tenesmus is rare because the rectum is often spared.
• Option C: Diverticulitis is the inflammation of diverticula. Its classic presentation is steady left lower quadrant pain, fever, and altered bowel habits, but not high-frequency, bloody diarrhea and tenesmus.
• Option D: Peritonitis is inflammation of the abdominal lining, not the bowel itself. It is a potential complication of a perforated bowel (e.g., from severe UC or diverticulitis), not the primary disease causing bloody diarrhea.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differentiating inflammatory and infectious gastrointestinal disorders based on clinical presentation to guide bedside assessment, documentation, and the next nursing action.
• The immediate nursing priority for this patient is fluid and electrolyte resuscitation to manage severe dehydration and prevent hypovolemic shock.
• Nurses must closely monitor vital signs, stool output (frequency, volume, amount of blood), and abdominal assessment for signs of complications like toxic megacolon (abdominal distension, decreased bowel sounds) or perforation (rigid abdomen, severe pain).
• Pain management and providing skin care to the perianal area are crucial comfort measures due to the high stool frequency and tenesmus.

How to Approach the Question

• This is a clinical scenario question that requires you to identify a disease based on a classic set of symptoms.
• First, break down the clinical presentation into key findings: 1) Severe rectal bleeding, 2) High-frequency diarrhea (16/day), 3) Abdominal pain, 4) Tenesmus, 5) Dehydration.
• Analyze the most specific symptoms. The combination of tenesmus (rectal inflammation) and severe bloody diarrhea is highly suggestive of a specific pathology.
• Evaluate each option against this symptom cluster. Recall the key differences between the inflammatory bowel diseases (UC and Crohn's) and other GI conditions.
• Ulcerative colitis characteristically starts in the rectum (causing tenesmus) and causes mucosal inflammation leading to bloody diarrhea. This is a perfect match.
• Rule out the other options based on their typical presentations (e.g., Crohn's has less bleeding, Diverticulitis has LLQ pain/fever, Peritonitis has a rigid abdomen).

Concept Tested & Keywords

• Concept Tested: Differentiating inflammatory and infectious gastrointestinal disorders based on clinical presentation.
• Stem keywords: severe rectal bleeding, 16 diarrheal stools a day, severe abdominal pain, tenesmus, dehydration
• Lead-in keywords: alert for, what disease
• Clinical cues: The combination of tenesmus and severe bloody diarrhea is a strong indicator of rectal and colonic inflammation.
• Clinical cues: A stool frequency of 16 per day signifies a severe disease process.

Question ID

Q6ezxp-srCIm6dfiqvUQmo

Copy ID

Reference Book

E6 Medicine Davidson Principles Practice 24e p. 837-839

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 92-94

E6 Medicine Harrison 22e Part 2 p. 461-463