METABOLISM CASE STUDIES (1)

A. PEPTIC ULCER DISEASE

SITUATION: A 39-year old man visits his health provider with complaints of
burning, epigastric pain occurring about two hours after he eats. He consistently
feels bloated and obtains little or no relief from over-the-counter (OTC) antacids.
His past medical history reveals cigarette smoking , stressful jobs, and chronic use of
NSAIDs for low back pain.
1. What further information related to risk factors and manifestations does the nurse
need to collect from the client about his chief complaint?
2. What is the clients most serious risk factor for peptic ulcer disease?
3. Why is smoking contraindicated for clients with peptic ulcer disease?
4. The clients practitioner prescribes an H2 receptor antagonist, an antibiotic, and a
cytoprotective agent. What is the rationale for administering these drugs to clients with
peptic ulcer disease?
5. List 3 priority nursing diagnoses for a client with peptic ulcer disease.
B. GASTRECTOMY
SITUATION: A 44-year-old woman on first day postoperative subtotal gastrectomy
for stomach cancer. Her vital signs are stable and she has been up to the side of the
bed one time. She has a nasogastric tube in place, which is connected to low
intermittent suction.
1. What assessments will the nurse need to make when evaluating the clients nasogastric
suction?
2. What potential problem the client is at risk for when she begins to consume food and
fluids and what can be done to prevent it?
3. The client is ready to be discharged to home. What problems or symptoms will the
nurse teach the client to report if they occur?
C. DUMPING SYNDROME
SITUATION: A 45-year-old client with peptic ulcer disease who has undergone a
Billroth II surgical procedure has been discharged home and has developed
dumping syndrome. During her first postoperative visit to the clinic, the client tells
the nurse practitioner that she experiences weakness, diaphoresis, tachycardia,
faintness, and abdominal distention 15-30 minutes after every meal. The client also
mentions that two or three hours after eating she experiences the symptoms of a
hypoglycemic reaction: sweating, mental confusion, anxiety, weakness, and
tachycardia. The nurse practitioner provides the client with a Teaching Guide,
which lists dietary regulations and restrictions for people with dumping syndrome.
She also advises the client to lie down following meals.
1. What causes the early manifestations of dumping syndrome?

2. How does it benefit the client to eat a high-fat, high protein, low carbohydrate diet?
3. Why is it important for clients with dumping syndrome to lie down after a meal?
4. Why does postprandial hypoglycemia occur two to three hours after eating in clients
with dumping syndrome?
D. ULERATIVE COLITIS
SITUATION: A 35-year-old woman is hospitalized for an exacerbation of ulcerative
colitis following a stressful holiday season spent with relatives. The client is
experiencing abdominal cramping, distention, and diarrhea, and she has signs of
dehydration. The client tells the admitting nurse that she has been eating a lot of
high-fat holiday foods, which she ordinarily avoids: rich gravies, turkey dressing
made with sausage, and creamy pies. In addition, she has been drinking bourbon
and several glasses of wine during dinner. The client explains that she had become
very upset when she allowed her mother, who was visiting, to bring up a lot of
painful issues from the past, which they normally never discuss unless they are
drinking.
1. How has the clients behavior over the holiday triggered exacerbations of ulcerative
colitis?
2. What role do diet, alcohol, and stress play in producing symptoms of ulcerative colitis?
3. What information can the nurse give this client that will help her prevent future attacks
of ulcerative colitis?
E. CROHNS DISEASE
SITUATION: A 25-year-old woman with an exacerbation of Crohns disease is
admitted to the emergency department with complaints of diarrhea, intermittent
abdominal pain, flatulence, abdominal distention, and severe fatigue. The clients
temperature is 38 C. The client states that she has felt under
stress because she recently lost her job, and has not yet
secured new employment. As a result, she is very anxious
about her finances.
1. The clients diarrhea and fever can create nutritional and hydration
problems. What should the nurse assess for and what nursing actions
should be taken?
2. The clients Crohns disease was apparently aggravated by recent
stressful events. How can the nurse help the client cope better with
stress?
3. What instruction can the nurse give this client that will help to
prevent another exacerbation of this disease?
E. CONSTIPATION
SITUATION: a 75-year-old man with congestive heart failure is being admitted to a

llong-term care facility. The client develops fatigue and dyspnea upon exertion, and
consequently tends to severely limit his activities. The client experienced chronic
constipation when at home that, at one point resulted in an impaction that had to be
manually removed by a home health nurse. During admission, the clients daughter
told the nurse that her father had not had a bowel movement in several days, and
had been straining at stools without results.
1. Given the daughters description of the clients bowel history, what possible
complications should be of concern to the nurse?
2. How should the nurse assess the client for fecal impaction?
3. What nursing activities will help to correct the clients constipation following
admission?