This report focuses on the case study of Bob Jackson who has been identified to be suffering with Crohn’s disease and ulcerative colitis based on his symptoms and past medical history. His presenting complaint was regarding diarrhoea and left lower quadrant (LLQ) abdominal pain and past medical history showed health issues of obesity, rhinitis, AF, hypertension, osteoarthritis right knee and AF. All the symptoms are linked to inflammation of the digestive tract. The purpose of this report is to analyze characteristics of pain in Bob and decide on one pain medication that would provide relief to patient. Secondly, as care of patients require multidisciplinary team approach, role of one multidisciplinary team member is discussed who would engage in Bob’s care during the hospital stay.
Choice of Medication for Bob:
After admission to the hospital ward following abdominal pain and diarrhoea, Bob has pressed his call bell for pain relief. The assessment of his LLQ abdominal pain using COLDSPA denotes that he experiences a dull pain all the time in his , which increases to a strong pressure on the body. The issue is that the onset of pain has got worse since the last two days. His abdominal pain at rest was 6/10 and it has the potential to increase to 9/10 if appropriate pain medication is not provided to student. Among the choice of three medications, Endone 5-10mg PO PRN is considered to be the most appropriate pain killer to control pain in patient. This is because his pain has become worst for the past 2 days and Endone can start working within 10-15 minutes to relieve pain. The patient had taken Endone at 1130 am and since he is complaining of pain again at 1200 pm, this is an indication that Endone dose is needed again. This can give relief to patient for 3-6 hours and the nurse can adjust the dose based on the severity of pain after consultation with the clinician (Endone | myVMC., 2017).
Considering his LLQ pain and increase of pain on movement, giving Endone medication is necessary. The rational for using Endone is that it is an opioid analgesic consisting of the active ingredient ocxycodone hydrochloride and it influences the way body responds to pain. The opioid activates the opioid pain receptors in the central nervous system and disrupts the transmission of pain signals through the nervous. This consequently reduces the transmission of signal through the spinal cord and cause relied from pain (Oxycodone - DrugBank. , 2017). Bob particularly had symptoms of diarrhea and abdominal pain and Endone works to reduce neuronal excitability in response to pain signals. Impairment of gastrointestinal tract function was a major issue in Bob indicated by symptoms of LLQ pain, lower abdominal distension, loose stool and watery diarrhea. Research study has also supported the opioid analgesics as one of the treatment option for relieving pain in patients with Crohn’s disease or ulcerative colitis (Regueiro, 2017). One research study also proves that opioid analgesics are used for treating bowel dysfunction. However, as it is associated with flare up of the condition and risk of infection, it is necessary to combine oxycodone with peripherally acting opioid receptor antagonist to reduce adverse effect on Bob. Oral laxatives and opioid switch may also be considered in case of adverse side effects in patient (Leppert, 2012).
Role of one Health Care Team Member in the Management of Bob:
While caring for Bob, the role of dietician will be the most important for the recovery of patient. This is because Bob has been diagnosed with ulcerative colitis and Crohn’s disease, which is the most common type of inflammatory bowel disease, and management of diet will be most important for improving the symptoms in patient. Appropriate diet and nutrition will be the most important priority for dietician because reducing symptoms and promoting recovery in patient. Diet may not be regarded as a factor contributing to the disease, however it plays an important role on healing of patient.
In inflammatory bowel disease like ulcerative colitis and Crohn’s disease, the inflammation of the intestine limits its ability to digest and absorb food. Hence, such unabsorbed nutrient may escape into large intestine, patients like Bob may suffer from diarrhea and malnutrition. Hence, the dietician can help to plan the diet chart of patient in such a way to reduce diarrhea and other adverse symptoms in patient. The British Dietetic Association also provided evidence-based guidelines for the dietary management of Crohn’s disease. As the disease is associated with acute flare ups and remissions, an expert dietitian plays a vital role in nutritional management of the disease condition (Lee, 2014).
The dietician can make individualize diet plan for Bob based on the type of intestine affected. There is no blanket rule or recommendation related to specific diet for patients, however dietician can identify food items that can cause digestive problem for patients and restrict those foods for Bob. The dietician may also play a role in identifying food intolerance or allergies in patient and yet preventing malnutrition in patient by providing balanced diet. Secondly, balancing fluid intakes is also critical for them to reduce the risk of dehydration due to chronic diarrhea (Burke & Ahmed, 2014). Research study also points out that dietician often prescribe low fibre or low residue diet for Crohn’s disease patient to reduce the risk of bowel obstruction and other symptoms. In addition, dieticians also consider providing probiotics and prebiotics to patients like Bob to manipulate intestinal microbiota to counterbalance harmful bacteria. Currently, dieticians also focus on reducing the disaccharides, polyols and fermentable sachharides as a diet management strategy to prevent abdominal pain, bloating and diarrhea (Camilleri, 2011). Hence, regular engagement of the dietician with Bob will reduce risk of remission and promote recovery of patient.
The paper discussed about the efficacy of Endone drug as a choice for managing pain in patients. It is considered effective to relieve pain, as it is an opioid analgesic that reduces transmission of pain signal. However, it was also argued that combining the drug with drugs is important as opioid analgesic increases the risk of infection in patient. Secondly, the role of dietician has been discussed to manage symptoms and promote recovery of patient. The report suggested that fluid management, balancing nutrition, preventing malnutrition and reducing fibre based diet are some important diet management strategies to manage care of patients with ulcerative colitis or Crohn’s disease.
Burke, A. &. (2014). Diet and the Dietitians Role in the Management of Inflammatory Bowel Disease: An exploration of Patients’ and Healthcare Professionals’ Perspectives.
Camilleri, M. (2011). Managing symptoms of irritable bowel. 60, 425–428.
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Lee, J. A. (2014). British Dietetic Association evidence?based guidelines for the dietary management of Crohn's disease in adults. Journal of human nutrition and dietetics, 27(3), 207-218.
Leppert, W. (2012). The impact of opioid analgesics on the gastrointestinal tract function and the current management possibilities. Contemporary Oncology, 16(2), 125.
Oxycodone - DrugBank. . (2017, September 7). Retrieved from
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Regueiro, M. G. (2017). Etiology and treatment of pain and psychosocial issues in patients with inflammatory bowel diseases. Gastroenterology, 152(2), 430-439.