Julie is a 42-year-old married woman. She has four children aged 5, 8, 12 and 14. Her children are very active and enjoy going to many clubs to do various sports. Julie enjoys running and is aiming to complete a marathon at the start of next year. She works four days a week as a personal assistant in a large supplies firm. Often her job is very busy and demanding. Her husband often works away from home for a couple of weeks at a time and she has minimal family support.

For the last 6 months Julie has felt generally unwell. She has had very bad crampy lower abdominal pain, diarrhoea and has noted fresh blood in her stools. She has lost 6 kg in weight without trying to and her appetite is poor. She feels exhausted after doing very little. After investigations a diagnosis of ulcerative colitis has been made.

Questions:

During your assessment of Julie what key information will you want to find out from her?

• Nutritional status
• Bowel Function
• Pain and discomfort
• Knowledge and understanding of IBD
• Lifestyle
• Psychological impact

Identify what assessment tools can be used to inform your assessment.

• MUST
• Pain Chart
• Bristol Stool Chart
• Food diary

What nursing skills and tools would you use to educate Julie regrading IBD?

• Quiet private environment
• Sit square facing Julie
• Use eye contact
• Ask her what she understands and ask her to explain it
• Explain IBD using non-medical jargon. Use pictures, leaflets to explain what you are saying.
• Allow Julie to ask questions

How will you ensure she understands the information you have provided?

• Use reflective questions
• Ask her to explain it back to you
• Get her to complete food diary for next appointment
• Give leaflets and websites for her to visit

Identify areas in Julie’s lifestyle that could potentially cause exacerbation of her IBD?

• Stress of caring for a family with minimal support
• Stress of her job. Worries regarding being off sick regularly and what her employers think. The potential of losing her job due to being off sick
• Financial worries
• Being continuously busy working, exercising and taking her family to many activities
• Scared and feeling alone

Make a list of coping strategies that could be incorporated into her life to help reduce stressors.

• Inform her direct employer regarding her illness
• Inform her close friends of her illness so they may help her
• Negotiate with friends regarding taking her children to activities
• When well, have food made and put in the freezer for times when not feeling well
• Continue exercising as able but not to over exert herself or put pressure on herself to complete the marathon
• Direct her to support networks locally or via website, e.g. https://companion.crohnsandcolitis.org.uk/support

Refer Julie to a IBD specialist nurse who will guide and advise and develop therapeutic relationships.