Case Study Assignment

Laura is a 30-year-old woman initially presented with a 6-week history of 5 loose, non-bloody stools daily, right lower quadrant abdominal pain (especially after eating), 10 kg weight loss, and bilateral knee and ankle pains. She is married with an 18-month-old child. Laura recently returned to work after her maternity leave.
She has smoked 1 pack of cigarettes daily for several years. She quit smoking during her pregnancy, but has since returned to smoking ½ pack per day since her child turned 6 months of age. No joint effusion or skin lesions are noted. Stool is negative for enteric pathogens, and the results from her blood work show mild anemia (hemoglobin 112 g/L), with a normal metabolic panel and normal thyroid-stimulating hormone levels. Radiographic findings demonstrate a 10-cm narrowing in the terminal ileum (string sign). She is diagnosed with Crohn’s disease. Initial therapy for the client is sulfasalazine 1000 mg every 8 hours PO.
However, in the past 3 months, Laura has required 2 hospitalizations for acute exacerbations, she is now prescribed adalimumab (Humira) maintenance therapy 40 mg SC q2 week and has been discharged home once her latest acute exacerbation had stabilized. Her husband has attended all health visits and states that it is important that he support his wife. Lately her husband has needed to assume more of the child care responsibilities in addition to his own work as they struggled to cope with Laura’s symptoms

1. Discuss health teaching the nurse would provide for this client regarding her prescribed medication of adalimumab and the rationale for use of this medication as relates to Laura’s underlying pathophysiology.
2. Describe the key findings from the article, “Effects of caregiver burden on quality of life and coping strategies by caregivers of adult patients with inflammatory bowel disease” by Parekh et al (2017). How can these findings be utilized to provide support for the family?  
3. Describe a plan of care, including the rationale, that would assist the client with managing the clinical manifestations of Crohn’s disease.
4. Describe health promotion measures the nurse could include to help develop promote Laura’s sense of self- efficacy and self-management skills.