The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician?
A. Hypotension
B. Bloody diarrhea
C. Rebound tenderness
D. A hemoglobin level of 12 mg/dL
Correct Answer: C. Rebound tenderness
Rebound tenderness may indicate peritonitis. During the physical exam, pertinent findings include fever and abdominal tenderness to palpation which usually is diffuse with wall rigidity in more septic presentations. Signs of peritonitis must be reported to the physician. It is important to conduct a thorough exam as certain thoracic or pelvic pathologies can mimic peritoneal irritation (empyema causing diaphragmatic irritation and cystitis/pyelonephritis causing peritoneum adjacent pain).
Option A: Because of the blood loss, the client may be hypotensive. In ulcerative colitis, bleeding can arise from the lining of the rectum or large intestine, and this blood can be visible in the stool. The bleeding generally comes from the ulcers that have formed in the lining of the large intestine or rectum.
Option B: Bloody diarrhea is expected to occur in ulcerative colitis. Ulcerative colitis’s main symptom is bloody diarrhea, with or without mucus. Associated symptoms also include urgency or tenesmus, abdominal pain, malaise, weight loss, and fever, depending on the extent and severity of the disease.
Option D: Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the physician. It may also be necessary to treat the loss of blood that has happened. If the client developed anemia from blood loss, he may need to supplement with iron, folic acid, or vitamin B12, depending on what your health provider says. In serious cases of blood loss, a blood transfusion might be required.
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