A client’s ulcerative colitis symptoms have been present for longer than 1 week. The nurse recognizes that the client should be assessed carefully for signs of which of the following complications?
A. Heart failure
B. DVT
C. Hypokalemia
D. Hypocalcemia
Correct Answer: C. Hypokalemia
Excessive diarrhea causes significant depletion of the body’s stores of sodium and potassium as well as fluid. The client should be closely monitored for hypokalemia and hyponatremia. Intestinal inflammatory processes reduce the absorption of sodium, chloride and calcium, while they increase potassium secretion. In addition, mild to severe metabolic alkalosis may occur in IBD patients, mainly depending on the severity of the disease and the part of the gastrointestinal tract being affected. Ulcerative colitis may place the client at risk for heart failure, DVT, or hypocalcemia, but this can rarely occur.
Option A: High levels of cytokines, C-reactive protein (CRP), and homocysteine in IBD patients may lead to endothelial dysfunction, an early sign of atherosclerosis. IBD patients, in general, do not show the typical risk factors for cardiovascular disease but changes in lipid profiles similar to the ones seen in cardiovascular events have been reported recently.
Option B: Patients with inflammatory bowel disease are at increased risk of thromboembolic complications which may affect patients’ morbidity and mortality. Many factors have been investigated as determinants of the pro-thrombotic tendency such as acquired risk factors or genetic and immune abnormalities, but a unique cause has not been found.
Option D: An inability to absorb enough calcium is one reason why people with IBD may experience calcium deficiency. Malabsorption occurs mainly in people with Crohn’s disease where the inflammation is located in the small intestine. Calcium is absorbed in the small intestine, so people who have ulcerative colitis, which mainly has inflammation in the large intestine, may have better calcium absorption.
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