QUESTION 5 You are reviewing a patient Ms Jenny Fisher, who is a 35 year old woman with a known history of inflammatory

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QUESTION 5
You are reviewing a patient Ms Jenny Fisher, who is a 35 year
old woman with a known history of inflammatory bowel disease (IBD).
She has been having multiple flare-ups of her IBD this year. This
time she has a 5-day history of bloody diarrhoea with abdominal
pain. She also reports a bit of weight loss and appears
lethargic.
She describes that she has been a bit stressed lately due to her
recent work situation and she has been moving houses. She is a
smoker, and she admits that cigarettes help to calm her when she is
stressed.
She has visited her doctor and was prescribed three new
medicines (see below). A colonoscopy has confirmed the diagnosis of
active Crohn’s disease. She has no allergies or other significant
medical conditions of note.
She is on the following medicines:
Paracetamol 500mg qid prn
Methotrexate 25mg once daily (new prescription)
Loperamide 2mg prn
Sulfasalazine 500mg qid (new prescription)
Hydrocortisone 100mg rectal foam daily prn (new
prescription)
The following laboratory tests are available:
Haemoglobin 92 g/L
Mean cell volume 112 fL
Erythrocyte sedimentation rate (ESR) 26 mm/h
C-reactive protein (CRP) 45 mg/L (reference range <5)
White cell count 15x109 /L
Low levels of micronutrients
Based on the information provided, identify and explain any
clinically relevant issues for this patient. Suggest how these
could be addressed and/or monitored, and any medication changes you
may recommend. Provide a comprehensive care plan for Ms Fisher. If
you make a change or recommendation, provide full rationale for
your answer.
(Suggested answer ~300-450 words max)