GI problems and the psychiatric mental health patient

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I am going illustrate a specific example and then request advice as to how to improve communication of assessment data to the attending.

The patient is a 45 year old African American male with an Axis I diagnosis of Schizophrenia, Chronic Paranoid and Axis III of Cerebral Palsy (CP), hypertension, gastritis, and urinary hesitancy.

Mr. M. is quite debilitated from his CP compounded by extra pyramidal side effects from his psychotropic medication. He is, quite to his embarrassment, incontinent of bowel and bladder. Very recently he began having tarry stools and his H&H; dropped significantly. Even though his stools were negative for blood it was obvious he was loosing blood. This is when he was worked up for and diagnosed with the gastritis. He was prescribed medication for the gastritis, his H&H; improved, but he continued to have frequent diarrhea stools.

Nursing staff vigilantly assessed volume and visualized the color and consistency of the stools. Auscultation of the abdomen found hyperactive bowel sounds, but little else.
As the days went by skin integrity became a legitimate concern. Daily, and sometimes multiple times, during the day nursing reported frequency of bowel movements to the attending psychiatrist and to the onsite internist. The problem seemed to be that the local consulting gastroenterologist had little patience or desire to work with the mentally ill and dismissed the patient. As the problem grew worse finally a successful appointment occurred and the patient was diagnosed with Crohn’s disease and treatment was prescribed.

How could the nurses have better articulated the distress that this patient was enduring?

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