pathogenesis of Ulcerative Colitis with Disease

Questions: 1.Prioritise the nursing responsibilities and associated rationales related to the administration of morphine to Eleanor? 2.Describe the structural and functional changes that occur in the pathogenesis of ulcerative colitis that led to Eleanors episodes of diarrhoea with blood and pus? 3. Explain the characteristics of the intravenous fluid that was ordered for Eleanor, and the rationale, related to Eleanors specific fluid balance status, for the administration of this intravenous fluid to Eleanor? Answers: 1. The nursing responsibilities for this case are Nursing responsibilities Rationale (Brunner, 2010) Assess the level of pain using pain scale method. Pain should be assessed before and after administration of the medication Pain score will help the health care providers to adjust the medication according to the level of pain The patient needs to be checked for allergies and immune compromised state. The medicine chart needs to be checked for other drugs that may react with morphine. Morphine is a common antigen in allergic reactions in patients. Morphine is also a respiratory depressant. Morphine reacts with other drugs, mainly depressants. Administer the pain medication as instructed by the physician. In this case the medication prescribed is morphine Morphine is highly effective in relieving pain and acts directly on the central nervous system to alleviate the pain Nurse must record any adverse outcome from the medication There are adverse outcomes of morphine such as decreased respiratory rate, constipation, vomiting, low blood pressure Incorporate non pharmacological measures to reduce pain The effectiveness of the pharmacological methods will increase with the increase in patient comfort level as it will distract Eleanor from pain. Monitoring the vial signs of the patient The patient already has low blood pressure, high level of c-reactive protein, weak peripheral pulses. Monitoring is important to prevent infection. Monitor fluid volume, input and output To improve the urine output of the patient. The important part of the hydration monitoring is fluid balance Provide emotional support It is an important part of the holistic care Patient needs to be educated about the potential side effects of morphine. It is legal duty of the nurse to educate patients about any potential harm caused by medications. The patient needs to be assessed for central nervous system (CNS) functioning Morphine is a CNS depressant for decreasing feelings of pain. It is crucial to monitor the functioning of the CNS to avoid any potential complications. 2. There is no single definitive cause of ulcerative colitis. It is a multifactorial disease and is known to involve complex interaction of genetic predisposition, immune system and environmental risk factors that cause changes in colon and rectum. Structural and Functional Changes: Ulcer lesions causing haemorrhage: According to Jghult et al. (2011) The primary lesion formation in the intestinal gland leads to haemorrhage. Such haemorrhage targets the gastrointestinal tract leading to bleeding in it. This condition is also called as gastric ulcer. As per Brunner (2010) aberrant immune system results in ulcerative colitis. Pathophysiology determines that when ulcer is not treated on time, it leads to the formation of lesions that attacks the duodenal wall and other linings of the gut. The ulcer lesions keep attacking the blood vessels as well that initiates the haemorrhage and the blood tends to flow in other systems and organs of the body. This blood neutralizes the acid present in the stomach and stops burning that cause pain. Psychological factors such as anxiety and depression are found to increase the permeability of the intestines. This causes leaky bowl and bloody diarrhoea with pus as in case of Eleanor. Ulceration: Ulceration is a process of formation of ulcer and most prevalent among all is mucosal ulcer. This process can be initiated by either an antigen or non-steroid anti-inflammatory drugs (NSAIDs). This ulcer targets the mucosal membrane leading to its slow degradation. Such degradation occurs when an ulcer tissue attaches itself to the epithelial border and spreads till submucosa. After the attachment the tissue starts decomposing the lining leading to the formation of lesion and further bleeding (Whitehead, 2016). Sloughing of Mucosa: Sloughing of Mucosa is also called as Oral Epitheliolysis that undertakes the shredding of mucosal lining due to the formation of lesions due to ulcers. Initiation of ulcer in mouth can occur due to change in daily brushing routine or attack by some foreign body such as Pemphigus vulgaris or Bullous pemphigoid or others. They attack the epithelium lining of the mouth and starts degrading the tissues leading to the formation of lesions. Further these lesions initiate the formation of ulcer and ultimate pain (Boye et al. 2011). The microscopic pattern of UC is characterized by an inflammatory reaction with special distribution and structural abnormalities of the mucosa. Crypt branching and irregularity of size and shape is formed with an increase in chronic inflammatory cells in the lamina propria. This response leads to inflammation of the intestine (colon and rectum) and consequently leads to the symptoms of bloody diarrhoea in patients, which was seen in Eleanor too (Varela et al., 2013). 3. Since Eleanor had episodes of diarrhoea with blood and pus it is necessary to prevent dehydration. Hartman fluid has been ordered for Eleanor, which is a mixture of sodium lactate, sodium chloride, calcium chloride and potassium chloride in water. It is administered to patients for replacement of fluids andelectrolyteswho havelow blood volumeorlow blood pressure. The Hartman solution is effective in combating acidosis due to dehydration. It contains 2?mmol/l of calcium. It modifies ringers solution through addition of sodium lactate to act as a buffering agentand it restores electrolyte balance (Mahajan et al., 2012). Hartmans fluid is used in perioperative period due to the anticipation of ongoing protracted losses from fistula and nasogastric tube. Hence, due to fluid and electrolyte imbalance in Eleanors body and to eliminate the effect of anaesthetic effects during operation, Hartmans fluid is administered for fluid replacement in the peri-operative period. Hartmans fluid has been specifically ordered for Eleanor because she is schedules for a total colectomy and construction of ileostomy, which may lead to fluid losses. References Boye, B., Lundin, K. E., Jantschek, G., Leganger, S., Mokleby, K., Tangen, T., ... Rivenes, A. C. (2011). INSPIRE study: Does stress management improve the course of inflammatory bowel disease and disease?specific quality of life in distressed patients with ulcerative colitis or crohn's disease? A randomized controlled trial.Inflammatory bowel diseases,17(9), 1863-1873. Brunner, L. S. (2010).Brunner Suddarth's textbook of medical-surgical nursing(Vol. 1). S. C. C. Smeltzer, B. G. Bare, J. L. Hinkle, K. H. Cheever (Eds.). Lippincott Williams Wilkins. Jghult, S., Saboonchi, F., Johansson, U. B., Wredling, R., Kapraali, M. (2011). Identifying predictors of low health?related quality of life among patients with inflammatory bowel disease: comparison between Crohns disease and ulcerative colitis with disease duration.Journal of clinical nursing,20(11?12), 1578-1587. Mahajan, V., Saini, S. S., Sharma, A., Kaur, J. (2012). Ringers lactate vs normal saline for children with acute diarrhea and severe dehydration: A double blind randomized controlled trial.Indian pediatrics,49(12), 963-968. Van Regenmortel, N., Jorens, P. G., Malbrain, M. L. (2014). Fluid management before, during and after elective surgery.Current opinion in critical care,20(4), 390-395. Varela, E., Manichanh, C., Gallart, M., Torrejn, A., Borruel, N., Casellas, F., ... Antolin, M. (2013). Colonisation by Faecalibacterium prausnitzii and maintenance of clinical remission in patients with ulcerative colitis.Alimentary pharmacology therapeutics,38(2), 151-161. Whitehead, L. (2016). The Impact of Biological Interventions for Ulcerative Colitis on Health-Related Quality of Life.AJN The American Journal of Nursing,116(11), 21.