Nursing Case Study Questions

Running head: NURSING CASE STUDY QUESTIONS 1
Nursing Case Study Questions
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NURSING CASE STUDY QUESTIONS 2
Nursing Case Study Questions
Question One
Ulcerative colitis is associated with specified structural and functional changes that often
results in weight loss by affecting mucosal and submucosal layers of the colon. According to the
case study, it can be noted that Eleanor lost about 9 kilograms of weight. According to the results
of the MRI scan done on the abdomen of Eleanor it can be confirmed that she has developed
Pancolitis. Pancolitis indicates that the entire colon is affected by ulcerative colitis. Pancolitis
affects the entire integrity of the entire colon membrane structure and hence affecting its
physiological functions (Keil et al., 2016). These changes explain Eleanor’s symptoms of
cramping, diarrhea, pain in the lower abdomen and bloating.
Given the severity of the abdominal cramps and bloating, Eleanor feels a lot of
discomforts. As she notes in the case study, she feels too ill and weak to eat. It is clear that the
structural changes resulting from persistent inflammation in her colon have caused her food
aversions and she relates eating to pain. Further, the inflammation that causes activation of the
immune system leading to the release of signals that include tumor necrosis factor and
interleukins reduce production and secretion of appetite related hormones (Yang et al., 2016;
López-Sanromán et al., 2017). These hormones leptin and ghrelin are required for one to feel
hungry or develop the urge to eat. This low consumption of food results in less nutrient
availability to enable normal body functions and results in weight loss.
Moreover, pancolitis and the inflammation process led to ulceration of the bowel. This is
manifested by Eleanor’s excretion of blood through stool as shown in the case study. Regular
loss of blood through stool accompanied by less food consumption leads to loss of essential

NURSING CASE STUDY QUESTIONS 3
nutrients from the body with little replacement. Similarly, the impacts of inflammation
accompanied by increased production and release of cytokines through the lamina propria of the
mucosal membrane of the colon affect the permeability of the lining leading to low absorption of
water and nutrients into the body (Owczarek et al., 2016). This can also be manifested in the
case study where Eleanor has experienced fourteen episodes of diarrhea. The diarrhea is caused
by the inability of the mucosal membranes to reabsorb water and sodium ions affectively leading
to a watery stool and hence loss of nutrients and development of fatigue. Cumulatively, these
structural and functional changes are linked to Eleanor’s weight loss.
Question Two
According to the case study, Eleanor was administered with 15mg of Morphine. The
administered morphine will help in the reduction of Eleanor’s pain caused by the effect of
intense inflammation caused by pancolitis. Morphine reduces pain through endogenous opiod
receptors that are G-protein coupled receptors utilized the modulation of pain along the nervous
system. Upon administration of 15mg of morphine to Eleanor’s system, it binds to the opiod
receptors located in different parts of the body to block pain. A cascade of events gets triggered
where the G-coupled protein receptors activate the associated g-proteins (Franken et al., 2016;
Hindryckx et al., 2016). The activated g-proteins enable the subsequent regulations of the
nervous system to control pain while Eleanor is still conscious. The morphine then acts on both
the central nervous system and the peripheral nervous system. It blocks the release of
neurotransmitters through inhibition of the calcium ion release into the presynaptic terminal.
Further, the g-protein mediated cascade opens the potassium ion channels which hyperpolarize