This article discusses the causes and symptoms of ulcerative colitis, a chronic inflammatory disease of the gastrointestinal tract. It explores the impact of inflammation on weight loss and nutrient absorption. The case study of Eleanor Brown is used to illustrate the manifestations and complications of the disease.
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Running head:NURSING Name of the Student Ashma Gyawali Kharel Name of the University Western Sydney University
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1 NURSING Answer 1 Ulcerative colitis (UC) is a chronic disease that leads to inflammation or irritation and sores (commonly known as ulcers) in the inner lining of the large intestine. It is classified underthechronicinflammatorydiseaseofthegastro-intestinal(GI)tract,knownas inflammatory bowel disease (IBD). UC has slow prognosis initially and during the course of time it becomes worse (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2019). Weight-loss is one of the common sign and symptom of UC, and is mainly driven by the morphologic and inflammatory changes in the colon. During the initial stages of the UC, the inflammation is limited to mucosa and mainly consists of constant involvement of the differing severity of ulceration, edema and haemorrhage along the length of the colon. Thus, weigh loss is not drastic at the initial stage. However, as the disease progresses there occurs distortion of the mucosal glands and depletion of the goblet cells due to infiltration of the colon area by the polymorphonuclear leukocytes and mono-nuclear cells leading to the developmentof chronic inflammation(Conrad, Roggenbuck & Laass, 2014). Elsherif, Alexakis and Mendall (2014) stated that inflammatory nature results in the generalised catabolic resulting in drastic weight loss. Moreover, the resting energy expenditure is found to increase gradually during the acute flares of the UC and heightened release of the pro- inflammatory cytokines exert an anorexic effect leading to further loss in the bio-mass. Elsherif, Alexakis and Mendall (2014) further highlighted that the inflammatory state of the UC is also associated with the changes in the level of numerous metabolic hormones secretion like leptin, ghrelin and adiponectin. Dis-equilibrium in hormonal secretion leads to hamper in the balance of the satiety leading to weight loss.
2 NURSING One of the consistent features of UC is presence of mucus and blood mixed with stool along with cramping in the lower part of the abdomen. This cramping is more intense during the passage of the bowel movements. This discharge of the blood promotes weight loss. Moreover, abdominal cramping and inflammation prevent absorption of the micro-nutrient and macro-nutrient leading to further weight loss due to nutritional deficiency (Conrad, Roggenbuck & Laass, 2014). Eleanor Brown has been suffering from UC for the past 17 years. This prolong prognosis of the disease is the reason behind her weight loss. Moreover, in relation to the above mentioned literature, it can be said that Eleanor Brown has 14 episodes of diarrhoea with excretion of blood and pus along with several pain in the lower portion of the abdomen. Excretion of pus in stool indicates the presence of chronic internal inflammation leading to weight-loss. Eleanor Brown is also experiencing abdominal bloating and cramping, decreasing her willingness to have food. Feeling ill to consume food and drink can be considered as another reason behind her drastic weight loss. Answer 2 There are two types of neurons, afferent neurons and efferent neurons, which are used as pain receptors. The neurons that receive information from the sensory organs like the skin and the eye and transmit the pain response to the along the spinal dorsal horn of the central nervous system are known as afferent neurons. Neurons that send impulses from the central nervous system through the spinal dorsal horn to the limbs and the other organs are known as efferent neurons. Morphine is opioids that attenuate the excitability of the peripheral terminal of the neurons and thereby preventing the transmission of the action impulses and reducing the sensation of pain. The action of morphine is exerted both in the brainstem nuclei and opirat receptors and thus preventing generation of conscious pain (Jagla et al., 2013). Morphine also inhibits the vasodilation generated by the entidromic electrical stimulation of
3 NURSING the C-fibres and this inhibiting pain.Morphine generally has high affinity towards the mu- receptors, and comparatively lesser affinity towards the kappa and delta receptors. The mu- opioid receptor is the principal part through, which morphine exerts its effect in the ventral segmental area that reinforces the effect of morphine (Jagla et al., 2013). Upon oral administration, morphine is instantly absorbed in the gastro-intestinal tract showing rapid action. However, Jagla et al. (2013) stated that over-use of morphine leads to habit-formationoraddictionandissimultaneouslycharacterisedbysymptomslike depression, anxiety, fatigue and drowsiness. Answer 3 Clinical manifestation of UC is characterised by diarrhoea along with excretion of blood and mucus through stool. According to the case study, Eleanor Brown is experiencing acute exacerbation of UC with 14 episodes of diarrhoea with stool mixed with pus and blood along with severe cramping pain in the lower abdomen. The rectal bleeding in her care is mainly attributed to the development of pseudopolyps in her descending and sigmoid colon. The development of the polyps in the colon is an indication of deterioration. The formation of thepseudopolypsismainlyattributedduetoinflammationandthus,indicatingthe seriousness of the disease. The increased level of inflammation in the colon and rectal area is also evident from the high levels of the C-reactive protein (C-reactive protein (CRP): 33.6mg/dl (normal range 20mg/dl) (Feuerstein & Cheifetz, 2014). The second clinical manifestation that indicates deterioration in case of Eleanor Brown is decrease in the level of haemoglobin in the body fluid (86g/L (normal range 117-157g/L) (Feuerstein & Cheifetz, 2014). The decrease in the haemoglobin is attributed due to the loss of blood in stool along with the cell death arising out of inflammation. The cell death is also indicted by the
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4 NURSING excretion of puss through stool along with high level of haematocrit: 52% (normal range 35- 47%) (Park et al., 2013). Answer 4 The intravenous injection of the Hartmann’s solution (sodium lactate solution) for an interval of 6 hours will help to restore the sodium, chloride, potassium, calcium and lactate balance of the body. This supplement will help Eleanor Brown to balance the loss of the electrolytes resulting out diarrhoea. Intravenous injection of the Hartmann's solution helps to restore the proper functioning of the ion channels and thereby helping to restore the normal functioning of the neuro-transmitter. Attaining the equilibrium of the electrolyte balance of the body will help to attain the normal parameters of respiratory rate and pulse rate along with decrease in the level of fatigue(El-Sharkawy et al., 2014). Hypotonic Hartmann’s solution is helpful for the treatment of the patients like Eleanor Brown who is suffering from the intracellular dehydration as reflected in lack of haemoglobin in blood and fatigue. Hypotonic solution has lower concentration of solutes or electrolytes. Infusing hypotonic solution into the vascular system will lead to the generation of unequal solute concentration in the fluid compartments. This will alter the osmolarity leading to transfer of fluid inside the cell compartments, hydrating the cells(El-Sharkawy et al., 2014).
5 NURSING References Conrad, K., Roggenbuck, D., & Laass, M. W. (2014). Diagnosis and classification of ulcerative colitis.Autoimmunity reviews,13(4-5), 463-466. El-Sharkawy, A. M., Sahota, O., Maughan, R. J., & Lobo, D. N. (2014). The pathophysiology offluidandelectrolytebalanceintheolderadultsurgicalpatient.Clinical Nutrition,33(1), 6-13. Elsherif, Y., Alexakis, C., & Mendall, M. (2014). Determinants of weight loss prior to diagnosisininflammatoryboweldisease:aretrospectiveobservational study.Gastroenterology research and practice,2014. Feuerstein, J. D., & Cheifetz, A. S. (2014, November). Ulcerative colitis: epidemiology, diagnosis, and management. InMayo Clinic Proceedings(Vol. 89, No. 11, pp. 1553- 1563). Elsevier. Jagla, G., Mika, J., Makuch, W., Obara, I., Wordliczek, J., & Przewlocka, B. (2014). Analgesic effects of antidepressants alone and after their local co-administration with morphine in a rat model of neuropathic pain.Pharmacological Reports,66(3), 459- 465. NationalInstituteofDiabetesandDigestiveandKidneyDiseases[NIDDK](2019). UlcerativeColitis.Accessdate:2thMarch2019.Retrievedfrom: https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis Park, S. H., Kim, D., Ye, B. D., Yang, S. K., Kim, J. H., Yang, D. H., ... & Kim, M. H. (2013).Thecharacteristicsofulcerativecolitisassociatedwithautoimmune pancreatitis.Journal of clinical gastroenterology,47(6), 520-525.