Nursing Paper on Sciatica and Liver Dysfunction

NURSING PAPER 1
Nursing Paper
Student’s Name
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NURSING PAPER 2
Q. 1
Sciatica is a therapeutic situation defined by discomfort going down the leg from the
lower back. It is normally generated by lumbar spine issues like a herniated disc or bulging
(Adams and Dolan 2016, p. 23). Intervertebral spinal discs contain an outer annulus fibrosus
along with an inner nucleus pulposus. The annulus fibrosus forms a ring around the nucleus
pulposus early in the development of human. It occurs when the herniated disk, narrowing of the
spine or bone spur on the spine compresses part of the nerve. Hence, it leads to inflammation,
discomfort along with numbness in the affected leg.
The ramifications of a herniated disc are worse. Apart from causing direct compression of
the nerve root against the interior of the bony spinal, the disc material also has an acidic chemical
irritant which results in nerve inflammation. Irritation along with nerve compression leads to
pain along with inflammation resulting in extreme numbness, muscle weakness, and tingling
sensations. The bulging disc or the herniated disc may generate pain to radiate into the back of
the thigh, calf or buttock (Vulfsons, Bar and Eisenberg 2017, p. 32). Occasionally, the pain may
extend down the foot.
Moreover, Kelly’s sciatica has escalated due to muscle tension along with stable joints. A
condition called piriformis syndrome which is an issue with one of the muscles in the buttocks is
common causes of sciatica during pregnancy (Baloh 2019, p. 19). This is a result of rising in
pregnancy hormones such as relaxin, that can generate ligaments which are the structures that
attach bones to the joints to loosen and stretch, more so in the pelvic part. The piriformis
syndrome is generated when the piriformis muscle compresses the sciatic nerve. The muscle is
based in the lower area of the spine and it links to the thigh bone and helps in rotation of the hip.
The disorder progresses when muscle spasms grow in the piriformis muscle hence squeezing the
sciatic nerve (Cass 2015, p. 43).
Q.2
Pharmacokinetics is the movement of medicines into, through and out of the body
(Versypt, Harrell and McPeak 2017, p. 312). The liver is among the largest organ in the body
which performs different roles. Usually, it filters the harmful substances from the blood and
helps the body in fighting infections. In that case, considering Kelly's liver dysfunction, it means
activities such as bilirubin metabolism; procoagulant synthesis, protein and even
biotransformation of drugs together with endogenous toxins in the body will be impaired.

NURSING PAPER 3
Ninety percent of Paracetamol is converted at medical doses by the liver to non-toxic,
inactive sulfate along with glucuronide conjugates which are eventually expelled in the urine
(Fong, Siu and Tam 2011, p. 9). Consequently, lower than five percent is assimilated by the
cytochrome P450 2E 1 to a highly virulent and reactive intermediate (1-4) which happens in the
kidneys along with the liver called N-acetyl-p-benzoquinoneimine (NAPQI)2. When the drugs
are overdosed, the pathways of glucuronide and sulfation are drenched bringing about precluding
of more medication down the pathway of P450 to create excessive NAPQI (3-4).
When the NAPQI rises, it depletes the glutathione stores of the body and when the stores
decline, the NAPQI clings leniently to the intracellular proteins resulting in death along with cell
dysfunction. Expeditious therapy using the glutathione precursor N-acetylcysteine may avert or
reduce the damage of hepatocellular (Fong, Siu and Tam 2011, p. 9). Moreover, changes of
pharmacokinetics while apparently expected do not frequently construe into medically relevant
toxicity and the elimination of medications like metoclopramide and paracetamol in people with
liver dysfunction is slower compared to healthy individuals (Hayward et al. 2016, p. 211).
Metabolism of drugs like paracetamol and metoclopramide through glucuronidation is
less affected than cytochrome P450 enzymes may be due to elevated uridine diphosphate-
glucuronyltransferase or extra-hepatic glucuronidation in remaining possible hepatocytes. In
people with liver dysfunction clearance of medications which undergo biliary excretion could
also be minimized demanding an avoidance of the medications or a decrease in dose (Imani et
al., 2014).
Biotransformation of drugs usually occurs largely in the liver and if the liver is not
functioning then it implies the activities will also be impaired (Fisher, Vuppalanchi and Saxena
2015, p. 876). In that case, the absorption, distribution, and metabolism of the paracetamol and
metoclopramide that Kelly is taking might not be done properly. This is because the drugs will
not be processed and excreted as required. The hepatic first-pass metabolism usually permits a
fraction of the oral dose to reach the circulation (Choe et al., 2017, p.4). As an illustration, this
usually occurs during absorption in the gut wall or the liver before reaching the liver.
Conversely, since the liver is dysfunctional, then it means that the drugs will reach the
bloodstream in high concentration and this might result in other side effects. Since the liver is the
main organ for handling the metabolism of xenobiotic such as drugs, Kelly is more likely to