Health Variation 2: Crohn's Disease, Pain, and Fluid Therapy

This assignment analyzes a case study of a patient, Jordan, diagnosed with Crohn's disease, focusing on the disease's impact on the gastrointestinal tract, specifically the terminal ileum. It describes the pathophysiology of Crohn's disease, including the development of strictures, ulceration, and malabsorption leading to malnutrition, diarrhea, and vomiting. The assignment also addresses pain pathways, explaining the neuronal paths involved and the mechanism of morphine in pain relief. Furthermore, it details the rationale behind administering Hartmann's solution to the patient to restore fluid and electrolyte balance, considering the patient's dehydration and symptoms. References from various medical and nursing publications support the analysis.

Running head: HEALTH VARIATION 1
Health Variation
Name of Student
Name of Institution
Date
Author’s Note

HEALTH VARIATION 2
Health Variation
Question 1
One of the most common ailments is Crohn’s disease. It is a condition that affects the
gastrointestinal tract. It is a chronic relapsing inflammatory disease. According to Bullock &
Manias (2013), the disease attacks any portion of the digestive tract ranging from the mouth, the
stomach or the anus. However, most of the report cases are in the ascending colon and the
terminal ileum. In the case study provided, the patient, Jordan, developed a stricture, which
resulted in an obstruction of bowel movement in the terminal ileum. He also experienced severe
diarrhea and vomiting, which resulted in his body being dehydrated
The first symptom of Crohn’s disease is a small aphthous lesion in the submucosa or
mucosa of the gastrointestinal tract. The lesion progresses and inflammation begins. It affects all
the layers of the intestinal wall. Later, deep ulceration, fissure or granulomatous lesion develops.
The affected area develops into a cobble shape lumen appearance. The fissure and the ulceration
surround the edematous submucosa and intact mucosa. The lesions in Crohn’s disease are not
continuous and are often referred to as skip lesions (Feuerstein & Cheifetz, 2017).
With progress of the disease, other changes begin to occur in the bowel wall. There is
fibrotic thickening and decreased flexibility. This change is due to inflammation and edema. If
an infection occurs, there is pus formation and the cells are damaged. In some cases, a fistula
may occur in the loop of bowel or other organs surrounding the intestine. The alternation in
structure of the bowel wall affects the functionality of the gastrointestinal tracts and results in
malabsorption, thereby causing malnutrition.

HEALTH VARIATION 3
In the case study provided, the patient developed a stricture in his terminal ileum. The
small intestine, therefore, was not able to absorb the macronutrients such as carbohydrates,
lipids, proteins and vitamins. This led to severe malnutrition and consequently weight loss. In
addition, due to the change in the structure and function of the ileum, the patient had persistent
vomiting and diarrhea which enhanced the loss of weight. The patient also had a reduced
absorption of the excess water and nutrients, causing a watery stool (Nurgali & Wildbore, 2014).
Question 2
The pain pathway involves in the brain and the neurons. Pain is a concise perception of a
stimulus that may result in tissue damage. The stimulus is detected, information of tissue damage
is then relayed to the cortex where it is perceived as pain. The pain pathway involves three
neuronal paths. The first neuron transmits the signal from the source of the injury of the
periphery to the spinal cord. In the spinal cord it synapses with the second order neuron. The
second neuron then transmits the information to the thalamus found in the brain. Here the brain
responds by sending the appropriate action either by increasing blood flow to the surrounding
area or by using reflexes to remove the limb form pain. The signal is then transmitted to the
cerebral cortex through the third order neuron where the individual is made aware of the pain
(Bullock & Manias, 2013).
By distracting the third neuron, it is possible to reduce the pain levels. Morphine works
buy soothing the cerebral cortex and encouraging it to relax. It contains active metabolites which
may trigger neuroexcitatory effects and in some patients, delirium. Once the brain is relaxed, the
pain level reduces significantly giving the effect of pain relieving. Morphine is commonly used
in patient in severe pain (Craft et al., 2015).

HEALTH VARIATION 4
Question 4
The fluid that was administered to the patient in the case study was Hartmann’s fluid. The
solution is a balanced crystalloid, which is isotonic to the salt concentration in the blood.
According to Hill, Hall, & Glew (2017), the intravenous fluid is a mixture of sodium lactate,
potassium chloride, calcium chloride and sodium chloride. In addition, the fluid also contains a
significant amount of water. The solution expands the intracellular fluid through osmosis and
restores the extracellular fluid loss thereby returning the patient's body to normal. This
intravenous fluid is commonly used in perioperative period to maintain a balance in the liquid
and the electrolyte in the body (Myles et al., 2017).
The rationale behind administering is that the patient appeared to be dehydrated due to
constant vomiting and diarrhea. His skin was pale and dry. Also, his extremities were cool to
touch. Most areas in his body as a poor capillary refill and a flat neck vein. The patient also
admitted that he had been reluctant to eat or drink much food for the past five days. The
reluctance was due to the vomiting and diarrhea which was irritating him. The patient was
administered with Hartmann’s solution for 6 hours to restore the average isotonic body balance.
Another rationale behind administering the intravenous fluid is that the solution helps to
maintain the normal blood pressure in the patient. In addition, this solution is also able to treat
mild metabolic acidosis which occurs when the body is dehydrated.

HEALTH VARIATION 5
References
Bullock, S., & Manias, E. (2013). Fundamentals of pharmacology. Pearson Higher Education
AU.
Craft, J., Gordon, C., Huether, S. E., McCance, K. L., & Brashers, V. L. (2015). Understanding
pathophysiology-ANZ adaptation. Elsevier Health Sciences.
Feuerstein, J. D., & Cheifetz, A. S. (2017, July). Crohn disease: epidemiology, diagnosis, and
management. In Mayo Clinic Proceedings (Vol. 92, No. 7, pp. 1088-1103). Elsevier.
Hill, R., Hall, H., & Glew, P. J. (2017). Fundamentals of Nursing and Midwifery: A Person-
Centred Approach to Care.
LeMone, P., Burke, K., Levett-Jones, T., Dwyer, T., Moxham, L., Reid-Searl, K., ... & Luxford,
Y. (2014). Medical-surgical nursing: Critical thinking for person-centred care.
Myles, P. S., Andrews, S., Nicholson, J., Lobo, D. N., & Mythen, M. (2017). Contemporary
approaches to perioperative IV fluid therapy. World journal of surgery, 41(10), 2457-
2463.
Nurgali, K., & Wildbore, C. (2014). Alterations of digestive function across the life span.