Health Variation: A Case Study of Eleanor's Ulcerative Colitis

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HEALTH VARIATION
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Contents
Question 1-Describe the structural and functional changes in the disease
process that led to Eleanor’s weight loss?..........................................................3
Question 2- Explain the pain pathway and how morphine alters the conscious
perception of pain................................................................................................6
Question 3 – Identify the clinical manifestations that may indicate the
deterioration of Eleanor’s ulcerative colitis condition and explain why these
may occur?..........................................................................................................9
Question 4 Explain the characteristics of intravenous fluid that was ordered
for Eleanor and the rationale for administration of the IV fluid to Eleanor’s
specific fluid balance.........................................................................................11
REFERENCES:.................................................................................................13
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Question 1-Describe the structural and functional changes in the
disease process that led to Eleanor’s weight loss?
It is also defined as a long term condition that results in ulcers and
inflammations of the rectum and colon. It is an inflammatory bowel disease.
Ranges from mild to severe.
Primary symptoms:
 Weight loss
 Fever
 Anaemia
 Abdominal pain
 Diarrhoea with pus and blood.
Comparisons of structural and functional changes that lead to ulcerative colitis
are:
STRUCTURAL CHANGES-
 Formations of a large number of pseudo polyps in ascending and descending
colon.
 Development of pancolitis -the inflammation of the whole colon which affects
the large intestine,( pan-ulcerative colitis and sometimes known as total
universal colitis).
 On the basis of examination, the distended abdomen is seen which indicates
bloating and swelling in the belly region with the pain.
 Skin –dry, pale, cool and has poor turgor.
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 Slow capillary refill.
 Neck veins flat, the reduced urinary output are noticed.
FUNCTIONAL CHANGES:
 Nutrient deficiency
 Ulcerative colitis also related to stress and weak emotions.
According to the studies, ulcerative colitis is related to the less sensitivity to
emotions with the positive content and emotional imbalances(course of the
disease is affected by the amygdala).
 The level of the hormones i.e. leptin and ghrelin are also affected.
 Inflammation plays a great role in weight loss due to changes in the level of
interleukins and TNFα.
 Cytokine response is roughly related to ulcerative colitis.
 According to studies hydrogen sulphide affects the intestinal mucosal barrier
of the patient of ulcerative colitis.
Various conditions are seen in this case-
 Poor Appetite
 Nutrient loss –She is having 14 episodes of diarrhoea.
 Intestinal bleeding
 Malabsorption- From the previous 2 weeks she is having abdominal cramping
and bloating pain.
 Fatigue
 In about 2 weeks 9kg of weight loss is seen.
Weight loss severity is calculated by-
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Percentage of weight loss= [(usual body weight- actual body weight)/usual
body weight]x 100
SIGNIFICANT WEIGHT LOSS: SEVERE WEIGHT LOSS:
5% in 1 month> 5% in 1 month
7.5% in 3 month>7.5% in 3 month
10% in 6 month.>10% in 6 month.
In this condition,
Age:48 years
Weight: 54kg
Height:165cm.
It is not easy to totally evaluate the nutritional status from one measurement
alone.
More research work is needed to learn the total effect.
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Question 2- Explain the pain pathway and how morphine alters the
conscious perception of pain.
Pain is defined as the “unpleasant emotional and sensory experience related
to potential or actual tissue damage.” -The International Association for the
study of pain.
Pain pathway-
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The action of morphine (heroin)-
It is an addictive drug, produces euphoria and acts as a positive reinforcer
through interacting the reward pathway in the brain (Richards, el. al., 2015).
Morphine (heroin)-
1. Injection – reaches quickly to the brain via bloodstream.
2. Smoking (to avoid needle)- not reaches as quickly but last longer.
Now, Heroin
(bloodstream)
Brain
With the help of enzymes
Converted to morphine.
Binds
Opiate receptors (including VTA, cortex and nucleus accumbens)+ Area
involved in pain pathway (brain stem, spinal cord and thalamus).
Produces analgesia that is a loss of sensation.
Tolerance- when the person does not responds to the drug in the way that
initially responds then tolerance develops.
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In the case of morphine it develops at the cellular level, repeated activation of
opiate receptor adapts the enzyme which diminishes the effect of morphine.
Dependence- With continuous use of morphine it develops when neuron
reacts to repeated drug use and function only in the presence of the drug
(Richards, el. al., 2015). This will lead to withdrawal symptom which is very
serious in the case of morphine.
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Question 3 – Identify the clinical manifestations that may indicate the
deterioration of Eleanor’s ulcerative colitis condition and explain why
these may occur?
Clinical conditions indicating a poor level of ulcerative colitis and the reasons
why these may occur includes-
 Acute exacerbation of ulcerative colitis from 2 weeks.
 9kg of weight loss within 2 weeks because of the feeling of fullness or change
of the taste due to medications or change in the level of hormones which lead
to improper diet (Greenwood, et. al., 2018).
 Up to 14 episodes of diarrhoea which causes dehydration and weakness.
 Feeling of tiredness due to stress level or weak emotions.
 Flat neck veins due to weakness
 Bloating and cramping pain in the lower abdomen because of inflammation.
 On examination-Low blood pressure, 90/50mm/hg is recorded due to the
stress level.
 Weak peripheral pulses are noticed.
 Weight and height of the patient is 54 kg and 165cm respectively.
 Dark coloured urine and 1040 specific gravity indicates reduced urine output
 Haemoglobin count 86g/L indicative of anaemia due to blood loss with stool.
 Presence of WBCs in stool indicative of ulcerative colitis, as it helps to rule out
infections.
 Colonoscopy reveals a large number of formations of pseudo polyps in
ascending and descending colon and MRI reveal the formation of pancolitis
which indicates inflammation of intestine suggestive of ulcerative colitis.
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 Painful and distended abdomen is also seen.
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Question 4 Explain the characteristics of intravenous fluid that was
ordered for Eleanor and the rationale for administration of the IV fluid to
Eleanor’s specific fluid balance.
The intravenous fluid that was ordered includes Hartman’s solution and
methylprednisolone.
Characteristics of methylprednisolone are-
 Synthetic corticosteroid with immunomodulating and anti-inflammatory
properties (Eckermann, et. al., 2010).
 It is a corticosteroid hormone receptor agonist.
 Inhibit proinflammatory cytokine production.
 Stimulates apoptosis and reduce the number of circulating lymphocytes.
Characteristics of Hartman’s solution or Ringer lactate solution-
 Use to replace extracellular fluid losses.
 For treatment of isotonic dehydration use to restore chloride, potassium,
sodium and calcium balances.
Rationale-
 Methylprednisolone: Administered intravenously, prescribed 20mg IVI TDS.
Initial dose will vary from 10 mg to 500 mg which is varied according to the
severity of the condition.
Useful because it acts as a corticosteroid.
 Hartman’s solution-
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Administered by the IV route. The main rationale is permitting adequate organ
perfusion by replenishing intravascular volume. Prescribed dose is 1000mls
over 6 hours.
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