Health Variation Assignment: Crohn's Disease Case Study Analysis

This assignment provides a detailed analysis of a case study focusing on a patient, Jordan, diagnosed with Crohn's disease. The analysis explores various aspects of the disease, including its clinical presentation, such as strictures in the small intestine leading to malnutrition, weight loss, vomiting, and diarrhea. The assignment delves into the complexities of the pain pathway, explaining how signals are transmitted from the peripheral tissues to the brain and the mechanisms of action of morphine. Furthermore, the assignment examines the clinical manifestations indicating the worsening of Jordan's condition, such as dehydration, dry skin, and poor capillary refill. The treatment administered, including Hartmann's solution, is also analyzed, highlighting its role in restoring fluid balance and addressing metabolic acidosis. The assignment references various medical sources to support its findings, providing a comprehensive overview of Crohn's disease and its management.

HEALTH VARIATION 1
Health Variation
Name of Student
Name of Institution
Date
Author's Note

HEALTH VARIATION 2
Health Variation
Question 1
Crohn's disease is a condition that causes inflammation of the gastrointestinal tract. The
condition can lead to redness, pain, and swelling of the digestive system. The condition tends to
affect any part of the digestive system, which ranges from the mouth to the anus. However, most
reported cases are inflammation in the ileum and the colon. The inflamed area could be a few
centimeters long or could extend over a significant distance in the lining of the bowel. In some
cases, the condition may cause abscess or fistulas in the bowel lining (Bullock & Manias, 2013).
In terminal and ileocecal Crohn's diseases, the inflammations are found in the ileum or
the terminal end of the ileum; this is the most common form of the condition. The patient will
often experience pain, diarrhea, weight loss, and their stool may appear to be black, indicating
that the individual is anemic. Other changes that may occur with the onset of this disease is that
skin tags, which are fleshy growths around the anus, may appear. Fissures may occur and could
result in bleeding and pain during a bowel movement. In some cases, an abscess may form and
be filled with pus causing fistula or fevers. Fistulas can occur between the skin and the digestive
system. The tiny openings can leak pus or, in some cases, fecal matter, which irritates the skin
and makes the area very sore and painful
Patients with Crohn's disease often experience strictures; this is when inflammation
occurs, followed by healing and, consequently, the formation of scar tissue. The scar tissue
makes the lumen of the bowel to be very narrow, thus forming a stricture. Also, the stricture can
cause blockage of the digestive system. Some of the clinical presentations of strictures include
weight loss, pain vomiting, nausea, and constipation. In rare cases, a perforation can occur as a

HEALTH VARIATION 3
result of the disease. Perforation is a rupture in the bowel due to inflammation. The contents of
the bowel can sometimes leak into the body resulting in a medical emergency
In the case study provided, Jordan had a stricture in the small intestine, which made it
difficult for the body to absorb the necessary nutrients. Jordan became malnutrition and
eventually began experiencing weight loss. Also, due to the stricture, he experienced vomiting
and persistent diarrhea, and this further contributed to weight loss (Nurgali & Wildbore, 2014).
Question 2
The pain pathway is very complicated. It begins when the motor neurons send signals to
the brain. The brain is connected to the peripheral tissues such as the skin, visceral organs, and
muscle using a three-neuron pathway (Craft et al., 2015). The first neuron carries the information
from the skin, muscle, or the visceral into the spinal cord. Here, this neuron synapses with the
second-order neuron. The information is then transmitted to the brain using this second-order
neuron. Once in the brain, the brain may trigger an autonomic reflex response to help ease the
pain; for example, increase ventilation rate and cardiac output. Alternatively, the brain may
trigger a voluntary reflex response by removing the body organ from the source of pain. Finally,
the second-order neuron transmits the signal to the third-order neuron found in the cerebral
cortex. This neuron is responsible for making the individual aware of the pain and the location of
the pain. Morphine works by relaxing the brain muscles. According to research, it is possible to
reduce the effects of pain by providing a significant distraction. Morphine works by preventing
the relay of information from the second to the third neuron (Bullock & Manias, 2013).
Question 3

HEALTH VARIATION 4
In the case study provided, different clinical manifestations may indicate that Jordan's
condition is becoming worse. First, Jordan skin was very dry and pale. It also had poor turgor. In
addition, his extremities were cool to touch. The medical officer noted that Jordan had flat neck
veins and a poor capillary refill. Jordan's urine was dark-colored and had a specific gravity of
1035, which indicates that he was dehydrated. Jordan had lost a lot of fluid through vomiting and
diarrhea, which resulted in the dehydration of the body (Myles et al., 2017).
Another indication of the condition worsening is that Jordan had a stricture. A stricture
makes it difficult for food particles to pass through the ilium and significantly reduce the size and
shape of the lumen. In addition, the stricture can cause blockage of the intestines. The most
common symptoms of strictures are nausea, vomiting. Constipation distended abdomen, bloated
stomach and the gut may make loud noises. These were symptoms that Jordan was experiencing.
Treatment of this condition is through surgical removal of the stricture or by endoscopic balloon
dilation. This condition cannot be managed by medications alone. The patient in the case study
had most of the clinical symptoms of stricture, and the doctor scheduled him for surgery
(Bullock & Manias, 2013).
Question 4
Jordan was administered with 1000 mL of Hartmann's solution for six hours through an
intravenous route. This fluid contains the necessary salt and liquids to help restore the normal
body function. Hartmann's solution is isotonic to the cells in the body and helps to restore
balance in the blood concentration. Also, the solution contains nutrients such as mineral salts and
water, which are beneficial to the body. Some of the mineral salts include sodium chloride,
potassium chloride, calcium chloride, and sodium lactate. Through osmosis, these mineral salts
enter into the cells and balance the intracellular fluid concentration and the extracellular fluid in

HEALTH VARIATION 5
the blood. This solution also contains electrolytes that help to reduce the imbalance in the body
(Myles et al., 2017).
The rationale behind administering this intravenous liquid to Jordan is to reduce the
effects of dehydration. Jordan's body was dehydrated, and it was evident in the pale, dry skin that
had very little turgor. In addition, Jordan had flat neck veins and very poor capillary refill. Jordan
had also reported that he had been experiencing severe diarrhea and vomiting. Vomiting results
in excess loss of water and fluids from the body. The administration of this liquid also helps to
treat mild metabolic acidosis that had begun to occur in Jordan's body (Hill, Hall, & Glew,
2017).

HEALTH VARIATION 6
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.
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.