401207 Health Variations 1: Ulcerative Colitis Nursing Assignment

This nursing assignment addresses a case study of a patient, Eleanor Brown, diagnosed with ulcerative colitis (UC). It begins by detailing the functional and structural changes associated with UC, including inflammation, edema, and the formation of pseudopolyps, which lead to symptoms such as cramping, diarrhea, and weight loss. The assignment explores the role of afferent and efferent neurons in pain sensation and the mechanism of action of morphine in pain management. It further examines the clinical manifestations of disease deterioration, such as rectal bleeding and elevated CRP levels, and the significance of blood tests like WBC count and hemoglobin levels. Finally, the assignment discusses the use of Hartmann’s solution to restore electrolyte balance and fluid depletion. The assignment is based on a case study from Western Sydney University, focusing on Health Variations 1.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

1
NURSING
Answer 1
Ulcerative colitis (UC), an inflammatory disease caused due to the formation of sores
and irritation in the inner-lining of the large intestine (National Institute of Diabetes and
Digestive and Kidney Diseases [NIDDK], 2019). In UC, the main functional change includes
generation of inflammatory response in the mucosal lining of the small intestine during the
initial stage of the disease prognosis. This type 1 hypersensitivity reaction is followed by the
formation of edema. This results in the structural changes in the intestinal lining spreading up
to the colon (Conrad, Roggenbuck & Laass, 2014). The structural changes is characterised by
the formation of haemorrhage along the length of the colon. This haemorrhage in the lower
part of the gastro-intestinal tract is responsible for the heightened cell death, this can be
regarded as another functional change in UC. During the later part of the disease progression,
as the disease progress to more chronic state there occurs distortion of the mucosal glands
along with decrease in goblet cells due to cellular extravasations from polymorphonuclear
leucocyte. This sudden depletion of the goblet cells associated with the inflammation in the
lower inner lining of the gastro-intestinal tract leads to further cell death. This heightened
increase in the cell death results in drastic weight loss. This is the reason why the weight loss
scenario for Eleanor Brown is not pronounced during the initial stage of the disease in
comparison to the later stages of the disease prognosis (Rogler, 2014).
The structural change in the gastro-intestinal tract along with chronic inflammation
hampers the peristalsis movement of the stomach. The functional change in the mechanism of
stomach, leads to cramping in the muscles located in the lower portion of the stomach. This
functional change attributes to indigestion and subsequent development of diarrhoea (Conrad,
Roggenbuck & Laass, 2014). Vomiting causes loss of fluid and electrolyte balance in the
body, further promoting drastic weight loss in Eleanor Brown. Another functional aspect that

2
NURSING
can be highlighted in this stage is, generalised state of inflammation generates a metabolic
state in the body leading to the rapid breakdown of the muscles cells, leading to loss of
protein and weight loss. Another functional aspect of UC is it increases the energy
expenditure of the body leading to the generation of fatigue and problem in executing daily
living activities as highlighted in the case of Eleanor Brown. Moreover, the catabolic
hormones like adiponectic, leptin and ghrelin are secreted in an unregulated manner leading
to further weight loss (Rogler, 2014).
Answer 2
The pain sensation in the body is mediated by two sensory neurons, afferent neurons
and efferent neurons. Afferent neurons work by receiving the pain signals from the sensory
organs and transmitting the signals to the brain through the spinal dorsal horn of the central
nervous system (CNS). The efferent neurons work opposite to afferent neurons. They receive
the pain impulses from the CNS and transmit the signal through the spinal dorsal horn to the
limbs or the other organs of the body (Gilron et al., 2015). Morphine, an opium analgesic is
alkaloid in nature and helps in the effect management of conscious perception of pain. It
mainly works as an antagonist of afferent neurons. Morphine binds to kappa, delta and mu
receptors and thereby helping to inhibit the downstream signal transduction through
nociceptive neurotransmitter. This hamper the progression of the pain impulses from the
sensory organs to the brain and thus reducing the sensation of pain. The action of morphine is
exhibited within 6 to 30 minutes of administration. Over use of morphine or long-term use of
morphine leads to the generation of morphine addiction (Gilron et al., 2015).
Answer 3
The main clinical manifestation in Eleanor Brown that reflects deterioration is rectal
bleeding arising out of pseudopolyps in the colon. The formation of pseudopolyps in the

3
NURSING
colon mainly results from the chronic inflammation in the inner lining of the colon. The
increase in the concentration of the C-creative protein [CRP] (33.6mg/dl (normal range
20mg/dl) in blood of Eleanor Brown is also an indicator of increase in the severity of disease
along with subsequent deterioration (Shussman, N.,& Wexner, 2014). CRP indicates level of
infection or sepsis in blood. High rate of infection in blood is also highlighted in through the
increase in the concentration of white blood cells (WBCs) count 16780/mm3 (normal range
3500-1100/mm3). The high WBCs count further indicates increased inflammation followed
by leucocyte extravassasion indication physiological deterioration. The decreased level of
haemoglobin in blood (86g/L (normal range 117-157g/L) is also an indicator of deterioration.
This decrease in haemoglobin count is mainly attributed to death of red blood cells (RBCs) as
highlighted in high haematocrit: 52% (normal range 35-47%). Death of RBCs is either
occurring due to cell toxicity arising out of type 1 hypersensitivity reaction along with
vomiting in diarrhoea. This increase in the haematocrit might eventually lead to
spleenomegally as spleen is the graveyard of RBC (Khonsary, 2017).
Answer 4
The intravenous infection of Hartmann’s solution with an interval of 6 hours will help
to restore the sodium, potassium, calcium, chloride and lactate balance of the body. This
intravenous supplement will help Eleanor Brown to regain the loss of electrolytes and fluid in
the body resulting of vomiting and diarrhoea (Hoorn, 2017). According to El-Sharkawy et al.
(2014) intravenous injection of Hartmann’s solution helps to regain the proper functioning of
the ion channels in the body by regaining the electrolyte balance and thereby helping to
restore the normal function of the neurotransmitter in the body. This will help Eleanor Brown
to restore her peripheral pulse ate, respiratory rate while improving the state of fatigue.

4
NURSING
The Hartmann’s solution is hypotonic in nature. The Hypotonic solution will help to
regain the fluid depletion in the cell. During dehydration the cells become depleted due to
loss of fluid from the cell cytoplasm. The injection of the hypotonic solution which have high
concentration of fluid in comparison to the concentration of fluid in the cell cytoplasm will
help to promote the flow of the fluid from out the side (from the high concentration) to inside
of the cell (lower concentration) thus restoring the fluid balance of the body (Hoorn, 2017).

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
of fluid and electrolyte balance in the older adult surgical patient. Clinical
Nutrition, 33(1), 6-13.
Gilron, I., Tu, D., Holden, R. R., Jackson, A. C., & DuMerton-Shore, D. (2015). Combination
of morphine with nortriptyline for neuropathic pain. Pain, 156(8), 1440-1448.
Hoorn, E. J. (2017). Intravenous fluids: balancing solutions. Journal of nephrology, 30(4),
485-492.
Khonsary, S. A. (2017). Guyton and Hall: textbook of medical physiology. Surgical
neurology international, 8.
National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK]
(2019).Ulcerative Colitis. Access date: 1st April 2019. Retrieved from:
https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis
Rogler, G. (2014). Chronic ulcerative colitis and colorectal cancer. Cancer letters, 345(2),
235-241.
Shussman, N., & Wexner, S. D. (2014). Colorectal polyps and polyposis
syndromes. Gastroenterology report, 2(1), 1-15.

6
NURSING