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  • University : Western Sydney University
  • Subject Name : Nursing

Case study


Q1) Describe the structural and functional changes in the disease process that led to Eleanors weight loss
Ulcerative colitis is a chronic inflammatory disease that causes the inflammation of colonic mucosa with the symptoms of frequent diarrhea, rectal bleeding, abdominal pain, weight loss and so on. It affects the long intestine and causes the inflammation that in turn produces the mucus and pus. The Ulcerative colitis is the abnormal bodys immune response and therefore is an autoimmune disease. The discomfort in the abdomen is caused due to the inflammation and the ulcers. The inflammation, irritation and ulcers are caused in the inner lining of large intestine. Weight loss along with the frequent diarrhea and abdominal pain is one of the major symptoms of the ulcerative colitis. As mentioned in the case study, Mrs. Eleanor Brown has lost nine kilograms weight in the past two weeks and is so ill that she is unable to eat and drink enough. The structural and functional changes in the disease process had led to the weight loss. The weight loss is the result of the underlying physiological disturbances that are associated with the disease (Elsherif, Alexakis amp Mendall, 2014). The malnutrition is the main cause of weight loss in patients with Ulcerative colitis.

This inflammatory bowel disease is marked by the weight loss due to the malnutrition, malabsorption, poor appetite, food aversions, nutrient loss due to intestinal bleeding and diarrhea, the calorie burn increase due to the body fighting the disease and its complications (Health union, 2019). The loss of appetite occurs because some people associate eating with pain and they try to avoid eating in order to avoid the unpleasant symptoms and pain. The hormones such as leptin and ghrelin are the key hormones that play a part in making a person feel hungry. In Ulcerative colitis, they are generally out of balance and the inflammatory signals such as tumor necrosis factor- (TNF-)and interleukins are associated with the malnutrition status (Health union, 2019). In ulcerative colitis, there is a significant decrease in the electrolyte and fluid absorption. These malabsorptions lead to the small intestine dysfunction (Mourad, Barada amp Saade, 2017). The epithelial destruction that leads to malabsorption is caused by the infiltration of neutrophils crypts (Martini, Krug, Siegmund, Neurath amp Becker, 2017). This epithelial cells tight junction destruction leads to the impairment of barrier functions. The second reason for the weight loss is the indigestion. The ulcers in the digestive tract make the patient suffer from indigestion. The frequent diarrhea with the bleeding and pus are a result of indigestion. All these structural and functional changes lead to the weight loss among patients with ulcerative colitis.



Q2) Explain the pain pathway and how Morphine alters the consicious perception of pain
The pathway starts with the nociception that starts in the periphery resulting in the activation of pain receptors that are connected to the afferent nerve fibers which are known as nociceptive neurons. Based on the presence of myelination and the axon diameter, there are different types of afferent fibers, for example, A-fibers, afferent fibers and nociception. Within brain, the information is sent from thalamus to the cortex region for the final processing. The pain is felt at this stage. The information of pain is processed in the brainstem, midbrain, hypothalamus and the limbic areas. These areas in the brain trigger the pain responses in the autonomic nervous system (Bullock amp Mania, 2013).

Morphine modulates the pain process in the medial and lateral pain pathways. Systemic morphine produces the marked clinical pain relief. Pain is generally centrally mediated and the portions of the brain that decides a chronically painful body part notes the sensational abnormal intensification. There is a possibility of rewiring the brain due to the brains plasticity. Morphine functions by binding to the opiate receptors in the Central Nervous System (Unbound Medicine, 2019). It alters the response to the painful stimuli and its perception by producing a generalized CNS depression.



Q3) Identify the clinical manifestations that may indicate the deterioration of Eleanors ulcerative colitis condition and explain why these may occur
The clinical manifestations that indicate the deterioration of Eleanors ulcerative colitis condition are as follows
Loss of weight- Eleanor Brown lost nine kilograms in past two weeks. The weight loss is the clinical manifestation that occurs in ulcerative colitis. This occurs due to the malabsorption, malnutrition and the poor appetite. The malnutrition is caused by the decrease in fluid and electrolyte absorption and the poor appetite is the result of the imbalance of the leptin and gehrlin hormones (Health Union, 2019).
Frequent diarrhea- Eleanor Brown had fourteen episodes of diarrhea with blood and pus every day. It is caused due to the decrease in the absorption of colonic fluids (Thiagarajah, Donowitz amp Verkman, 2015).
Fatigue- The continuous diarrhea and the low intake of food causes the fatigue in patients with ulcerative colitis (Collins at al., 2018). The bodys response to the colon inflammation causes fatigue in patients (Everyday Health, 2019).
Abdominal pain- It is the major clinical manifestation in patients with ulcerative colitis. The abdominal pain is due to the inflammation in the large intestine and the ulcers that are produced by the tiny spores present.
Weak peripheral pulses- Ulcerative colitis affects the digestive track so the normal blood flow becomes compromised and the heart pumps the blood under the stress thus causing weak peripheral pulses (Bionews, 2019).



Q4) Explain the characteristics of intravenous fluid that was ordered for Eleanor and the rationale for the administration of IV fluid relating to Eleanors specific fluid balance.
The intravenous fluid that was ordered for Eleanor was Hartmanns solution. The Hartmanns solution for IV infusion is a source of electrolytes and water. The metabolic acidosis associated with the dehydration or potassium deficiency is treated with this solution as it is also a source of bicarbonate (Baxter Healthcare, 2018). The active compounds present in it are the sodium chloride, sodium lactate, potassium chloride, calcium chloride dehydrate and the glucose.

Mrs. Eleanor Browns urine colour is dark coloured so this indicated the water imbalance in the body. The dehydration causes the urine to get dark in colour. In a dehydrated state, a human body loses more of sodium than water (Study.com, 2019). This causes the water imbalance and thus there is a need of Hartmanns solution in the body of patients with ulcerative colitis. The solution is isotonic with pH 5.0- 7.0. The osmolarity of the solution is 278mOsmal/L (EMC, 2018). This solution can be used to correct the electrolyte imbalance in the body. As mentioned in the case study, Eleanor Brown is experiencing heavy weight loss. The electrolyte and fluid malabsorption that is causing the weight loss can be mitigated by infusing Hartmanns solution.



Baxter healthcare. (2018). Compound sodium lactate (Hartmanns solution). Retrieved from https//medsafe.govt.nz/profs/datasheet/c/CompoundsodiumlactateandGlucoseHartmannsinf.pdfBionews. (2019). Pulmonary hypertension and ulcerative colitis. Retrieved from https//pulmonaryhypertensionnews.com/pulmonary-hypertension-ulcerative-colitis/Bullock, S., amp Manias, E. (2013).Fundamentals of Pharmacology.Pearson Higher Education AU.
Collins, A., Nolan, E., Hurley, M., DAlton, A., amp Hussey, S. (2018). Anorexia Nervosa Complicating Pediatric Crohn DiseaseCase Report and Literature Review.Frontiers in Pediatrics,6.
Elsherif, Y., Alexakis, C., amp Mendall, M. (2014). Determinants of weight loss prior to diagnosis in inflammatory bowel disease a retrospective observational study.Gastroenterology Research and Practice.
EMC. (2018). Compound sodium lactate solution for infusion BP. Retrieved from https//www.medicines.org.uk/emc/product/1812/smpcEveryday Health. (2019). Beyond Tired is your ulcerative colitis causing fatigue. Retrieved from https//www.everydayhealth.com/hs/ulcerative-colitis-treatment-management/colitis-causing-fatigue/Health Union. (2019). Loss of appetite and weight loss. Retrieved from https//inflammatoryboweldisease.net/symptoms/loss-of-appetite-and-weight-loss/Martini, E., Krug, S. M., Siegmund, B., Neurath, M. F., amp Becker, C. (2017). Mend your fences the epithelial barrier and its relationship with mucosal immunity in inflammatory bowel disease.Cellular and Molecular Gastroenterology and Hepatology,4(1), 33-46.
Mourad, F. H., Barada, K. A., amp Saade, N. E. (2017). Impairment of small intestinal function in ulcerative colitis role of enteric innervation.Journal of Crohns and Colitis,11(3), 369-377.
Study.com. (2019). Water balance in the body Healthy intake amp output. Retrieved from https//study.com/academy/lesson/water-balance-in-the-body-healthy-intake-output.htmlThiagarajah, J. R., Donowitz, M., amp Verkman, A. S. (2015). Secretory diarrhoea mechanisms and emerging therapies.Nature Reviews Gastroenterology amp Hepatology,12(8), 446.
Unbound Medicine. (2019). Morphine. Retrieved from https//nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51518/all/morphine

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