Eleanors Weight Loss Process - Nursing Case Study Assessment Answer

Case study

Q1) Describe the structural and functional changes in the disease process that led to Eleanors weight loss
Ulcerative colitis is a colon disease that is chronic that affects long intestine which becomes inflated that produces mucus and pus through tiny spore formation. The inflammation and ulcers causes the abdominal discomfort leading to frequent emptying of colon. It is the abnormal bodys immune response. The immune response mistakes the bacteria, food and body materials as foreign substances and starts to react. It sends white blood cells to the lining therefore producing chronic inflammation and ulcers (Crohns and colitis foundation, 2019).
People suffering from Ulcerative colitis experiences loss of appetite and therefore weight loss. The main reason behind weight loss is the disturbed gastrointestinal tract. The little food eaten by the patients is not fully digested by the body thus leading to diarrhea with blood and pus. The inflammation is the cause of diarrhea in such patients.
Eleanor lost nine kilograms in two weeks. This is an indication of high degree of ulcerative colitis. The disease that is associated with malnutrition is a health burden that is frequent and it significantly affects both the quality life of the patient and the disease outcome. The weight loss which is a result of underlying physiological disturbance associated with the disease is considered as a marker of disease activity (Elsherif et al., 2014). In this case, BMI of the patient is too low. MRI scan revealed she has developed pancolitis which means the entire colon is now affected. This is the reason for her rapid weight loss due to fluid loss and poor nutrient absorption (Discover therapies, 2019). The structural and functional changes leading to her weight loss includes her illness to a level that she cannot eat and drink adequate amount and also the fatigue is making her weaker. The ulcers in the digestive tract are responsible for non-digestion of food. The erythrocyte sedimentation rate (ESR) is 31.3 mm/hour and C-reactive protein is 33.6 mg/dl. Both are too high as compared to their normal range which indicates the severity of Ulcerative colitis. The high level of white blood count that is 16780 per mm cube also refers to high infection. Such high infection results in heavy weight loss thus the person feels extremely exhausted which unable them to carry on daily activities. The respiration rate is high and blood pressure of the patient is very low. The respiration rate of Eleanor is 25 breaths per minute and the blood pressure is 90/50 mm/Hg. All these factors contribute to the illness and severity of ulcerative colitis. All these structural and functional changes have led to weight loss.
Q2) Explain the pain pathway and how Morphine alters the consicious perception of pain
In ulcerative colitis, the patient has chronic abdominal pain. It mainly affects rectum and sigmoid colon and may even cover entire colon and the terminal ileum (Khan, 2019). There are periods of inflammation and remission in UC. The patient experiences pain during inflammation because inflammatory mediators and cytokines activate the endings of afferent nerves in the gut (Farell et al., 2014). These mediators excite sensory nerves that convey information about the gut to the brain. Even after the inflammation has got over, some pain still persists. This pain is known as referred which starts from gut and ends at cutaneous or other visceral regions. The source of both the pains that is chronic and referred pain (pain after the inflammation is over) resides in CNS.
In medial and lateral pain pathways, morphine modulates pain process. The marked clinical pain relief can be generated by systemic morphine. Mostly, pain is centrally mediated and the sensational abnormal intensification are noted in those portions of brain that decides a chronically painful body part. The brains plasticity allows for the possibility of rewiring the brain. In Central Nervous System, morphine works by binding to the opiate receptors. While generating generalized CNS depression, it alters the response to painful stimuli and its perception (Unbound medicine, 2019).
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 Elaenors ulcerative colitis are as follows
Loss of nine kilograms in just two weeks - This occurs due to the loss of appetite that occurs because of the poor digestive system. It is an indication of malnutrition caused by nutrition loss due to diarrhea (Health union, 2019).
Weak peripheral pulses - A weak pulse indicates some kind of emergency as heart is not able to pump enough blood through arteries.
Dark colored urine
Fatigue according to Katkov, people with ulcerative colitis experience fatigues because of the bodys response to the colon inflammation (Everyday health, 2019). The feeling is like being extremely exhausted enough to not let the patient carry out daily activities. Fatigue is corelated with anemia, diarrhea, certain medications and so on.
Skin manifestation such as dry skin
Fourteen episodes of diarrhea with blood and pus everydayThe main cause of diarrhea is inflammation. When an intestine is inflated, less sodium and water are absorbed. More fluid may also leak. This is the reason for diarrhea in people with UC (HealthUnion, 2019).
Abdominal painInflammation is the key cause of pain in Ulcerative colitis.
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.
Eleanor was prescribed all the fluids and none of them were given by mouth. The electrolytic imbalance and acid-base imbalance is due to the secretion and impaired absorption of electrolytes and the inflammation in mucosa. The transport abnormality is the reduction in sodium and chloride absorption that results in impaired water absorption and secretion (Barkas, 2013). She was given the following
Morphine 15mg (1 M) QID PRN
Metoclopramide (Maxolon) 10mg IMI TDS - the available solution form is 10mg/ml. it is prescribed for delayed gastric emptying and gastroesophageal reflux. It is a dopamine antogist. It is given 10mg IV as a single dose for 1-2 minutes (Glowm, 2015).
Methylprednisolone 20mg IVI TDS Methylprednisolone is prescribed to treat any condition in which rapid and intense corticosteroid effect is required as in Ulcerative colitis. The doses are given according to the severity of disease and in adults, it should range between 10-500 mg (consilient health, 2019).

Reference
Barkas, F., Liberopoulos, E., Kei, A., ampElisaf, M. (2013). Electrolyte and acid-base disorders in inflammatory bowel disease.Annals of Gastroenterology Quarterly Publication of the Hellenic Society of Gastroenterology,26(1), 23.
Consilient health. (2019). Methylprednisolone solution for injection. Retrieved from https//www.medicines.org.uk/emc/product/758/smpcCrohnsamp colitis foundation. (2019). What is Ulcerative Colitis. Retrieved from http//www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/what-is-ulcerative-colitis/Discover therapies. (2019). Symptoms of ulcerative colitis. Retrieved from https//discovertherapies.com/articles/17-symptoms-of-ulcerative-colitisElsherif, Y., Alexakis, C., ampMendall, M. (2014). Determinants of weight loss prior to diagnosis in inflammatory bowel disease a retrospective observational study.Gastroenterology research and practice,2014.
Everyday health. (2019). Beyond Tired is your ulcerative colitis causing fatigue. Retrieved from https//www.everydayhealth.com/hs/ulcerative-colitis-treatment-management/colitis-causing-fatigue/Farrell, K. E., Callister, R. J., amp Keely, S. (2014). Understanding and targeting centrally mediated visceral pain in inflammatory bowel disease.Frontiers in pharmacology,5, 27.
Glowm. (2015). Metoclopramide hydrochloride. Retrieved from https//www.glowm.com/resources/glowm/cd/pages/drugs/m039.htmlHealth Union. (2019). Loss of appetite and weight loss. Retrieved fromhttps//inflammatoryboweldisease.net/symptoms/loss-of-appetite-and-weight-loss/Khan, A.A. (2019). Ulcerative Colitis Imaging. Retrieved from https//emedicine.medscape.com/article/375166-overviewUnbound medicine. (2019). Morphine. Retrieved from https//nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51518/all/morphine

Looking For Complete Assignment Sample Get It On WhatsApp