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Case Study on Ulcerative colitis

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INTRODUCTION

Physiology helps in understanding the living mechanisms i.e. how living things work. It also explains about interaction of the cells, organs, muscles and organs. Sonia was suffering from the disease Ulcerative Colitis, a disease of the large intestine, which includes features such as ulcers or opens sores. This disease is caused by the immune system, which in the digestive tract overreacts to normal bacteria. This disease can affect any person but most people who have it are diagnosed before the age of 30. The case study is covered by the following points: Pathophysiology, pharmacology, nursing interventions, psychosocial issues, assessment tools etc.

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TASK 1: PATHOPHYSIOLOGY, TO INCLUDE AETIOLOGY, RISK FACTORS, SIGNS & SYMPTOMS, BIOCHEMISTRY & DIAGNOSTIC TESTS

Disordered physiology related to the condition – what is happening to the body

As per the case study, Sonia was admitted in the hospital and suffering from the disease Ulcerative Colitis. Her body was pale and has very little energy. She has lost her half a stone in weight because of the suffering and was unable to eat much because of her stomach cramps (Belland et.al., 2005). Frequency of diarrhea was increasing and is now needed to pass tools 7 to 8 times a day. After examination she is pyrexial means the temperature of the body was rising and also causes infection to the body, Tachycardic means heart rate increases and exceeds the normal range. She also suffers from the abdominal discomforts and abdominal distension means outward expansion away from the normal girth of the stomach (Brownand et.al., 2006).

Effects

Pathophysiology means a disordered physiological process associated with disease or injury. Sonia was suffering from the disease Ulcerative Colitis, a disease of the large intestine, which includes features such as ulcers or opens sores. It is a kind of inflammatory disease. It has affected Sonia’s body and because of that Sonia was pale with little energy. She has lost a half a stone weight over the previous week and she was not enabling to eat much due to her stomach cramps. When the doctor examined she is pyrexial means the temperature of her body rises, Tachycardic means her heart rate exceeds from the normal range and she has abdominal discomfort and abdominal distension means outward expansion beyond the normal girth of the stomach and waist.

Predispose someone to be at risk of having this condition

Ulcerative colitis causes are not known directly. Sonia immune system was affected, which in the digestive tract overreacts to normal bacteria. The different types of viruses and bacteria can cause it. This disease can affect any person but most people who have it are diagnosed before the age of 30. (Changand et.al., 2006). The genetic components to the etiology are based on the following: Aggregation of the ulcerative colitis in families, in incidence there are ethnic differences, linkages and genetic makers. For ulcerative colitis many environmental contributions to the pathogenesis are: Diet, Breast feeding, Accutane.

Signs and Symptoms

The main symptom of the ulcerative Colitis is the bloody diarrhea. The different signs and symptoms of Ulcerative colitis are as follows:

  • Rectal bleeding
  • Iron deficiency because of blood loss in diarrhea
  • Weight loss
  • When disease symptoms are severe fever can occur
  • Lower abdominal pain and cramps
  • Urgency to defecate (urgent bowel movements)
  • Elevated temperature

Sonia is suffering from disease and it can increase arthritis, Skin rashes, 4% get liver disease and inflammation of the eye. Sonia faced many complications such as increasing frequency of diarrhea and the potentially severe inflammation. Sonia has lost weight because of she was unable to eat. (Madara and Denino, 2007).

Diagnostic tests need to be carried out to confirm/disconfirm the diagnosis

Ulcerative colitis is diagnosed by the tests, which look inside the large intestine by passing a special telescope. Diagnostic tests done to confirm/ disconfirm the diagnosis are:

  • Total blood count test done for checking anemia or looks for infection or inflammation.
  • ESR for temporal arthritis and polymyalgia rheumatic.
  • CRP is done for checking the inflammation in the body. It determines person risk for heart disease.
  • Colonoscopy is done which helps for looking inside the entire colon with the help of a thin lighted tool.
  • Stool sample testing is done to look for infection, blood and white blood cells.
  • X- Ray and urine analysis is also done.

Ulcerative colitis includes drug therapy, surgery and changes in diet for treatment. Proper treatment is required to Sonia because of increasing frequency of diarrhea (Copsteadand Banasik, 2010).

Results

Results expected from the diagnostic tests are: ESR is the main test and helps in supporting diagnosis. ESR of Sonia is 33mm/h and CRP is 45 mg/h. It monitors activity and response to therapy for both inflammatory diseases. CRP is not detachable in the blood. It helps in determining the risk for the heart disease. The main role is to solve the heart problems.

Different tests are done by the doctor for Sonia and he has prescribed the following such as IV fluids of Dextrose saline to run 1 liter over 6 hours, abdominal x-ray etc. Sonia’s X- ray is done and it provides the picture of the inside of abdomen. Pulse rate of Sonia is normal i.e. is 98 beats per minute. The normal pulse rate of women is always should be in between 60 to 100 beats per minute. O2 saturation is normal in Sonia i.e. 98% it must be between 97 to 99 % in a healthy individual.

TASK 2: NURSING INTERVENTIONS – INCLUDING EVIDENCE BASED RATIONALE FOR HEALTH CARE AS APPROPRIATE

Focus on the actual care you would be required to assess, plan, implement & evaluate

Sonia was suffering from the disease Ulcerative Colitis and she was admitted in the hospital. Actual care is required by the nurses for Sonia to assess, plan, implement and evaluate. Nurses should help Sonia for coping up. Nurses play an important role for taking care of her for the problem of UC by open line of communication and providing support (Crawfordand et.al., 2010). Sonia should be kept hydrated and comfortable because she is suffering from UC.

Nursing interventions which are planned and implemented are as follows:

  • Importance of maintaining a high fluid intake and manifestation of dehydration
  • Maintain an adequate nutritional status
  • Related to the nutritional status dietary modifications must be discussed.
  • With change for each pouch teach stoma and peristomal skin assessment
  • Management of food blockage

Nurses should try to properly evaluate and should be correctly know about the suffering of Sonia. The proper evaluation should be done for her to know that the deficits of the nourishment are managed with the help of total parental nutrition with vitamin supplements. Nursing measure for Sonia must be maintained by adequate nutritional status and should give priority for fluid balance. The temperature of the body of Sonia was high i.e. 38.3 degree C, nurses should take proper care about her (Baumgart, 2012.).

Nurses need to be doing to make sure that the patient is cared for holistically

For making sure that the patient Sonia is cared holistically nurses play an important role. She should be kept hydrated and comfortable by the nursing care. Sonia should regularly attended by the nurse because of the suffering of Ulcerative Colitis. Psychological support must be provided to her for UC. The communication should be open ended by the nurse and thry should properly communicate and try to help Sonia for the disease. (Shelton, 2010).

Sometimes Sonia can feel stressed because of her suffering so nurse should try to avoid the stress problem and help in healing the bowel and restricting the individual activity. Nurses must try to set proper goal for Sonia so that they properly examine the disease. Respiration rate of Sonia is also more it should be 12 to 24 respirations per minute. If the respiration rate is high then the level of carbon dioxide in the blood should be raised Cappuccio and et.al., 2010.

Support rationale for the suggested care

The rationale is supported by the particular material such as: Psychological distress helps in recognizing the psychological support for Sonia with UC. For UC, with the help of education, problem solving, coping etc. prevents psychological distress. (Ahasan and et.al., 2002). All the goals set by the nurses must be properly updated and must be clearly communicated to the Sonia. The goals of her are for the quality of life, normalcy for symptoms, complications etc. (Nibaand Niba, 2003).

Multidisciplinary team

A multidisciplinary team of physiotherapist, occupational therapy and district nurse can help Sonia in its complete treatment in order to deal with the disease many exercises can be suggested by the physiotherapist. (Brown and et.al., 2006). Sonia should keep her body in the rest. She was not well and she stopped functioning altogether. Sonia should discourage the weights as a part of the exercising of her legs. Occupational therapy can help Sonia for maintaining the physical condition. It can also help her in adapting the environment, teaching the skills for increasing the participation. Physiotherapist will help Sonia for control and function for her arms and hands. Therapy also will help for providing the positive effect on the health of Sonia. District nurse can help Sonia and also manage the team of nurses. They can advice and support to the organizations and also to the health concerns. Normal blood pressure of a human being is 80 but Sonia has very high blood pressure i.e. 110/60 mmHg. Sonia should control her blood pressure and it can be done by doing exercise as suggested by Physiotherapist. Exercise done in presence of nurse is very effective for controlling blood pressure because it stimulates a substance within bodies called nitric acid (Inbar and et.al., 2012).

TASK 3: ASSESSMENT TOOLS AND GUIDANCE

Assessment tools need to be utilized

As per the NICE department of Health following guidelines which offers recommendations are: Medication therapy helps in reducing symptoms for UC. It helps in improving quality of her life and maintains remission. It is incorporated by the nurses and helps for improving the health of Sonia (Eyre and Brady, 2013). Eating, Diet and nutrition helps for reducing symptoms of UC. Sonia should try to do exercise so that it will help her in reducing the blood pressure. The results include glucose that is 7 mmol/I. The level must be increased so that Sonia can feel healthy and can get energy. Nurses also should guide her for maintaining energy level. The oxidation level and pulse rate of Sonia is normal.

MEWS tool can be used for an ulcerative colitis patient means modified early warning score. It should be used by the nursing and the medical staff for the treatment of Sonia. It can help in knowing the illness of Sonia. In hospitals, MEWS is used by the nurses as a part of the “track and trigger system”. It will help the nursing staff for increasing the frequency of Sonia’s observation.

VIP tool can be used for an ulcerative colitis patient means Veterans Independence program. It helps the nursing staff by keeping the Sonia healthy. This would help in preventive community care approach for continuing care. Helps in early intervention, home support, self managed approach to care etc. This all helps the nurse and also helps in supplements provincial and community programs (Dawber, 2010).

TASK 4: PSYCHOSOCIAL ISSUES

Affect of the diagnosed condition and its implications for the patient

The major psychosocial issues are mood, self-esteem, self efficacy, lifestyle changes and hope. Nurse can assess how the Sonia is responding and she can fairly quickly attend the mood by observing her. Self esteem also helps the nurse to know how she feels. (Murphy and McVey, 2001).

Body of Sonia has changed because she was suffering from disease Ulcerative colitis. She has very little energy and was pale. She lost half a stone in weight and she is not unable to eat much because of the stomach cramps. She has to adjust with the lifestyle to adapt the diagnosis. She also has to avoid making choice for food. The treatments prescribed by the doctor’s affects the physical and psychological function to Sonia because of ulcerative colitis. Because of the suffering she may be in misery and needed a support of friends etc. She also gets psychological distress and may be disturbed because of the disease. As per the case study, Sonia has been admitted in medical ward of local hospital. The treatment includes the management of the symptoms and consequences of the UC. Sonia may be stress induced because of IBD symptoms experienced by her. She should interact with the family members so that he can get support from them. (Gamble and et.al., 2013).

Disease can cause Sonia to avoid food choices which may not serve a balanced diet (Pope, 2009). Psychological Distress is more likely to occur in form of Anxiety, depression, loneliness etc. are caused because of basic symptomatology. Nurses should help Sonia for her psychological distress. They can motivate Sonia and also try to communicate properly so she may feel less distressed (Ward and et.al., 2004).

TASK 5: PHARMACOLOGY

Drugs prescribed and dosage

Sores and Ulcers are caused by the Ulcerative disease. Treatment for disease includes surgery, medications, changes in diet and managing stress. Drugs prescribed to treat Ulcerative Colitis are fluids of Dextrose saline to run 1 litre over 6 hours, IV Hydrocortisone, Aminosalicylates, Prednisone, TNF blockers. Sonia normally takes Sulfasalzine 500 mg orally QDS. The GP has prescribed 40 mg daily of oral Prednisolone and she is taking for the past 3 days. Sulfasalzine tablet acts locally in the colon to decrease inflammation. It helps by inhibiting the formation of a chemical and it works throughout the body. The chemical known as Prostaglandins. This help for control of pain and inflammation.

Aminosalicylates are the compounds and also called mesalamine. These are used to treat Ulcerative Colitis, Crohn’s disease and rheumatoid arthritis and also reduce inflammation. This helps in preventing the development of specific chemicals in the body, which are causing inflammation (Schoenfeld, 2013).

Corticosteroids are used to treat various types of conditions including skin allergies, allergic rhinitis, eye inflammation, edema, asthma, adrenal insufficiency etc. corticosteroids also known as Prednisone. They are not contacting directly to the tissues of inflammation. In few days, patients may experience many improvements.In the body the swelling is caused, Corticosteroids work for the blocking substance in the body(Staceyand Rayner, 2008).

TNF Blockers work for decreasing swelling of the skin and the joints. They also used to treat Crohn’s disease, psoriasis, rheumatoid arthritis etc. Sonia also takes IV Fluids of Dextrose Saline to run 1 liter over 6 hours and also IV hydrocortisone 100 mg QDS. Hydrocortisone is a type of drug called steroids. Sonia should not use this drug if there is fungal infection in her body. Usual dose 100 mg can be taken for 21 days of Hydrocortisone. If it does not effect then there is a need of therapy.

Dosages are given by the doctors according to the sufferings caused her. Aminosalicylates contains 5-aminosalicylic acid and helps in reducing inflammation. These also help in maintaining remission in mild to moderate Crohn’s disease. Corticosteroids can be taken as pill. If Sonia is not able to take oral form then this is given. Dosage is recommended by the doctors a remission of the adult patients. Active, mild to moderate ulcerative colitis, 1.2 g two to four tablets must be taken one time with a meal. The total 2.4 g or 4.8 g tablets dose has to be taken(Staff, 2013).

Effects of Medication, their side effects and how to cope up with the side effects

The main aim of medication is to lower the Inflammation in the colon. Many drugs are used for the treatment of Ulcerative Colitis and they are prescribed of the anti inflammatory agents or immune system suppressors. The medications have many effects such as:

  • In Aminosalicylates drugs the side effects are included and they also cause the problem in Sonia’s kidney. The side effects are gas, hair loss, Diarrhea, headache, Dizziness, Abdominal pain etc.
  • Hydrocortisone has side effects it may signs for an allergic reaction. The side effect also may be on the problem of vision of Sonia, swelling, rapid weight gain, severe depression, high blood pressure, diarrhea etc.
  • In corticosteroids, they have sometimes long term effects which include: Weight gain, excess hair growth, weakened bones, cataracts and glaucoma, diabetes, muscle wasting, upper etc. If the dosage is less than the withdrawal symptoms may occur such as fever, malaise and joint pain(Brown, 2011).
  • Sulfasalzine cause side effects such as pale skin, pain or burning headache, sore throat, skin rashes etc. Sonia was also pale and has very little energy it may be because of the tablet which he normally takes.
  • Ulcerative colitis immune system drug has side effect. They use immunomodulators for decreasing the activity of the system(Foster, 2013). They also help in body ability to combat infection. For coping with the side effect Sonia should take proper treatment by the doctor otherwise it may cause the flu, headache, diarrhea, vomiting, etc. (Sajadinejadand et.al., 2012).
  • To cope up with the side effects following points must be included. When the dosage amount increase the risk of the side effects also increases. She should properly monitored to the physician if he is on medication for more than 6 weeks.For decreasing the side effects the tapering of steroids, taking them every other day, and she should use rental cream forms of the drug and they have less side effects.

Interactions between drugs prescribed

Sulfasalzine is an immunosuppressive type of medicine. It helps in over activity of the immune system. Alcohol can interact with the medicine. This can also interact with certain foods. Sonia must try to avoid certain foods and it may be harmful (Surg, 2004). The medicine may also interfere with the ability to drive for the operating machinery safely. The person should judge and this can affect so Sonia must take proper precautions for that.

CONCLUSION

From the above study it has been concluded that Sonia was suffering from the disease called Ulcerative Colitis, it is a kind of inflammatory disease.It is caused by different viruses and bacteria and in a family if any person is suffering from such disease can cause the other member also. The main symptom is the bloody diarrhea of the disease. Sonia normally takes Sulfasalzine 500 mg orally QDS. The GP has prescribed 40 mg daily of oral Prednisolone and she is taking for the past 3 days. The diagnosis of Sonia disease is done and the tests applied for the diagnosis are ESR, CRP, stool test etc. Occupational therapy helps her for maintaining the physical condition. Drugs prescribed to treat Ulcerative Colitis are Aminosalicylates, Corticosteroids and TNF blockers. From the study it has been learnt that combination of the nursing interventions and the pharmacology is the best measures for the treatment.

REFERENCES

Books

  • Baumgart, C. D., 2012. Crohn'sDisease and Ulcerative Colitis: From Epidemiology and Immunobiology to a Rational Diagnostic and Therapeutic Approach. Springer.
  • Bell, C. and et.al., 2005. Case-based Medical Physiology. Wiley.
  • Brown, P. S. and et.al., 2006. Exercise Physiology: Basis of Human Movement in Health and Disease. Lippincott Williams & Wilkins.
  • Cappuccio, P. F. and et.al., 2010. Sleep, Health, and Society: From Aetiology to Public Health.Oxford University Press.
  • Chang, E. and et.al., 2006. Pathophysiology: Applied to Nursing Practice. Elsevier Australia.

Journals

  • Ahasan, R. and et,al.,2002. Psychosocial and socio-economic issues relating to female workers in Bangladesh. Work Study.51(7).pp.374– 381.
  • Dawber, R., 2010. Workforce redesign utilising advanced practice to improve the lifestyle and cognitive function of patients with alcohol-related brain damage.Journal of Mental Health Training, Education and Practice.5(3).pp.31– 40.
  • Eyre, A. and Brady, K., 2013.Addressing Psychosocial and Community Recovery in Emergency Management.International Journal of Emergency Services.2(1).
  • Gamble, J. and et.al.,2013. Psychological well-being and the role of food in healthy middle-aged and older women who have experienced acute gastrointestinal disturbances.British Food Journal.115(5).pp.711– 726.
  • Inbar, N. and et.al.,2012. Physiotherapists' attitudes towards old and young patients in persistent vegetative state (PVS).Quality in Ageing and Older Adults.13(2).pp.111– 124.

Online

  • Brown, D. S., 2011. Optimizing Outcomes in Ulcerative Colitis Requires Open Communication: A Nurse Practitioner's Perspective. [Online]. Available through:<http://www.medscape.org/viewarticle/748394>. [Accessed on 8th June 2013].
  • Foster, L., 2013. Managing the Side Effects of Ulcerative Colitis Treatment. [Online]. Available through:<http://www.everydayhealth.com/ulcerative-colitis/ulcerative-colitis-treatment-side-effects.aspx>. [Accessed on 11thJune 2013].
  • Sajadinejad, S. M. and et.al., 2012. Psychological Issues in Inflammatory Bowel Disease: An Overview. [Online]. Available through: <http://www.hindawi.com/journals/grp/2012/106502/>.[Accessed on 8th June 2013].
  • Schoenfeld, A., 2013.Ulcerative Colitis. [Online]. Available through: <http://www.medicinenet.com/ulcerative_colitis/page6.htm#what_are_ulcerative_colitis_medications>. [Accessed on 9thJune 2013].
  • Staff, C. M., 2013.Treatments and drugs.[Online]. Available through: <http://www.mayoclinic.com/health/ulcerative-colitis/DS00598/DSECTION=treatments-and-drugs>. [Accessed on 11th June 2013].
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