Question

In: Nursing

Explain the admission data in terms of the pathophysiology of her condition. The client remains home...

Explain the admission data in terms of the pathophysiology of her condition.

The client remains home for three weeks. She is readmitted again after a severe GI bleed secondary to her ulcerative colitis. Since her trip to Jamaica, she has lost over 30 lbs. due to loss of appetite, nausea, vomiting, and diarrhea. Due to her ulcerative colitis, she has uncontrollable bowel movements, both with and without rectal bleeding. She often chooses not to eat because she states, “it just runs right through me so why bother?”

Second Admission Data:

T 98.7 F (98.6) normal

BP 70/50 (120/80) extremely low

P 133 (60-99) extremely high

RR 18 (12-16) high

O2 sat (by pulse oximetry) 93% on room air (RA) (95-100) low

BUN 10 ( 6-20 mg/dl) normal range

Serum creatinine 0.5 (0.6-1.3 mg/dl) low

Hgb 7.8 (13.5-18 g/dl) low

Hct 25 (42%-52%) extremely low

WBC 10 (4K-10.5K/mcl) normal range

INR 7 (1.1 or below) extremely high

Sodium 128 (135-145 mEq/L) low

Potassium 2.9 (3.7-5.2 mEq/L) extremely low

Calcium 7.4 (8.6-10.3) low

Magnesium 1.5 (1.7-2.2) low,

Glucose 124 (< 100) low

Total protein 5.4 (6.0-8.3) low  

Albumin 1.6 (3.4 to 5.4) extremely low

Solutions

Expert Solution

Introduction:

Ulcerative colitis is chronic inflammatory disorder of the large intestine in which there is chronic inflammation and ulceration of the mucosa of the large intestine. It is characterized by diarrhoea, most often bloody diarrhoea ,abdominal cramps and pain. The disorder is caused by probably an immune malfunction; dietary and stress factors may also cause ulcerative colitis.

Pathophysiology of ulcerative colitis

In ulcerative colitis, there is inflammation of the mucosal lining of the colon with ulcerations which initially starts in the rectum and then gradually extends to involve the entire colon. This inflammation is characterized by episodes of diarrhoea and bloody stools with abdominal cramps and pain. The inflammatory diarrhoea and bleeding that is associated with ulcerative colitis causes a lot of metabolic derangements for the patient with chronic malabsorptive status and anaemia.

Discussion of the patient's pathophysiological state

The patient here has had episodes of acute diarrhoea with uncontrollable bowel movement and there is a pathophysiological state of acute dehydration with a chronic malabsorptive state.

The patient has presented with shock and anaemia due to chronic diarrhoea and bleeding, hypoproteinemia hypomagnesemia hypocalcemia and elevated INR which are due to chronic malabsorption that is associated with ulcerative colitis.

There is a higher risk of Travelers diarrhoea in patients of inflammatory bowel disease. Since the patient has traveled to Jamaica and has exacerbation of the symptoms following return from Jamaica there is a possibility that she has a developed Travelers diarrhoea .The organism that are commonly responsible for travelers diarrhoea include clostridium difficile,Giardia  and cytomegalovirus. Immunosuppression exists in patients of ulcerative colitis due to long term use of Steroids and they are at a higher risk of developing Travelers diarrhoea which exacerbates the inflammatory bowel disease. The possibility of this occurrence in our patient has to be ruled out by performing a stool examination and culture

The explanation of the admission data with respect to the disease of the patient and its pathophysiology has been detailed In The table below.

parameters explanation with the pathophysiology of ulcerative colitis
temperature 98.7 (normal) low grade chronic inflammation without infection with normal body temperature.no pyrexia.
bp 70/50 hypotension (due to ongoing fluid loss and blood loss)hypovolemia due to diarrhoea ,nausea and vomiting bleeding.hypovolemic shock.
p133/min tachycardia secondary to hypotension and shock
rr 18(12-16) tachypnea secondary to hypotension
O2 saturation 93% low

1.anaemia with low hemoglobin concentration leading to low pO2.

(less hemoglobin to bind with oxygen)

2.shock state,less perfusion of the lungs

bun 10mg|dl normal renal function
Serum creatinine 0.5mg/dl low low protein diet with microalbuminuria and microproteinuria causes low serum creatinine levels.
Hgb low 7.8

The three causes of anaemia in ulcerative colitis are

1.poor iron absorption due to intestinal inflammation

2.decreased intake of iron rich foods and food in general by the patient due to the fear of diarrhoea

3.chronic blood loss because of ulcerative colitis with rectal bleeding.

wbc normal

haematocrit low(25)

normal wbc levels.

low haematocrit due to chronic blood loss and anaemia.

rectal and colonic bleeds in ulcerative colitis with poor dietary intake of food and iron.

INR 7 extremely high

1.Vitamin K is required for the synthesis of four out of the 13 clotting factors. it is the most important vitamin that helps in the clotting of blood .vitamin K is derived from the green leafy vegetables which is part of the diet of the patient and also synthesized by the bacteria in the large intestine

2.In case of inflammatory bowel disease the dietary intake of the patient has reduced drastically and the synthesis of vitamin K is also affected because of the inflammation in the large intestine in ulcerative colitis.

3.Hence the synthesis of clotting factors here is affected and the PT INR is highly elevated .Factors dependent on vitamin K are Prothrombin protein C proteinS and factor IX and factor 7.

4.Hypoproteinemia has also affected the synthesis of clotting factors leading to their deficiency and increase in the clotting time

The deficiency of Vitamin K and clotting factors has caused the increase in the PT INR levels in this patient.



sodium 128 low

1.loss of sodium in the body fluids through vomitus and bowel fluids leading to hyponatremia.

2.poor absorption of sodium and chloride in case of Bowel inflammation seen in ulcerative colitis

3.sodium loss in vomiting.

potassium 2.9 extremely low

1.loss of potassium in the large intestinal fluid diarrhoea leading to hypokalemia

2.increased secretion of potassium and diarrhoea

3.potassium loss in vomiting.

calcium 7.4 low

the reasons of hypocalcemia are as follows


1.Use of steroid medications in patients of ulcerative colitis which interfere with absorption of calcium

2.avoidance of Dairy Foods and other specific dietary items because of food intolerance leading to calcium deficiency.

3.Lower Transit Time due to diarrhoea and inflammatory cytokines leading to poor absorption of calcium.

4.poor dietary intake.

The patient often chooses not to eat because in her words it just runs right through me so why bother?

Long term use of Steroids causes bone loss and osteoporosis by interfering with the calcium absorption

magnesium1.5 low

1.magnesium is absorbed in the colon,since there is inflammation of the colon and chronic diarrhoea, magnesium absorption is affected.and hence hypomagnesemia.

2.poor dietary intake.

The patient often chooses not to eat because in her words it just runs right through me so why bother?

glucose 124(<100) low

patient levels of glucose is <100 mg/dl. blood glucose indicative of hypoglycemia

1.poor glucose absorption due to diarrhoea and vomiting and chronic malabsorption.

2.decreased intake of food due to fear of diarrhoea.

The patient often chooses not to eat because in her words, it just runs right through me so why bother?

rationale if elevated blood glucose levels found.

Long term use of corticosteroids can elevate the fasting blood sugar to greater than hundred in patients of ulcerative colitis and point towards steroid induced Diabetes mellitus .in our patient if the fasting blood sugar found is greater than normal, investigation must be made to rule out steroid induced Diabetes mellitus

normal fasting blood glucose <100mg/dl (random<200mg/dl)

prediabetic 100-125mg/dl

diabetic>126mg/dl

total protein5.4 low

1.ulcers in the mucosa of the large intestine cause leakage of protein rich fluids causing hypoproteinemia

2.Micro proteinuria and microalbuminuria are found in ulcerative colitis due to leaky renal capillaries which is caused by the inflammatory cytokines that are associated with the ulcerative colitis

3.poor dietary intake of protein.

The patient often chooses not to eat because in her words it just runs right through me so why bother?

albumin 1.6 extremely low

1.ulcers in the mucosa of the large intestine cause leakage of protein rich fluids causing hypoproteinemia

2.Micro proteinuria and microalbuminuria are are found in ulcerative colitis due to leaky renal capillaries which is caused by the inflammatory cytokines that are associated with the ulcerative colitis

3 poor dietary intake of albumin

The patient often chooses not to eat because in her words it just runs right through me so why bother?


Related Solutions

Explain the pathophysiology of a condition that involves decreased production of adrenal gland hormones.
Explain the pathophysiology of a condition that involves decreased production of adrenal gland hormones.
44. Explain the pathophysiology of the condition that results from too little ADH. What is it...
44. Explain the pathophysiology of the condition that results from too little ADH. What is it called?
Explain the pathophysiology of COVID-19 using any anatomical topics and terms.
Explain the pathophysiology of COVID-19 using any anatomical topics and terms.
You are a home health nurse visiting an 85-year-old client, Mrs. Smith, in her home. Mrs....
You are a home health nurse visiting an 85-year-old client, Mrs. Smith, in her home. Mrs. Smith lives alone and has a small dog for companionship. Her daughter comes to visit every Sunday. Mrs. Smith takes a total of seven different medications and keeps them in unlabeled containers. She is also prescribed home oxygen therapy. Upon observing the client’s environment, you notice that the living room is dimly lit. Mrs. Smith tells you, “I don’t like a lot of lights,...
Mrs. Cass is an 87-year old African American client living in her own home. Her daughter...
Mrs. Cass is an 87-year old African American client living in her own home. Her daughter lives nearby and is Mrs. Cass’s primary care giver. Mrs. Cass is a widow but has a few long-time friends who are concerned about her welfare. Due to mobility issues, they have difficulty making trips to visit her, limiting her socialization. She “gets by” financially, as she describes her situation. “I don’t have many needs, but my medication is expensive.” Mrs. Cass suffers from...
Explain what would happen to the terms of trade should home offer a subsidy to home...
Explain what would happen to the terms of trade should home offer a subsidy to home producers that export to the rest of the world under the two set of assumptions below (10 points, 5 points for each case): Home is considered a large country (hence, it is able to affect world prices) Home is considered a small country (unable to affect world prices) (Note: Assume no counter-action by foreign countries.)
Client Profile Mrs. Kidway is a 71-year-old Russian woman who lives at home with her daughter’s...
Client Profile Mrs. Kidway is a 71-year-old Russian woman who lives at home with her daughter’s family. She only speaks Russian; her daughter speaks English and translates for her Mother. Mrs. Kidway has a history of Heart failure (HF, CHF); pneumonia; chronic obstructive pulmonary disease (COPD); gastroesophageal reflux disease (GERD). Her daily medications prior to admission include digoxin (Lanoxin) 0.125 mg once a day. Case Study Mrs. Kidway arrives in the emergency room with her daughter who explains, “She was...
Your client, Nora, has a 300-square-foot room in her 2,000-square-foot home that she uses as an...
Your client, Nora, has a 300-square-foot room in her 2,000-square-foot home that she uses as an office for her bakery business for administrative functions such as paying bills and ordering supplies. She has heard of other small businesses taking the home office deduction, as she does not want to miss out on any deductions. Write a short memorandum advising Nora on whether she can take any deductions for her home office, detailing your conclusion. You are allowed to make some...
Explain what would happen to the terms of trade if home imposes a tariffs on imports...
Explain what would happen to the terms of trade if home imposes a tariffs on imports from the rest of the world under the two set of assumptions below (10 points, 5 points for each case): Home is considered a large country (hence, it is able to affect world prices) Home is considered a small country (unable to affect world prices) (Noted: Assume no retaliations from the foreign countries.)
1 - Explain these two terms: Secondary data and Primary data Then give two advantages and...
1 - Explain these two terms: Secondary data and Primary data Then give two advantages and disadvantages of each term (We are in marketing field)
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT