Subtotal Colectomy for Ulcerative Colitis

Question: Discuss about the Subtotal Colectomy for Ulcerative Colitis. Answer: Intorduction: The case history of Eleanor shows that she has been suffering from chronic ulcerative colitis that has recently exacerbated. Upon receiving instruction from the medical officer regarding the administration of morphine to the patient in appropriate dosage of 15 mg, four times a day through intramuscular (IM) route and as needed, the registered nurse is liable to perform her nursing responsibilities. The nurse who has been deemed competent for medication administration like that of Morphine is to undertake the duty. The NMBA guidelines for registered Nurses Standards of Practice are to be abided by to harbor optimal outcomes in the patient. Critical thinking and analysis of the nursing practice will be strictly followed. Management of acute pain will be done by means of IM morphine injection due to variable drug absorption as per peripheral perfusion that might be delayed post administration (Parisinos, 2014). Therapeutic and professional relationships will be emphasized whereby the un ique experiences of the Eleanor as patient, respect for her autonomy and legal capacity will be considered to optimize the health related decisions. Upon administration, continuous pain assessments need to be conducted to procure pertinent information thereby informing appropriate practice. In case any discrepancy to pain management upon IM morphine administration is noted, the findings should be documented and reevaluated through consultation with the attending physician to modify the therapeutic plan for facilitating quicker respite. The available guidelines for morphine administration are to be followed and implemented to allow provision for quality, safe and appropriate intervention. Evaluation must be carried on regular basis upon administration for any adverse drug reactions or side effects for monitoring the progress towards the projected objective of pain amelioration (Buchs et al., 2017). Ulcerative colitis refers to a kind of inflammatory bowel disease that affects the innermost lining of the large intestine in the colon and rectum region causing inflammation and repetitive soreness in the gastrointestinal tract. Persons who are genetically predisposed to develop an aberrant immunological response concerning the gut luminal antigen are likely to develop the disease in combination with the influence of the external and internal environmental factors. Further the altered immune response occurs as a result of antibodies generation against bacteria and bacterial materials (Dalal Chang, 2014). Mucosal and sub mucosal structural changes at the level of the colon cause increase in the cellular infiltrate, mucosal atrophy and faulty crypt architecture characterized by an irregular surface. The architectural disorientation and pattern of inflammation appears to intensify from proximal to distal colon in ulcerative colitis that are revealed on histological examination. As a c onsequence of these structural alterations certain functional changes also take place. Mucosal damage followed by bile acid malabsorbtion, heightened bacterial growth, and protein exudation from mucosa occurs. The colonic mucosa is the vulnerable site for inflammation and ulceration in ulcerative colitis along with the rectum. Bacterial products and inflammatory mediators together contribute to account for these changes (Rogler, 2014). All these culminated in the pathogenesis of ulcerative colitis in the patient that further led to Eleanors episodes of diarrhea with blood and pus. The intravenous fluid that was ordered for Eleanor was that of Hartmans solution. It is considered as a crystalloid solution having a mixture of fluid in which the active ingredients are sodium chloride, sodium lactate, potassium chloride and calcium chloride in water. It is generally used an an intravenous fluid for replenishing the body fluid and electrolytes that might have been lost due to various underlying pathologic reasons. It is closely isotonic with blood and therefore preferred as IV fluid. It is also suitable for application in cases of rise in the acidity of the blood. Situations relevant to low blood volume or hypotension are also pertinent for application of Hartmans fluid. It is usually considered inappropriate for patients suffering from congestive heart failure, ischemic disease, liver disease and kidney impairment (Severs, Hoorn Rookmaaker, 2014). As per the case study Eleanor has been reported of having low blood pressure along with slow capillary refilling. Furt hermore her urine output is found to be lower and coupled with the ulcerative colitis condition she has been suffering from it is likely to result in loss of vital fluid and electrolytes due to impaired digestion and absorption. Therefore it is quite justified to apply Hartmans fluid to replace her body fluid satisfactorily in keeping with the specific fluid balance status. However following application of this fluid, symptoms for side effects should be monitored and appropriate dosage should be administered for allaying the possibility of overdose repercussions (Raghunathan et al., 2014). References Buchs, N. C., Bloemendaal, A. L., Wood, C. P., Travis, S., Mortensen, N. J., Guy, R. J., George, B. D. (2017). Subtotal colectomy for ulcerative colitis: lessons learned from a tertiary centre.Colorectal Disease. Dalal, S. R., Chang, E. B. (2014). The microbial basis of inflammatory bowel diseases.The Journal of clinical investigation,124(10), 4190-4196. Parisinos, C. A. (2014). Station 4.1: Severe ulcerative colitis.The Unofficial Guide to Prescribing, 97. Raghunathan, K., Murray, P. T., Beattie, W. S., Lobo, D. N., Myburgh, J., Sladen, R., Shaw, A. D. (2014). Choice of fluid in acute illness: what should be given? An international consensus.British journal of anaesthesia,113(5), 772-783. Rogler, G. (2014). Chronic ulcerative colitis and colorectal cancer.Cancer letters,345(2), 235-241. Severs, D., Hoorn, E. J., Rookmaaker, M. B. (2014). A critical appraisal of intravenous fluids: from the physiological basis to clinical evidence.Nephrology Dialysis Transplantation, gfu005.