401010 Health Variations 1

1.Prioritization of Nursing Responsibilities

It is important for the nursing practitioner to ensure that they have the right patient before asking for consent and administering the drug. When administering morphine, it is vital for the nurse to uphold Eleanor’s rights because of the risks associated with drug administration (Nursing & Council, 2005).

Documentation of medical records must be done accurately and unambiguously to make sure that those seeking health care services get safe and optimal medication therapy. This is accordance with NMBA 5.1 (Council, 2002) and NSW documentation policy. By demanding accurate documentation, the policy ensures that health care information is available for every patient to aid in assessment and treatment.

According to NMBA 5.2, a nurse will have to use a wide range of techniques to gather relevant data necessary to decipher the effect of the administered drug. Some of the applicable data gathering techniques include observations, interviews, and physical examination (urine output). Monitoring of effect of drug effect is vital in changing of dosages or withdrawal or addition. Assessment of the side effects of morphine is also important. Nurses should be on the lookout for symptoms such as respiratory distress, sleepiness and sedation as well as urinary retention and constipation (Nursing & Council, 2005).

2.Structural and functional changes in the pathogenesis of ulcerative colitis

Prior to Eleanor’s episodes of diarrhoea with blood and pus, several structural and function changes took place in the GI tract. Ulcerative colitis starts in the rectum and proximally spreads to the rectum (Khor and Gardet Xavier, 2011). Ordinarily, a balance has to be maintained between pro- and anti-inflammatory cytokines to ensure that the colonic mucosa performs its functions optimally. Microscopically, the pattern of ulcerative colitis is typified by an inflammatory reaction with focused dispersal and structural anomalies of the mucosa. The cellular lamina propria changes with respect to structure and distribution. In a normal GIT, the lamina propria infiltrate is situated in posterior part of the mucosa with its pattern continues with prognosis of colitis. The infiltrate is more elaborate in ulcerative colitis and extends rapidly deeper. The increase of plasma cellular matter in proximity to the mucosal base is a common occurrence (M?zes et al., 2012).  Ulcerative colitis is an illness in which all the inflammatory response and morphologic alterations take place in the colon. The inflammation primarily occurs in the mucosa. Continued inflammation has been associated with severe ulceration, localized accumulation of fluids (edema) and bleed along the walls of the colon (Khor and Gardet Xavier, 2011).

3.Characteristics of the intravenous fluid ordered for Eleanor

A suitable fluid is necessary for all ulcerative colitis with high episodes of water stools. Diarrhea occasions high fluid loss and subsequent loss of electrolytes and metabolic acidosis. Giving an IV solution full of electrolytes unlike water is vital for their restoration. The main characteristics of the intravenous fluid are its composition; which regulates the longevity of time before the medicine is administered (Pellino et al., 2013). A hypertonic IV solution such as prednisolone is composed of 30 mg IV and is administered after every 12 hours while methylprednisolone which is made up of 16 to 20 mg IV is administered after every eight hours. Sodium-potassium content is another characteristic of interest in intravenous fluid suitable for Eleanor. IV fluids with minimal sodium retention and potassium-wasting are preferable. One such example is prednisolone (Dychter et al., 2012). Administration of the wrong IV fluid will increase diarrhea and dehydration. In addition, administration of an IVF that is low in electrolytes (low amounts of sodium and other solutes), or giving less than 50% glucose infusions, the patients will develop hypernatremia. This happens because fluids are being absorbed from the gut while losses of sodium remain uncontained occasioning high sodium losses in excess water.

References

Council, A. N. (2002). National competency standards for the registered nurse and the enrolled nurse. Brisbane, Australia: Author.

Dychter, S. S., Gold, D. A., Carson, D., & Haller, M. (2012). Intravenous therapy: a review of complications and economic considerations of peripheral access. Journal of Infusion Nursing, 35(2), 84-91.

Khor, B., Gardet, A., & Xavier, R. J. (2011). Genetics and pathogenesis of inflammatory bowel disease. Nature, 474(7351), 307-317.

M?zes, G., Molnár, B., Tulassay, Z., & Sipos, F. (2012). Changes of the cytokine profile in inflammatory bowel diseases. World J Gastroenterol,18(41), 5848-5861.

Nursing, A., & Council, M. (2005). National Competency Standards for the Registered Nurse [electronic Resource]. Australian Nursing and Midwifery Council.

Pellino, G., Sciaudone, G., Candilio, G., Camerlingo, A., Marcellinaro, R., Rocco, F., … & Selvaggi, F. (2013). Complications and functional outcomes of restorative proctocolectomy for ulcerative colitis in the elderly. BMC Surgery, 13(2), S9.