Nsg2Anb Bachelor Of Nursing Assignment Assessment Answers

Q1.

Which medication would you administer to Bob? And Why? Provide a detailed rationale for your answer (use literature to support your choice)

o State your medication that you will give

Answer:

Introduction

The assignment is about bob Jackson, who had been suffering from a chronic abdominal disorder and whose symptoms are more like ulcerative colitis. Some of the clinical issues manifested by Bob Jackson are-Lower abdominal pain in the left quadrant, stools containing with blood, diarrhea, pain in the rectal region and joint pain due to arthritis and joint swelling.

This paper would describe some of the mode of actions of the medicines that will be used for Bob and the rationale behind their use. Bob Jackson required a multidisciplinary approach to treat the symptoms and second part of the assignment will discuss about the role of a registered dietician managing the dietary health of Bob Jackson.

Question 1

Treatment of pain can be challenging for people with ulcerative colitis as many of the painkillers might cause flare up of the disease. New studies have found that Celebrex does not pose long-term risk. According to some of the studies painkillers such as ibuprofen and naproxen has been linked to ulcerative colitis flare ups (Setia, Nehru & Sanyal,  2014) .It is a COX-2 inhibitor that is a non- steroidal anti-inflammatory drugs. Cox -2- enzyme is the one that is responsible for the production of the prostaglandins that causes pain in arthritis. Celebrex specifically inhibits COX-2 but does not affect the COX- 1 enzyme (Setia, Nehru & Sanyal, 2014).

Corticosteroids can also be administered orally or intravenously and these medications can be used to reduce the inflammation in the intestinal lining. These steroids cannot be used for long term, as the patients might become steroid independent (Li et al., 2015). Since paracetamol is a weak inhibitor of the prostaglandins.  Although the effects of the paracetamol is much like  selective cox -2 – inhibitors but , paracetamol might not be suitable for Bob, as Bob has reported a dull abdominal pain with intensity ranging from 6-8 out of 10, which indicates towards moderate to severe pain (Jó?wiak-Bebenista & Nowak, 2014).

Endone tablets can also be given to Bob as a painkiller as its action is similar to the opioid analgesics. The active ingredients of endone is oxycodone hydrochloride and it affects the way how a body reacts to the pain. However, it binds to the receptor, inhibits the adenylyl cyclase and the hyperpolarization of the neurons, and thus reduces the excitability.

Since the intestinal micro biota plays an important role in the development of chronic ulceritis, antibiotics can have impact by decreasing the concentration of the bacteria residing in the gut lumen and modifying the concentration of the intestinal micro flora for favoring the beneficial bacteria (Nitzan,  Elias, Peretz & Saliba, 2016). Hence, antibiotics might be used for the treatment of the progression of the disease. Antibiotics like metronidazole can be used (Nitzan, Elias, Peretz & Saliba, 2016).

However, there are several side effects in relation to administration of the painkillers like allergic symptoms or difficulty in breathing, dizziness or disorientation.  

Question 2

A multidisciplinary team is normally created to as abdominal pain and diarrhea requires an array of treatment. The importance of the multidisciplinary team is that it emphasizes to the patient all aspects of pain experience and contribution from each members of the pain management team (Bitton et al., 2014). The team member that has been chosen for the discussion and who is also a part of the multidisciplinary team is a registered dietician. The activated receptors interferes with the pain signals that are transmitted through the central nervous system.

A clinical dietician is the one that promotes nutrition to the patient in the hospitals as per their disease conditions and the nutritional requirements, due to this they are often taken as members of multidisciplinary teams. It is evident from the case study that Bob Jackson had been suffering from ulcerative colitis (Triantafillidis, Vagianos & Papalois, 2015).Various dietary and nutritional factors have been found to be the etiological factors for ulcerative colitis.   Management of the gastrointestinal disorders largely depends upon the dietary supplements prescribed by registered dieticians. This referral has been chosen for Bob, as dietary habits and food choices often play an important role in the treatment and the prevention of the gastrointestinal disorders.

According to Triantafillidis, Vagianos & Papalois, (2015), exclusion of lactose or other disaccharides from the diet has been proven effective for the individuals with diarrhea. Conversely, the intake of the citrus fruits, the fruit juices and vegetables have been found to lower the risk of the development of ulcerative colitis. Abdominal pain, discomfort, diarrhea deeply affects the quality of life of millions of people. According to Limdi, Aggarwal & McLaughlin, (2015), a healthy diet plan can be helpful to treat the eating habits of the patients and helps them to maintain a healthy life style. Based on the latest scientific findings, dietary fibers, probiotics and non-absorbable antibiotics targeting the gut have some impact upon the patients with abdominal disorders. Mikocka-Walus et al. (2017), have stated that there are certain foods that exacerbate the diarrheal symptoms. Bob Jackson had been suffering from osteoarthritis and joint pain, this can be related to the fact that patient having ulcerative colitis displays and increased loss of the bone mass. Hence a dietician can plan the diet of the patient accordingly, such as implementation the of iron and folic acid supplements in the diet plan. The deficiency of the folic acids can be linked to increased risk of colitis-associated carcinogenesis. Recommending with probiotics can increase the stimulation of the intestinal immune system, greater permeability of the intestinal mucosa. Hence, sufficient calorie and protein intake recommended by a registered nurse can be helpful in managing the symptoms of ulcerative colitis in Bob Jackson.

Conclusion

In conclusion, it can be said that since pain management is an important aspect of treating ulcerative colitis symptoms, medicines like paracetamol, Endone, celebrex can be used in treating severe pain in the patient. Antibiotics and corticosteroids are the recommended medications for the treatment of ulcerative colitis. However, it is recommended to look after the contraindications of each of the medications. Since, treatment of the clinical issues of Bob required a multidisciplinary approach and diet plays an important role in managing gastrointestinal disorders, hence the role of the dieticians has been discussed supported by some literary evidence. As per the age of Bob Jackson, he required a holistic care approach to cope up with the pain and other issues.

References

Bitton, A., Buie, D., Enns, R., Feagan, B. G., Jones, J. L., Marshall, J. K., ... & Panaccione, R. (2012). Treatment of hospitalized adult patients with severe ulcerative colitis: Toronto consensus statements. The American journal of gastroenterology, 107(2), 179. https://www.nature.com/articles/ajg2011386

Jó?wiak-Bebenista, M., & Nowak, J. Z. (2014). Paracetamol: mechanism of action, applications and safety concern. Acta poloniae pharmaceutica, 71(1), 11-23. https://europepmc.org/abstract/med/24779190

Li, J., Wang, F., Zhang, H. J., Sheng, J. Q., Yan, W. F., Ma, M. X., ... & Zheng, P. (2015). Corticosteroid therapy in ulcerative colitis: clinical response and predictors. World Journal of Gastroenterology: WJG, 21(10), 3005.   10.3748/wjg.v21.i10.3005

Limdi, J. K., Aggarwal, D., & McLaughlin, J. T. (2015). Dietary practices and beliefs in patients with inflammatory bowel disease. Inflammatory bowel diseases, 22(1), 164-170. https://doi.org/10.1097/MIB.0000000000000585

Mikocka-Walus, A., Andrews, J. M., Rampton, D., Goodhand, J., van der Woude, J., & Bernstein, C. N. (2014). How can we improve models of care in inflammatory bowel disease? An international survey of IBD health professionals. Journal of Crohn's and Colitis, 8(12), 1668-1674. https://doi.org/10.1016/j.crohns.2014.07.009

Nitzan, O., Elias, M., Peretz, A., & Saliba, W. (2016). Role of antibiotics for treatment of inflammatory bowel disease. World Journal of Gastroenterology, 22(3), 1078–1087. https://doi.org/10.3748/wjg.v22.i3.1078

Setia, S., Nehru, B., & Sanyal, S. N. (2014). Celecoxib prevents colitis associated colon carcinogenesis: an upregulation of apoptosis. Pharmacological Reports, 66(6), 1083-1091. https://doi.org/10.1016/j.pharep.2014.07.001

Triantafillidis, J. K., Vagianos, C., & Papalois, A. E. (2015). The Role of Enteral Nutrition in Patients with Inflammatory Bowel Disease: Current Aspects. BioMed Research International, 2015, 197167. https://doi.org/10.1155/2015/197167