401010 Health Variations 1


1.Prioritise all nursing responsibilities, and any associated rationales, related to the administrations of morphine Eleanor.

2. Describe what structural and functional changes occurred in the pathogenesis and treatment of ulcerative Colitis. These were the causes of Eleanor’s episodes of diarrhoea accompanied by blood and pus.

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3.Explain the intravenous fluid ordered for Eleanor. The rationale, in relation to Eleanor’s specific fluid balance status for the administration of this intravenous water to Eleanor.

Answer to Question: 401010 Health Variations 1

It is vital for the nursing practitioner that they ensure that the patient is the right person before administering the drug.

Eleanor’s rights are important when administering morphine. This is because of the dangers associated with drug administration.

It is important to document medical records accurately and clearly in order to ensure that people seeking treatment for their health problems receive safe and effective medication.

This is in compliance with NMBA 5.1, Council 2002, and NSW documentation policy.

The policy demands accurate documentation in order for each patient to be able to access their health information.

According to NMBA 5.2 a nurse will use a wide variety of techniques to gather the data needed to understand the effect of the administered medication.

Interviews, observations and urine output are all examples of data gathering methods.

Monitoring the effects of drug withdrawals and additions is critical.

Assessing the side effects is also crucial.

Nursing & Council, 2005.

2.Structural & Functional Changes in Ulcerative Colitis’ Pathogenesis

Many structural and function changes were made in the GI tract before Eleanor’s episodes.

Ulcerative collitis develops in the rectum. It then spreads proximally to the rectum.

In order to ensure optimal colonic mucosa function, an equilibrium must be achieved between pro-inflammatory and antiinflammatory cytokines.

Microscopically the ulcerative colitis pattern is characterised by an inflammatory response that includes focused dispersal of structural anomalies and mucosa changes.

The structure and distribution changes in the cell lamina propria.

Normal GIT will show the lamina propria intrusion in the posterior mucosa. This pattern can be seen with colitis diagnosis.

The infiltrate becomes more complicated in ulcerative colitis and grows rapidly deeper.

An increase in plasma cell matter is common near the mucosal basal area (M.zes et. al., 2012.

Ulcerative collitis is a condition where all the morphologic alterations and the inflammatory response occur in the colon.

The mucosa causes the majority of the inflammation.

Continued inflammation has been linked to severe ulceration, localized fluid accumulation (edema), bleed along walls of the colon (Khor Xavier, 2011).

3.Characteristics for the Intravenous fluid ordered for Eleanor

All episodes of ulcerative colitis that involve high amounts of water stools require a fluid.

Diarrhea causes high fluid loss which can lead to metabolic acidosis and loss of electrolytes.

The IV solution must contain electrolytes other than water. This is critical for their restoration.

The main characteristics for an intravenous fluid are their composition. This controls how long the medicine takes to take effect (Pellino. et. al., 2013).

A hypertonic IV solution like prednisolone contains 30 mg IV. This is administered after twelve hours. While methylprednisolone has 16 to 20 mg IV and is administered every eight.

Eleanor can also benefit from intravenous fluids that contain sodium-potassium.

IV fluids that are low in sodium retention and potassium-wasting is preferred. One such example is prednisolone (Dychter et al., 2012).

The wrong IV fluid may cause diarrhea or dehydration.

Patients will develop hypernatremia if they are given IVF fluids with low electrolytes (low quantities of sodium and other soluables) or that contain less than 50% glucose infusions.

This occurs because fluids are being absorbed into the body while sodium losses remain uncontained.

Refer toCouncil, A. N. (2002).

National competency standards of the registered nurse and the enrolled nursing. Brisbane, Australia: Author.Dychter, S. S., Gold, D. A., Carson, D., & Haller, M. (2012).

Intravenous therapy: A review and economic considerations for peripheral access.

Journal of Infusion Nursing. 35(2), 84-91.Khor, B., Gardet, A., & Xavier, R. J. (2011).

Genetics and pathogenesis inflammatory bowel disease. Nature, 474(7351), 307-317.M?zes, G., Molnar, B., Tulassay, Z., & Sipos, F. (2012).

Modifications in the cytokine profile of inflammatory bowel conditions. World J Gastroenterol,18(41), 5848-5861.Nursing, A., & Council, M. (2005).

National Competency Standards for Registered Nurses [electronic Ressource].

Australian Nursing and Midwifery Council.Pellino, G., Sciaudone, G., Candilio, G., Camerlingo, A., Marcellinaro, R., Rocco, F., … & Selvaggi, F. (2013).

Reconstructive proctocolectomy for ulcerative Colitis: Complications and Functional Outcomes in the Elderly

BMC Surgery 13, 2: S9.