Ulcerative colitis. The young gentleman I took part in his care had an underlying condition of ulcerative colitis but was admitted as suffering from acute nephritis. This is normally a condition that exhibits itself in the form of inflammation of the kid

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Introduction

The young gentleman I took part in his care had an underlying condition of ulcerative colitis but was admitted as suffering from acute nephritis. This is normally a condition that exhibits itself in the form of inflammation of the kidney’s glomeruli (Milly 2005, pg 234). The patient was admitted exhibiting symptoms like; cola-colored urine, high blood pressure, edema, increased proteins and electrolytes in urine, anemia and headaches (Greig 2000, pg 329). As a professional, I played an important role in getting the medical history of the client, undertook the anthropometric assessments before admitting him. From the underlying medical condition the patient had ulcerative colitis and hence it was very likely that he had been on anti-cancer drugs used to control any abnormal proliferation of cells. The underlying conditions therefore called for careful planning of care so that the acute nephritis could be taken care of while keeping in mind that the underlying condition of ulcerative colitis could be responsible for most of the symptoms and even the acute infection hence must also be addressed properly. In terms of assessment and testing, I undertook to establish the patient’s blood pressure, abnormal sounds from the heart and lungs as well as seeking to establish external signs like swellings on the face. When dispensing the care for the acute condition of acute nephritis, it should be done with the bigger picture of the underlying condition, which is ulcerative colitis. Because acute nephritis also presents with almost similar signs like ulcerative colitis, it was important to first review the details of ulcerative colitis before dispensing care. The review of the underlying condition is as follows in the case review;

Case review

Ulcerative colitis can be both acute and chronic disease/disorder that brings with it extensive ulceration or inflammation or both in the colon. This mainly takes place in its mucosa or submucosa. It is just but one of the many conditions lumped together as inflammatory bowel disease. In most cases, the ulcers form in places where cells lining the colon have died due to the inflammation. It can happen to anyone regardless of age but mostly starts among the population between 15 and 30 years of age (Thomas 2006, pg 623). The most common symptoms associated with this condition is bloody diarrhea and pain in the abdomen. In most severe cases, it is always necessary that the physicians offering care remove the colon! The term idiopathic is always used in reference to this condition because its etiology is really never known clearly.  In several situations, this condition is always not just limited to pathological changes in the co0lon but also involves systematic degenerations of other parts of the body that involve joints hence resulting in migratory arthritis, ankylosing spondylitis and even sacroileitis (Jill 2008, pg 45). Other organs like the liver, the skin and the eyes can also be affected and hypercoagulability is also exhibited.

The clinical manifestations and complications of ulcerative colitis

Emotional or physical stress is known to bring about bloody mucoid diarrhea among the patients. These are often acute attacks that can last from a few days to weeks or even a few months and are always followed by some periods of remission, which can extend from months to even decades! This patient had already been having these remissions for three years according to his medical records. In some patients, the attacks are relatively few while in others it can take long, become more prolonged or even be more severe hence predispose the colon to even unforeseen malignant alterations. The diarrhea, whether acute or chronic, brings about severe alterations in electrolyte balance in the body system, interfere with the patient’s nutrition condition, and bring about severe fevers, weight loss and even stomach cramps (Ferguson 2000, pg 1120). This patient exhibited most of these signs and if they were because of the acute nephritis for which he was admitted, it could not be accurately refuted that they were not due to the underlying condition of ulcerative colitis.

In cases where the disease attack is severe and sudden, the patient may suffer from cessation of the bowel function, colon dilatation or bring about toxic megacolon. This normally takes place spontaneously but in some cases can be preceded with barium enema, anticholinergic narcotics or even hyperkalemia. Bacterial growth characterized with the production of exotoxin can also take place like was the scenario in this case. Still when it is sudden, other complications like systemic toxicity, metabolic alterations and severe blood loss leading to anemia, are also exhibited. The sequela of long-term chronic ulcerative colitis is in most cases the colon carcinoma. This carcinoma occurs in approximately 5% of all the people suffering from ulcerative colitis (Hanauer 2001, pg 98). Those patients who suffer fewer relapses are always at reduced risk of this carcinoma compared to those who remain symptomatic over the years. Colonoscopy has been accepted across the medical board as the most effective method of screening ulcerative colitis patients for this form of carcinoma and hence was what we used to screen this patient. Ulcerative colitis patients are therefore supposed to undergo colonoscopy at intervals of one or two years for a period of about 8 years especially for those who have had it for a period of 15 years. This patient had already undergone one colonoscopy and was negative.

Patient care for ulcerative colitis

During the acute attacks, the patient always presents medical problems related to the deficit of fluid volume, changes in normal nutrition, electrolyte imbalance and even the potential of having skin breakdown in the anal region. Disturbances from rest and even sleep also occur. During care, it is important to note that long-term problems can also occur and are mostly related to anxiety, changes in one’s self concept and the fears of developing even more malignancies and social isolation.  All these were put into consideration when designing and interacting with this patient. It was necessary to provide more luxurious sleeping bedding to make the patient get some sleep. Counseling him to assure that his condition was under control and that he would receive the best management that would relieve his pain and return him to normalcy helped to ease out his anxiety. This counseling was also important in alleviating the fears that he was at risk of developing malignancies. An arrangement was made to make a family member come and stay with him in the hospital and as such stress associated with social isolation was reduced.

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The care involved the observation of the stool character as well as the number, the auscultation of the bowel sounds, weight monitoring, and establishment of the nutrition intake and output. This was done every day and sometimes periodically in a day depending on the severity of the symptoms exhibited. Other activities involve checking for any signs of bleeding and anemia, monitoring the blood gases and electrolytes, assessing the PH at specific time intervals to ascertain the acid-base balance in the body due to the electrolyte imbalance.  It was also important at this point in time to check for any abnormal ...

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