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Crohn Disease Patient Care: Pethidine

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Crohn Disease Patient Care: Pethidine Question: Discuss about the Crohn Disease Patient Care for Pethidine.   Answer: Priority Nursing Responsibilities and associated rationales related to the administration of pethidine to Harry. Pethidine (meperidine hydrochloride) is an opioid agonist analgesic. It acts as an agonist at specific receptors in the CNS to produce analgesia, euphoria and sedation. It’s therefore used as preoperative medication, support of anesthesia and obstetric analgesia. Nurses have the responsibility to watch the use of other medications when pethidine has been administered, this include medications (depressants) that affect the central nervous system i.e. anxiolytics, hypnotics antidepressants, alcohol, general anesthetics and other analgesics. They should also note respiratory rate, depth, and rhythm and size of pupils in Harry (Lewis et al., 2015). If respirations are 12/min or below and pupils are constricted or dilated or breathing is shallow, or if signs of CNS hyperactivity are present, the physician shold be informed; Monitor vital signs closely. Heart rate may increase markedly, and hypotension may occur. Meperidine may cause severe hypotension in postoperative patients and those with depleted blood volume; Chart patient’s response to drug and evaluate continued need.the nurses shold be aware of other effects as follows.CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflex. CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope. Dermatologic: Pruritus, urticaria, laryngospasm, bronchospasm, edema. GI: Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm, increased colonic motility in patients with chronic ulcerative colitis.GU: Ureteral spasm, spasm of vesical sphincters, urine retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency.Local: Tissue irritation and induration (subcutaneous injection).Major hazards: Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest. Other: Sweating, physical tolerance and dependence, psychological dependence (Bright et al., 2003).   Describtion of the structural and functional changes that occur in the pathogenesis of Crohn’s disease that led to Harry’s weight loss and the development of the stricture and fistula in Harry’s ileum. Crohn’s disease can have several patterns of involvement: jejunoileitis, ileitis, ileocolitis and colitis. Each subtype has a distinct clinical presentation and typical course. Patients with inflammation of the jejunum and ileum often present with cramping abdominal pain after meals and eventually develop diarrhea. These patients, many of whom are teenagers or young adults, may have prominent extraintestinal manifestations including arthritis, fever, skin lesions, and delayed growth. Ileitis causes discomfort 1–2 hours after meals. Patients lose weight because they eat less to avoid discomfort, thus Harry’s weight loss (Karamanakos et al., 2008). The inflammation in the ileum can extend transmurally into adjacent structures as tracks or fistulae, or can cause perforation of abscesses adjacent to the bowel. This form of Crohn’s disease is known as fistulizing or perforating. It has the worst prognosis of all the forms and often requires surgical resection after three or four years. Other patients with ileitis develop intestinal obstruction 8–10 years after the onset of disease because muscle hypertrophy and fibrosis narrow the lumen of the bowel. This form of Crohn’s disease is known as stricturing or stenosing. This explains the presence of stricture and fistula in Harry’s ileum (Cosnes et al., 2013). Crohn’s disease in the colon causes diarrhea and may be difficult to distinguish from ulcerative colitis.  Characteristics of the intravenous fluid that was ordered for Harry, and the rationale, related to Harry’s specific fluid balance status, for the administration of this intravenous fluid to Harry. In vitro measurements of the net transport and simultaneous bidirectional flux rates of water and electrolytes across the human colonic epithelium demonstrates that in CD there is a reversal of Na+ and water flux, and K+ secretion was increased (Barkas et al., 2013).Notable seasonal variations in vitamin D status and bone turnover markers have been reported in CD patients. Specifically, the 25-hydroxyvitamin D becomes significantly lower (up to 65%) in CD patients compared to healthy people, potentially due to reduced intestinal absorption, disturbed enterohepatic circulation and reduced nutrient intake of vitamin D. Infliximab is an intravenous fluid used in tretment of Corhon’s disase.It works by targeting a protein called tumour necrosis factor-alpha (TNF-alpha), which is believed to be responsible for the inflammation associated with Crohn’s disease. Infliximab can be used for children over six years old and adults.Infliximab is given as a drip into a vein in your arm (known as an infusion). Treatment with tumor necrosis factor (TNF)-α  antibodies is very successful as it helps in downregulating the inflammatory process (Sands et al., 2004).   References Barkas, F., Liberopoulos, E., Kei, A., & Elisaf, M. (2013). Electrolyte and acid-base disorders in inflammatory bowel disease. Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology, 26(1), 23.  Bright, E., Roseveare, C., Dalgleish, D., Kimble, J., Elliott, J., & Shepherd, H. (2003). Patient-controlled sedation for colonoscopy: a randomized trial comparing patient-controlled administration of propofol and alfentanil with physician-administered midazolam and pethidine. Endoscopy, 35(08), 683-687.  Cosnes, J., Gower–Rousseau, C., Seksik, P., & Cortot, A. (2011). Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology, 140(6), 1785-1794.  Karamanakos, S. N., Vagenas, K., Kalfarentzos, F., & Alexandrides, T. K. (2008). Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Annals of surgery, 247(3), 401-407.  Lewis, S. L., Maltas, J., Dirksen, S. R., & Bucher, L. (2015). Study guide for medical-surgical nursing: Assessment and management of clinical problems. Elsevier Health Sciences.  Sands, B. E., Anderson, F. H., Bernstein, C. N., Chey, W. Y., Feagan, B. G., Fedorak, R. N., … & Rachmilewitz, D. (2004). Infliximab maintenance therapy for fistulizing Crohn’s disease. New England Journal of Medicine, 350(9), 876-885.

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