Inflammatory Bowel Disease 

Case Study The patient is an 11-year-old girl who has been complaining of intermittent right lower quadrant pain and diarrhea for the past year. She is small for her age. Her physical examination indicates some mild right lower quadrant tenderness and fullness. Studies Results Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL) Hematocrit (Hct), 28% (normal: 31%-43%) Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL) Meckel scan, No evidence of Meckel diverticulum D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL) 120 min: 6 mg/dL (normal: >20 mg/dL) Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in glucose) Small bowel series, Constriction of multiple segments of the small intestine Diagnostic Analysis The child’s small bowel series is compatible with Crohn disease of the small intestine. Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive regimen, and her condition improved significantly. Unfortunately, 2 years later she experienced unremitting obstructive symptoms and required surgery. One year after surgery, her gastrointestinal function was normal, and her anemia had resolved. Her growth status matched her age group. Her absorption tests were normal, as were her B12 levels. Her immunosuppressive drugs were discontinued, and she is doing well. 

Critical Thinking Questions 

1. Why was this patient placed on immunosuppressive therapy? 

2. Why was the Meckel scan ordered for this patient? 

3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards) 

4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease? 

Respond  on two different days who selected different factors than you, in one or more of the following ways:

Offer alternative diagnoses and prescription of treatment options for osteoarthritis and rheumatoid arthritis.

Share an insight from having read your colleague’s posting, synthesizing the information to provide new perspectives.

                                                        Main Post

Rheumatoid arthritis and osteoarthritis both involve inflammation and affect the joints. Rheumatoid arthritis is a chronic systemic inflammatory disease characterized by the persistent symmetric inflammation of multiple peripheral joints (Hammer & McPhee, 2019). Osteoarthritis is characterized by local areas of loss and damage of articular cartilage, inflammation, new bone formation of joint margins, subchondral bone changes, variable degrees of mild synovitis, and thickening of the joint capsule (Huether & McCance, 2017).

Pathophysiology

Osteoarthritis is most commonly from wear and tear of the cartilage around the joint; this can be enhanced form sports or overuse at a particular occupation. Pro-inflammatory factors are released, and catabolic activation begins resulting in a net degradation of cartilage extracellular matrix (Esa et al., 2019). The cartilage becomes and may be absent over some areas, leaving the bone unprotected (Huether & McCance, 2017). Rheumatoid arthritis pathophysiology involves the destruction of the synovial linings that protect the joints; these linings provide nutrients and lubrication for the articular cartilage. Hammer and McPhee (2019) explain that enhanced pro-inflammatory cytokine production is a dominant feature of rheumatoid arthritis. 

Gender and Ethnicity’s Impact 

Rheumatoid arthritis is most typically a persistent, progressive disease presenting in women in the middle years of life (Hammer & McPhee, 2019). Studies have shown that hormones play a role in the development of rheumatoid arthritis, specifically when women are undergoing hormonal changes at childbirth and menopause. All these phenomena have in common an acute decline in ovarian function and/or in oestrogen bioavailability (Alpízar-Rodríguez, Pluchino, Canny, Gabay, & Finckh, 2016). The peak incidence in females coincides with menopause when the ovarian production of sex hormones drops markedly (Karsdal, Bay-Jensen, Henriksen, & Christiansen, 2012). No evidence supports that ethnicity is a factor in rheumatoid arthritis. Several studies performed, but due to their limitations and sample sizes, they could not be validated.

Although osteoarthritis incidence rates are quite similar in men and women, after age 50, women typically are more severely affected (Huether & McCance, 2017).  Following the same pattern as rheumatoid arthritis with menopausal and post-menopausal women. Several experimental studies have shown that estrogens are implicated in the regulation of cartilage metabolism (Mahajan & Patni, 2018). Again for osteoarthritis, no research clearly recognized that ethnicity enhanced the disease process. 

Conclusion

Both osteoarthritis and rheumatoid arthritis are the two most common forms of arthritis that affect millions of people. The symptoms can be very similar, and a thorough examination should be done to distinguish between the two. Osteoarthritis usually affects one joint, while rheumatoid arthritis affects several joints at once. 

                                                                                                                           References

Alpízar-Rodríguez, D., Pluchino, N., Canny, G., Gabay, C., & Finckh, A. (2016). The role of female hormonal factors in the development of rheumatoid arthritis. Rheumatology. https://doi-org.ezp.waldenulibrary.org/10.1093/rheumatology/kew318

Esa, A., Connolly, K., Williams, R., & Archer, C. (2019). Extracellular Vesicles in the Synovial Joint: Is there a Role in the Pathophysiology of Osteoarthritis? Malaysian Orthopaedic Journal, 13(1), 1-7. https://doi-org.ezp.waldenulibrary.org/10.5704/MOJ.1903.012

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Karsdal, M. A., Bay-Jensen, A. C., Henriksen, K., & Christiansen, C. (2012). The pathogenesis of osteoarthritis involves bone, cartilage and synovial inflammation: may estrogen be a magic bullet? Menopause International, 18(4), 139–146. https://doi-org.ezp.waldenulibrary.org/10.1258/mi.2012.012025

-org.ezp.waldenulibrary.org/10.4103/jmh.JMH_157_18doi(4), 171. https://9 Journal of Mid-life Health,, R. (2018). Menopause and Osteoarthritis: Any Association? Patni, A., & Mahajan

  Week 2 Discussion 2 Post.doc (59 KB) 

4-The main problem that is affecting the organization that I work for is the problem of staff shortage. This has resulted in the nurses and other personnel being over worked and in some cases having to work longer hours. However, addressing this problem is proving to be a difficult job as one would think that the organization should just hire new nurses and other staff to solve the problem. However, this has not been a solution to the facility for different issues. One of the main issue that has resulted in the facility being unable to hire more staff is the decrease in finances in the facility (Jones, 2005). Therefore, the facility has been unable to successfully hire new nurses so as to be able to solve the problem of nurse shortage. As time goes, the allocations that are made to the facilities have reduced significantly as well as the decrease in the money that patients are paying as the government aims at providing affordable care.

The first solution to this problem is that the facility should begin by finding a new source of income. This means that the facilities need to engage in extra activities that will ensure that they are able to raise some money (Berent & Anderko, 2011). This money can be used to boost the allocations that they have as well as the money they get from treatments to ensure that they are able to have enough money to ensure that they are able to hire as well as pay more nurses and other workers. Further, facilities need to engage in the process of giving scholarships to nursing students. This will look to support education and training of nurses that will in turn increase the number of nurses in the country. One of the reasons that the facilities have been unable to fill the gap is because there are not enough nurses in the country.

References

Berent, G. R., & Anderko, L. (2011). Solving the Nurse Faculty Shortage. Nurse Educator, 36(5), 203-207. doi:10.1097/nne.0b013e3182297c4a

Jones, D. (2005). California nurse leaders address the state’s nurse shortage. Nurse Leader, 3(1), 46-49. doi:10.1016/j.mnl.2004.11.011

5-Developing a model that there are nurses that are experts in education and research therefore keeping the staff and organization up to date on evidence based practices. Staffing on the floors must be maintained and the funding for the evidence-based practices could be with each specialty such as ICU,ER, Peds, GI, family medicine, etc. Depending on the staffing and patient population there may be a higher demand for more than one evidence-based practice nurse. “Evidence-based health care makes a positive difference for patients and their families; excellence in providing that care is a pressing need. Adoption of evidence-based practice (EBP) leads to important improvements in outcomes for patients and their families as well as for clinicians and organizations. Health care-acquired conditions and complications are reduced, patient symptoms are improved, and cost of care is less.

Building support, however, for nurse-led EBP is a journey of persistence that requires a strategic and multifaceted approach. As part of their daily work and as members of interprofessional teams, nurses can lead the way in advancing EBP. A clear vision, infrastructure, climate, resources, formal reporting, and recognition—discussed below—are essential elements of the journey” (Sigma, 2018).

Sigma. (2018). Journey to evidence-based healthcare. Retrieved from: https://www.reflectionsonnursingleadership.org/features/more-features/journey-to-evidence-based-healthcare

,

6-Pay and benefits are one important factor for many health care organizations especially with budget cuts and higher acuity of patients. Some staff are mandated and burnout occurs causing an increase in staff shortage. How would you see this as a possible solution in your own facility or how likely would you see the ability to implement this intervention into your own facility?

4-The main problem that is affecting the organization that I work for is the problem of staff shortage. This has resulted in the nurses and other personnel being over worked and in some cases having to work longer hours. However, addressing this problem is proving to be a difficult job as one would think that the organization should just hire new nurses and other staff to solve the problem. However, this has not been a solution to the facility for different issues. One of the main issue that has resulted in the facility being unable to hire more staff is the decrease in finances in the facility (Jones, 2005). Therefore, the facility has been unable to successfully hire new nurses so as to be able to solve the problem of nurse shortage. As time goes, the allocations that are made to the facilities have reduced significantly as well as the decrease in the money that patients are paying as the government aims at providing affordable care.

The first solution to this problem is that the facility should begin by finding a new source of income. This means that the facilities need to engage in extra activities that will ensure that they are able to raise some money (Berent & Anderko, 2011). This money can be used to boost the allocations that they have as well as the money they get from treatments to ensure that they are able to have enough money to ensure that they are able to hire as well as pay more nurses and other workers. Further, facilities need to engage in the process of giving scholarships to nursing students. This will look to support education and training of nurses that will in turn increase the number of nurses in the country. One of the reasons that the facilities have been unable to fill the gap is because there are not enough nurses in the country.

References

Berent, G. R., & Anderko, L. (2011). Solving the Nurse Faculty Shortage. Nurse Educator, 36(5), 203-207. doi:10.1097/nne.0b013e3182297c4a

Jones, D. (2005). California nurse leaders address the state’s nurse shortage. Nurse Leader, 3(1), 46-49. doi:10.1016/j.mnl.2004.11.011

5-Developing a model that there are nurses that are experts in education and research therefore keeping the staff and organization up to date on evidence based practices. Staffing on the floors must be maintained and the funding for the evidence-based practices could be with each specialty such as ICU,ER, Peds, GI, family medicine, etc. Depending on the staffing and patient population there may be a higher demand for more than one evidence-based practice nurse. “Evidence-based health care makes a positive difference for patients and their families; excellence in providing that care is a pressing need. Adoption of evidence-based practice (EBP) leads to important improvements in outcomes for patients and their families as well as for clinicians and organizations. Health care-acquired conditions and complications are reduced, patient symptoms are improved, and cost of care is less.

Building support, however, for nurse-led EBP is a journey of persistence that requires a strategic and multifaceted approach. As part of their daily work and as members of interprofessional teams, nurses can lead the way in advancing EBP. A clear vision, infrastructure, climate, resources, formal reporting, and recognition—discussed below—are essential elements of the journey” (Sigma, 2018).

Sigma. (2018). Journey to evidence-based healthcare. Retrieved from: https://www.reflectionsonnursingleadership.org/features/more-features/journey-to-evidence-based-healthcare

,

6-Pay and benefits are one important factor for many health care organizations especially with budget cuts and higher acuity of patients. Some staff are mandated and burnout occurs causing an increase in staff shortage. How would you see this as a possible solution in your own facility or how likely would you see the ability to implement this intervention into your own facility?

4-The main problem that is affecting the organization that I work for is the problem of staff shortage. This has resulted in the nurses and other personnel being over worked and in some cases having to work longer hours. However, addressing this problem is proving to be a difficult job as one would think that the organization should just hire new nurses and other staff to solve the problem. However, this has not been a solution to the facility for different issues. One of the main issue that has resulted in the facility being unable to hire more staff is the decrease in finances in the facility (Jones, 2005). Therefore, the facility has been unable to successfully hire new nurses so as to be able to solve the problem of nurse shortage. As time goes, the allocations that are made to the facilities have reduced significantly as well as the decrease in the money that patients are paying as the government aims at providing affordable care.

The first solution to this problem is that the facility should begin by finding a new source of income. This means that the facilities need to engage in extra activities that will ensure that they are able to raise some money (Berent & Anderko, 2011). This money can be used to boost the allocations that they have as well as the money they get from treatments to ensure that they are able to have enough money to ensure that they are able to hire as well as pay more nurses and other workers. Further, facilities need to engage in the process of giving scholarships to nursing students. This will look to support education and training of nurses that will in turn increase the number of nurses in the country. One of the reasons that the facilities have been unable to fill the gap is because there are not enough nurses in the country.

References

Berent, G. R., & Anderko, L. (2011). Solving the Nurse Faculty Shortage. Nurse Educator, 36(5), 203-207. doi:10.1097/nne.0b013e3182297c4a

Jones, D. (2005). California nurse leaders address the state’s nurse shortage. Nurse Leader, 3(1), 46-49. doi:10.1016/j.mnl.2004.11.011

5-Developing a model that there are nurses that are experts in education and research therefore keeping the staff and organization up to date on evidence based practices. Staffing on the floors must be maintained and the funding for the evidence-based practices could be with each specialty such as ICU,ER, Peds, GI, family medicine, etc. Depending on the staffing and patient population there may be a higher demand for more than one evidence-based practice nurse. “Evidence-based health care makes a positive difference for patients and their families; excellence in providing that care is a pressing need. Adoption of evidence-based practice (EBP) leads to important improvements in outcomes for patients and their families as well as for clinicians and organizations. Health care-acquired conditions and complications are reduced, patient symptoms are improved, and cost of care is less.

Building support, however, for nurse-led EBP is a journey of persistence that requires a strategic and multifaceted approach. As part of their daily work and as members of interprofessional teams, nurses can lead the way in advancing EBP. A clear vision, infrastructure, climate, resources, formal reporting, and recognition—discussed below—are essential elements of the journey” (Sigma, 2018).

Sigma. (2018). Journey to evidence-based healthcare. Retrieved from: https://www.reflectionsonnursingleadership.org/features/more-features/journey-to-evidence-based-healthcare

,

6-Pay and benefits are one important factor for many health care organizations especially with budget cuts and higher acuity of patients. Some staff are mandated and burnout occurs causing an increase in staff shortage. How would you see this as a possible solution in your own facility or how likely would you see the ability to implement this intervention into your own facility?