Concept Map

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Running head: ULCERATIVE COLITIS CONCEPT

MAP 1

 

 

 

Ulcerative Colitis Concept Map

Student

Rasmussen College

 

 

 

Author Note

This paper is being submitted on September 5, 2013, for Ms. Carole Guye’s NUR2034C

Fundamentals of Professional Nursing.

 

 

 

ULCERATIVE COLITIS CONCEPT MAP 2

 

ULCERATIVE COLITIS (UC)

PATIENT TEACHING  Information about UC including acute

episodes, remissions and symptom mgmt.  Monitor for signs &symptoms of GI bleeding  Ostomy care management  Identify outpatient support groups  Self-management at home (Winkelman, 2013)

 

PATHOPHYSIOLOGY  Ulcerative Colitis (UC) usually begins in the rectum. It

may remain localized to the rectum (ulcerative proctitis) or extend higher, sometimes involving the entire colon. There is a sharp border between normal and affected tissue.

 It causes sores and inflammation of the lining, along with bleeding, pus, diarrhea and abdominal discomfort.

 Fistulas and abscesses do not occur  Toxic or fulminant colitis is when the ulcerations

extends through the intestinal wall, resulting in localized ileus and peritonitis. (Ulcerative Colitis, 2014 )

CAUSES  Not caused by stress or hypersensitivity to foods or

products but may trigger symptoms (Ulcerative Colitis, 2014)  Studies suggest caused by combination of heredity,

immune system, and environmental causes  Cause Unknown (What is Ulcerative Colitis, 2014)

NURSING CONSIDERATIONS  Ostomy or perineal wound care  Assess patient for pain pattern, occurrences  Monitor for signs/symptoms of GI bleeding  Monitor Vitals and Labs  Monitor pain and symptoms to maintain

comfort (Winkelman, 2013)

 

TREATMENTS & MEDICATIONS Treatments – No medical cure  Treatment goals to reduce symptoms:

1) Induce / maintain remission, 2) Improve quality of life, and 3) Individualize to treat patient

Diet & Nutrition  Avoid foods that aggravate UC

(What is Ulcerative Colitis, 2014)

Surgery  Total proctocolectomy with permanent

ileostomy – colon, rectum & anus removed  Total Colectomy – colon removal  Restorative Proctocolectomey with Ileal Pouch

Anal Anastomosis (RPC-IPAA) – create ileoanal reservoir

Medications  Route

– Enema – Rectal Foam – Suppository

– PO – IV

 Aminosalicylates – Reduce Inflammation – balsalazide – mesalamine – olsalazine – sulfasalazine

 Corticosteroids – Reduce immune system activity & Decrease inflammation – budesonide – hydrocortisone – methylprednisone – prednisone (Ulcerative Colitis, 2014)

 Immunomodulators – Decrease immune system activity – azathioprine – 6-mercaptopurine, or 6-MP

 Biologics – Decrease inflammation – adalimumab – golimumab – Infliximab – vedolizumab

 Other medications – Acetaminophen – mild pain – Antibiotics – prevent/treat infection – Loperamide – slow/stop diarrhea

(Ulcerative Colitis, 2014) – Cyclosporine – immunosuppresnt

(Cyclosporine, 2014)

SIGNS & SYMPTOMS  Bowel movements become looser and more urgent  Persistent diarrhea accompanied by abdominal pain

and blood in the stool (What is Ulcerative Colitis, 2014)  Anemia  Fever  Fatigue  Weight loss  Loss of appetite

 Skin lesions  Rectal Bleeding  Cramping abdominal pain  Growth failure in children  Loss of body fluid & nutrients

(Ulcerative Colitis, 2014)

DIAGNOSED  Physical Exam & Interview (health, diet, history)  Blood test – monitor anemia  Fecal matter – rule out bacterial/viral diarrhea causes  Sigmoidoscopy – see rectum/colon inflammation  Total Colonoscopy – visualize entire colon  Biopsy – sample of affect tissue removed for testing  Chromoendoscopy – blue spray during colonoscopy

to detect changes in lining (What is Ulcerative Colitis, 2014)  Computerized Tomography (CT) Scan – 3D image  Barium Enema X Ray – x-ray contrast (Ulcerative Colitis, 2014)

NURSING DIAGNOSES  Ineffective Coping r/t repeated episodes of diarrhea  Acute pain r/t abdominal cramp  Deficient fluid volume r/t frequent and loose stools  Impaired skin integrity r/t frequent stools, and

development of anal fissures  Imbalanced Nutrition: less than body requirements r/t

anorexia, decreased absorption of nutrients GI tract  Social Isolation r/t diarrhea (Ackley, 2014)

 

 

 

ULCERATIVE COLITIS CONCEPT MAP 3

References

Ackley, B. J. and Ladwig, G. B. (2014). Inflammatory Bowel Disease [Child and Adult].

Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (10th ed.).

Online: Mosby. Retrieved from Skyscape.

Ulcerative Colitis. (2014). National Digestive Disease Information and Kidney Diseases.

Retrieved from http://digestive.niddk.nih.gov/ddiseases/pubs/colitis/

What is Ulcerative Colitis? (2014). Crohn’s & Colitis Foundation of America. Retrieved from

http://www.ccfa.org/what-are-crohns-and-colitis/what-is-ulcerative-colitis/

Winkelman, C. (2013). Ulcerative Colitis. Clinical Company for Medical-Surgical Nursing:

Critical Thinking for Collaborative Care (7th ed.). Retrieved from Skyscape.

 
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Gastrointestinal Disorders Case

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BIO/1015 Week 4 Assignment 1 Discussion Question (***** Both Questions Answered + APA Format + Original Work + References ******)

 

Question 1

 

Alcohol Abuse

 

 

Mr. Wilko is a 40-year-old salesperson with a wife and three teenage children. He has recently begun to have a beer at lunch and a few drinks after work to reduce his work-related stress. An economic downturn in the housing industry has reduced the need for new home appliances and his income and sales record has been affected. Several other salespeople have been laid off at his firm. He has been told that if his sales and attendance records do not improve he will be fired. He and his wife are constantly arguing about finances and the children’s increasing demands for money. His drinking has increased to several beers at lunch and continued drinking after dinner. When he returns to work with alcohol on his breath, he is dismissed from his job. He continues to consume alcohol during the day as he attempts a job search. His wife is very concerned, as are his teenage children.

  • Mr. Wilko states he is a social drinker and “can stop at any time.” How accurate is his self-assessment? his self -assessment is not accurate for the simple fact that he considers himself a social drinker he is in denial that depression has set in.
  • What stressors are present in Mr. Wilko’s case? anxiety,depression
  • Why does Mr. Wilko continue to increase his alcohol intake? to surpress the feelings on depression or fear of losing his job he feels as if he continues to increase his drinking it will subside the feelings that he is having
  • What changes in liver function can Mr. Wilko expect if he continues to drink large amounts of alcohol? his liver function
  • Mr. Wilko complains to his wife that all the stress is causing “indigestion.” How do stress and alcohol consumption affect GI function?
  • Why is Mr. Wilko at greater risk of trauma? because he is consuming way too much alcohol at an increasing rate above normal which can lead to gastritis as well as pancreatitis

 

 

Question 2

 

Gastrointestinal Disorders Case

 

A 50-year-old man has been suffering from substernal pain for the last 5 months, particularly on waking up in the morning. He lost his job a year ago and was suffering from depression. He consumes about 12–16 cans of beer every day. He has lost his appetite too and says that eating aggravates pain.

  • Is this acute or chronic gastritis?  Chronic gastritis
  • What factors may lead to the development of gastritis? Loss of appetite black or tarry stools upset stomach depression
  • What investigation should be performed?
  • How can the patient be treated?

 

BIO 1015 Week 4

Week 4 assignments pathophysiology

 

 
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PATIENT CASE STUDY PROFILES – CANCER CAUSES

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Overview

Even though Tanya has the breast cancer gene, it does not necessarily mean she will ever develop breast cancer. However, she does have a chance. In this assignment, you are going evaluate the medical histories and breast cancer risks of Tanya’s friends, and estimate how they might reduce their risks. You will learn about the various risk factors, both genetic and lifestyle related, as well as prevention methods for breast cancer.

Instructions

For this assignment, you will use a Patient Case Study Profile Form to evaluate four patient profiles and their medical histories. Refer to the resources listed in the What You Need To Know section.

  1. Examine the four patient profiles and medical histories of Tanya’s friends (Mary, Paula, June, and Nora) with respect to their breast cancer risk.
  2. Use the various resources presented this week to help you analyze the cancer causes for each profile.
  3. Use the National Cancer Institute’s Breast Cancer Risk Assessment Risk Calculator Tool ( https://bcrisktool.cancer.gov/calculator.html  )to estimate the patient’s risks of developing breast cancer.
  4. Provide recommendations for each patient profile as to how they might reduce their cancer risk.
  5. Enter your recommendations in the Patient Case Study Profile Form next to each patient profile.
  6. Submit your completed document in the assignment area of the courseroom. All assignments are due at end of the week, unless otherwise specified.CU_Horiz_RGB Patient Profiles – Cancer Risks / Causes

    Week 8 Assignment

    Date: Click or tap here to enter text.

    Name: Click or tap here to enter text.

     

    Patient Profile – Cancer Causes Patient Recommendation
    Mary

    · She is a 64 year-old woman in generally good health.

    · She had her first child when she was 20.

    · She entered menopause at the age of 58.

    · She has been on hormone replacement therapy since entering menopause (for the past 6 years).

    · She has gained some weight since menopause.

    · Her mother had breast cancer diagnosed at age 37.

    · She had her first period at 13.

     

    		 Mary’s Recommendation:

    Click or tap here to enter text.
    Paula

    · She is 71 years of age, and currently has a urinary bladder tumor, with metastases in the ovaries and possible involvement of one lymph node.

    · She had her first period at 13.

    · Paula’s sister was diagnosed with breast cancer three years ago, then ovarian cancer two and a half years ago.

    · Paula’s mother died of lung cancer.

    · Two maternal uncles had pancreatic cancer.

    · Her maternal aunt had myeloma.

    · Her maternal grandmother has uterine cancer.

    · Paula’s sister had genetic testing, and was found to have a BRCA1 mutation.

    		 Paula’s Recommendation:

    Click or tap here to enter text.

     
    June

    · June is 58 years old.

    · She has been having “regular” mammograms (at two to three year intervals).

    · Her first period was at age 13.

    · She has had two pregnancies, resulting in two children, the first of which was at age 27.

    · She experienced menopause at age 51. She did not take hormone replacement therapy (HRT), but she used oral contraceptives for a total of four years in the past.

    · She has high blood pressure and high cholesterol. She has low levels of thyroid hormones.

    · She also has “weak bones.”

    · Her maternal aunt died of breast cancer in her 30’s.

    · Her mother died of a brain tumor at age 39.

    · Her father is alive and well at age 84.

    		 June’s Recommendation:

    Click or tap here to enter text.
    Nora

    · She is a 51-year-old, pre-menopausal woman.

    · Her last bilateral mammogram showed no evidence of a mass.

    · She had her first period at the age of 13.

    · She has had two pregnancies, each resulting in the birth of a child, the first of which was at age 32.

    · She used oral contraceptives for six years.

    · She has not taken any hormone-replacement therapy (HRT).

    · She smoked until age 26.

    · She consumes between 1 and 4 alcoholic drinks per week.

    · Her mother had breast cancer at 48 years of age, and now has lymphoma (at age 72).

    · Her maternal grandmother had breast cancer at age 47, and died of lung cancer.

    · Her paternal first cousin presently has breast cancer.

    · Her paternal aunt died “at a young age” from breast cancer.

    · Her father was of Ashkenazi Jewish heritage, and died of colon cancer at 66 years of age.

    		 Nora’s Recommendation:

    Click or tap here to enter text.

     

     

    © Capella University

 
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BiologyQuestions

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QUESTION 1

1. Having hair on the back of the hands is a dominant trait. If two people who heterozygous for the condition have children, what is the probability that they will have a child who does NOT have hair on the back of their hands?

    0%
    25% or 1/4
    50% or 2/4
    75% or 3/4
    100% or 4/4

8.5 points   

QUESTION 2

1. Who is responsible for sex determination in humans?

    male
    female

6.5 points   

QUESTION 3

1. In the pedigree below, all shaded individuals express the gene in question.  For example, Arlene “has” the trait, she displays the phenotype in question.  For example, if we were following the inheritance pattern of a widow’s peak, Arlene has a widow’s peak (that is NOT the trait here, just an example).  Unshaded individuals (blank circles and squares) do not manifest the trait in question, but their specific genotype is unknown – they could be heterozygous, homozygous dominant, or homozygous recessive.

2. What is the mechanism of inheritance of this trait? 

    recessive
    dominant

8.5 points   

QUESTION 4

1. In the pedigree below, all shaded individuals express the gene in question.  For example, Arlene “has” the trait, she displays the phenotype in question.  For example, if we were following the inheritance pattern of a widow’s peak, Arlene has a widow’s peak (that is NOT the trait here, just an example).  Unshaded individuals (blank circles and squares) do not manifest the trait in question, but their specific genotype is unknown – they could be heterozygous, homozygous dominant, or homozygous recessive.

What is Sam’s genotype?

 

    homozygous recessive (hh)
    heterozygous (Hh)
    homozygous dominant (HH)

 

8.5 points   

QUESTION 5

1. Normally when a person consumes a product that contains lactose (such as milk or cheese), the body breaks the sugar lactose down into galactose and glucose.  Galactosemia is disorder caused by a missing or defective enzyme which ends up causing galactose to accumulate to poisonous and sometimes deadly levels. Galactosemia is a recessive disorder. If two individuals are heterozygous for this trait, what is the probability that their children WILL HAVE galactosemia?

    0%
    1/4 or 25%
    2/4 or 50%
    3/4 or 75%
    4/4 or 100%

8.5 points   

 

 

QUESTION 6

1. Huntington’s disease is characterized by a late onset of nerve degeneration that leads to death.  The allele that causes the disease is dominant.  Lucille is homozygous dominant for the disease and Joe is homozygous recessive.  What is the probability that their children will have Huntington’s disease?

    0%
    1/4 or 25%
    2/4 or 50%
    3/4 or 75%
    4/4 or 100%

8.5 points   

QUESTION 7

1. Hemophilia, disease in which the blood lacks a clotting factor, is caused by an X linked recessive gene. Joe doe not have hemophilia and Lucille is heterozygous for the condition.  What is the chance that their MALE child will have hemophilia? (Note: you are calculating the probability for their MALE children only, in other words if they have 1 male child, what is the probability that he will be born with the disease?)

    0%
    1/4 or 25%
    2/4 or 50%
    3/4 or 75%
    4/4 or 100%

8.5 points   

QUESTION 8

1. In humans, having facial dimples is dominant to not having facial dimples. Mary has dimples, yet only 3 of her 10 children have dimples.  What must Mary’s genotype be?

    homozygous dominant
    heterozygous
    homozygous recessive
    has dimples
    does not have dimples

8.5 points   

 

 

QUESTION 9

1. Red-green color blindness is an X-linked recessive disorder.  If Allison is heterozygous (a carrier), and her husband, Michael, is NOT colorblind. What is the chance that their male children will be colorblind? (Note: you are calculating the probability for their MALE children only, in other words if they have 1 male child, what is the probability that he will be born with the disease?)

    0%
    25% or 1/4
    50% or 2/4
    75% or 4/4
    100% or 4/4

8.5 points   

QUESTION 10

1. Red-green color blindness is an X-linked recessive disorder. If Allison is heterozygous (a carrier), and her husband, Michael, is NOT colorblind. What is the chance that their female children will be colorblind? (Note: you are calculating the probability for their FEMALE children only, in other words if they have 1 female child, what is the probability that she will be born colorblind?)

    0%
    25% or 1/4
    50% or 2/4
    75% or 3/4
    100% or 4/4

8.5 points   

QUESTION 11

1. Match the term to its best description.

  the observable trait expressed by an organism
  the genes for a trait present in an organism
 

 

 

 

 

 the different varieties of a gene for a particular trait
  the state of having two identical alleles for a particular trait

 

 

 
A. homozygous
B. genotype
C. phenotype
D. alleles

 

 

QUESTION 12

1. Why do X-linked genetic disorders occur more frequently in males? Answer in a few short sentences.

 
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