Inflammatory Bowel Disease Custom Essay
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Name: RESEARCH ARTICLE SUMMARY – I need this on the 9th of November(2 pages and please use 1 reference)
Description: PURPOSE OF PROJECT: Search various databases to find relevant and current research articles on pathophysiology. Read and analyze current literature and research related to course modules. . RELATED COURSE OBJECTIVE: Discuss current research in pathophysiology related to select patient case studies of pathophysiological processes across the lifespan.
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POINTS COMMENTS
1) 10 POINTS: Article is a recent publication (within 5 years) from a scientific, advanced practice, peer-reviewed journal that reflects a research focus Points:
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2) 25 POINTS: Summarize the major concepts and/or research question and research design covered in the research article. Points:
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3) 25 POINTS: Briefly describe the pathophysiology related to the problem or diagnosis being studied. Use your own words to describe the pathophysiology. Points:
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4) 25 POINTS: Analyze the article and findings of the research presented ? include the following:
1) Identify how did this article changed the way you thought about the subject; and
2) Identify specific actions or implications for your future practice, for society and/or the profession. Points:
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5) 10 POINTS: Use APA format for article summary and reference citation. Use correct spelling, grammar and sentence structure.
Use your own words, only one quote per page is allowable.
Use subheadings representing sections 2, 3, and 4.
Paper length: 1-2 pages (excluding title page and references). Points:
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6) 5 POINTS: Submit an electronic copy of the research article or URL address that can be accessed and viewed by the faculty. Points:
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Name:RESEARCH ARTICLE SUMMARY
Description:PURPOSE OF PROJECT: Search various databases to find relevant and current research articles on pathophysiology. Read and analyze current literature and research related to course modules. . RELATED COURSE OBJECTIVE: Discuss current research in pathophysiology related to select patient case studies of pathophysiological processes across the lifespan.
****** I WANT AN ELECTRONIC COPY OF THE RESEARCH ARTICLE USED****
Please focus on the research article summary first. Then use the research summary article as one of the references for the case study***
***INSTRUCTIONS FOR THE CASE STUDY** I have the case study which would be utilized in the case study part of the project****
Content
Name: CASE STUDY PAPER (6 pages and 9 sources including the research article summary. This should be referenced well and the research article summary should be included on the reference page.)
Description: PURPOSE: Select a disease of interest to examine the relationship between normal physiology and pathophysiology occurring in a case scenario. Analyze information from history, physical and diagnostic tests to support the diagnosis and discuss the pathophysiology of the case. RELATED COURSE OBJECTIVES: (1) APPLY KNOWLEDGE of physiological alterations and pathophysiological processes to disorders and diseases manifested across the lifespan. (2) DISCUSS current research in pathophysiology related to select patient case studies of pathophysiological processes across the lifespan. (3) DESCRIBE the relevant findings of diagnostic or other evaluative studies as they relate to pathophysiological processes. (4) APPLY KNOWLEDGE about pathophysiological processes to clinical reasoning in advanced practice nursing.
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POINTS COMMENTS
1) 5 POINTS – CASE STUDY SUMMARY: Develop a summary of a patient case scenario (in paragraph format) to include only pertinent: (a) Presenting signs / symptoms (HPI ? History of Presenting Illness) (b) Relevant History & Physical findings (c) Concluding diagnosis. Do not include normal findings, unless it is a pertinent negative finding. Points:
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2) 40 POINTS – PATHOPHYSIOLOGY of the DIAGNOSIS: Explain the pathophysiology of the problem or diagnosis and, as appropriate, contrast with normal physiology. Points:
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3) 30 POINTS – PATHOLOGICAL BASIS OF MANIFESTATIONS: Identify the manifestations presented in the case study that are relevant to the diagnosis and explain the underlying pathophysiology leading to each of the manifestations. Points:
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4) 10 POINTS – EVALUATION / DIAGNOSTIC STUDIES: Identify and discuss appropriate evaluation techniques or diagnostic studies that are specific to the case study. Discuss only those studies that are specific/sensitive to help differentiate it from similar pathology. Note: No discussion of treatment Points:
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5) 10 POINTS – REFERENCES: All references used are to be (a) advanced practice level (b) peer-reviewed (c) published within the past 5 years (unless historical) Cite at least two references used that are research-based Points:
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6) 5 POINTS – Use APA format for discussion and reference citation and (a) include an introduction and conclusion (b) use correct spelling, grammar, sentence structure (c) limit use of quotations to one per page (d) use section headings (e) follow HIPPA requirements (patient data is not identifiable) Points:
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CASE STUDY TO BE USED
Case:
CC: Bloody diarrhea and abdominal pain
HPI: The patient, a 25-year-old white male, was well and in his usual state of excellent health until 3 months ago when he had 3 to 4 days of bloody diarrhea. The diarrhea recurred approximately 4 times in the past 2 months; typically, it would last for several days, then resolve. The diarrhea was described as loose to semi-solid bowel movements occurring 4 to 5 times per day, and usually associated with mild cramps and left lower quadrant abdominal pain. With each bowel movement, there was a small amount of bright red blood. The blood was seen on the toilet tissue and mixed with dark yellow to brown stool. The most recent episode was more severe and lasted longer than usual (more than 6 days). The patient denies fever, night sweats, nausea, vomiting, abdominal bloating or distension, fecal urgency, joint pain, and rash. He denies unusual food exposures or recent travel. There have been no ill contacts. He reports that he has lost about 10 pounds unintentionally over the last 3 months.
PMH: occasional tension headaches
Medications: ibuprofen 400 mg prn headaches
FH: mother has Crohn?s disease.
SH: pt smokes about 1ppd
PE: only abdominal tenderness on palpation/percussion
Labs: Hgb 12.5, HCT 36, the rest unremarkable, stool cultures are negative, stool analysis is negative for ova and parasites
Pts’ physician has clinical suspicion that this patient has IBD.
Questions:
What additional tests will pt?s physician need to support this provisional diagnosis and to differentiate b/w Crohn?s Disease (CD) and Ulcerative Colitis (UC)?
What clinical and diagnostic features can help to differentiate b/w UC and CD?
What are the common complications of IBD?
What are the goals of therapy for IBD?
If this patient had UC, what are possible treatment options?
If this patient had CD, what are possible treatment options?
What else dose this patient need to know?
Answers:
What additional tests will pt?s physician need to support this provisional diagnosis and to differentiate b/w Crohn?s Disease (CD) and Ulcerative Colitis (UC)?
The two primary procedures used to confirm the diagnosis of IBD are colonoscopy/sigmoidoscopy (C/S) and barium contrast radiography. C/S, rather than contrast radiography, is better to define the severity and extent of mucosal inflammation. In addition, endoscopic biopsy can be done with C/S to permit a histologic diagnosis. C/S findings correlate better with disease activity and thus can be used to monitor response to therapy. Multiple biopsies may be necessary to differentiate UC and CD.
What clinical and diagnostic features can help to differentiate b/w UC and CD?
Ulcerative Colitis Crohn’s Disease
Circumferential disease Eccentric disease
Regional (continuous disease) Skip lesions (discontinuous disease)
Rectum usually involved Rectum normal in 50%
Confluent superficial ulcers Confluent deep ulcers
No aphthous ulcers Aphthous ulcers early
Collar button ulcers Transverse and longitudinal ulcers
Terminal ileum usually normal Terminal ileum usually diseased
No fistulas/strictures Fistulas/strictures are common
High risk of colon cancer Low risk of colon cancer
Risk of toxic megacolon No toxic megacolon
What are the common complications of IBD?
Some of the complications associated with CD include abscesses, fistulas, strictures, obstruction, perianal disease. These complications are usually not present in pts with UC. Extra-intestinal manifestations of IBD include arthritis, hepatic and biliary complications, urinary tract complications, dermatologic complications, ocular complications, amyloidosis, and hypercoagulability. Additional complications may result from malabsorption; they include anemia, cholelithiasis, nephrolithiasis, and metabolic bone disease. Extra-intestinal complications are usually less frequent with UC. The development of toxic megacolon, however, is more common in pts with UC than in pts with CD and may require emergency colectomy.
What are the goals of therapy for pt with IBD?
The goals of therapy are to induce remission of symptoms and mucosal inflammation and to maintain remission. Management depends on the clinical severity of the acute episode and on the anatomic extent of disease. It is also important to maintain an adequate nutritional status, minimize side effects of medical treatments, and improve pt?s quality of life.
If this patient had UC, what are possible treatment options?
For acute management of mild-to-moderate colitis, initial treatment options include oral aminosalicylates, topical aminosalicylates, or topical corticosteroids, depending on disease location. Remember that topical (rectally administered) agents only go as far as the splenic flexure. They do not affect the ascending or transverse colon. Treatment generally is efficacious within 2 to 4 weeks. The advantages of topical therapy are a more rapid response and less frequent dosing. 5-ASA therapy is effective in inducing and maintaining remission. Oral therapy with sulfasalazine is effective in inducing and maintaining remission; however, treatment with sulfasalazine may be limited by intolerance to side effects caused by the sulfapyridine component. Oral and rectal preparations containing 5-ASA (mesalamine) alone (e.g., Asacol, Colazal, Dipentum, Pentasa) may be useful in patients who are unable to tolerate sulfasalazine. Topical corticosteroid therapy is effective in inducing remission, but has not been shown to be effective in maintaining remission. Some patients, unresponsive to therapy given by one route, may respond to combination therapy with topical and oral therapies. In patients who are unresponsive to these therapies, oral corticosteroids are recommended.
Immunomodulators, such as 6-mercaptopurine (6-MP) and azathioprine, are used in UC for their steroid-sparing effect in patients dependent on corticosteroids. These agents should not be considered until a trial of 5-ASA maintenance therapy is tried first.
UC is cured by surgery! Surgery today doses not involve long-term presence of an ostomy.
If the patient had CD, what are possible treatment options?
For mild-to-moderate acute CD, treatment with oral budesonide or systemic (oral) corticosteroids is considered first-line therapy. For mild disease involving the colon alone, 5ASP may be useful. Antimicrobials can be added for (ileo) colonic or perianal disease (metronidazole or ciprofloxacin). For moderate-to-severe acute CD, oral corticosteroids are considered first-line therapy. Remember: you need to start your maintenance medication when you start corticosteroids. The addition of azathioprine or 6-MP to corticosteroids may also allow use of lower corticosteroid doses or even allow them to be tapered off completely. Methotrexate has also been used for this purpose.
Patients treated acutely with corticosteroids often relapse within one year without some maintenance therapy. Corticosteroids are ineffective for maintaining remissions in Crohn’s disease. Azathioprine and 6-MP are the drugs-of-choice for maintenance therapy in CD to prevent relapse after steroid-inductive therapy. Use methotrexate only if AZA/6-MP intolerant or pt. fails them. Infliximab (TNF antagonist) may be useful if oral maintenance therapies do not work optimally.
What else dose this patient need to know?
You need to tell him to avoid NSAIDs (i.e. ibuprofen). Even though NSAIDs are anti-inflammatory agents, they make IBD symptoms worse. Even COX-2 selective NSAIDs do this. He?ll need something else for his headaches (eg, acetaminophen).
