Ulcerative Colitis Pathophysiology, Podcast, and Nursing Care Plan

Ulcerative colitis

Ulcerative Colitis

Ulcerative colitis is an illness that is characterized by inflammation in the lining of the colon and rectum, Crohn’s disease is a similar condition and both are a form of inflammatory bowel disease (IBD).

Ulcerative colitis causes chronic ulcers and inflammation in the digestive tract, resulting in poor absorption of nutrients.

As the colon becomes swollen (edema), ulcers & bleeding can occur leading to perforation. This is a medical emergency.

In acute ulcerative colitis, the patient may develop ulcerations of the bowel, hemorrhages, vascular congestion, and edema.

This condition can become debilitating to the patient and even become life threatening. There is no cure, however, with treatment and care, the patient can have long remission periods.

 

Cause:

While the exact cause of ulcerative colitis is unknown, there are some theories:

  • Possibly autoimmune disorder
  • Genetics may play a factor
  • Environmental factors are also thought to be a possible cause

Ulcerative Colitis

 

Sign and symptoms of Ulcerative Colitis:

Symptoms may vary among affected people. Studies have proved that about 50 percent of people diagnosed with ulcerative colitis may have the following symptoms:

  • malnutrition
  • electrolyte imbalances
  • increased abdominal sounds
  • diarrhea
  • weight loss
  • bloody stools
  • abdominal pain
  • rectal pain
  • fever
  • joint pain
  • joint swelling
  • skin ulcers
  • mouth sores
  • Nausea
  • Vomiting

 

Diagnosis of Ulcerative Colitis:

Diagnosis by exclusion is made after ruling other possible causes out.  The following tests may be performed:

  • Blood tests to include CBC, CRP, and ESR.
  • Stool sample
  • Colonoscopy
  • Endoscopy
  • CT Scan
  • X-Rays
  • Flexible sigmoidoscopy
  • Barium Enema

 

 

Complications of Ulcerative Colitis:

 

  • thickening of the intestinal wall
  • severe dehydration
  • inflammation of skin, joints, and eyes
  • toxic megacolon (rapidly swelling colon)
  • liver disease (rare)
  • kidney stones
  • intestinal bleeding (can become severe)
  • perforation
  • sepsis – blood infection


 

Treatments of Ulcerative Colitis:

Both medications and surgery are used to treat ulcerative colitis. Surgery is utilized for those who are suffering from severe inflammation and life-threatening complications. Other treatments can include:  

    • Anti-inflammatory drugs

 

  • Immune system suppressors

 

 

  • Anti-diarrheal medications

 

 

  • Pain medications

 

 

  • Antibiotics

 

 

  • Iron

 

 

  • Proctocolectomy – removing entire colon and rectum

 

 

 

Nursing Interventions:

If patient is admitted with an acute phase of ulcerative colitis, the healthcare practitioner may order the following:

    • NPO status (nothing by mouth) bowel rest

 

  • IV fluids to maintain hydration and electrolytes

 

 

  • Limit activity

 

 

  • Monitor bowel sounds

 

 

  • Monitor for signs and symptoms of infection (peritonitis)

 

 

  • Monitor for signs and symptoms of hemorrhage (caused by ulcers).

 

 

  • As diet advances, place on a low fiber, high protein diet

 

 

  • Avoid the following foods: nuts, alcohol, caffeine

 

 

  • Need instruction on smoking cessation

 

 

Nursing Care Plan

Nursing Diagnosis

1. Acute pain related to inflammatory process of the Ulcerative Colitis as evidenced by patient rates pain at 8/10 on pain scale and states abdominal cramping and tenderness in abdomen.

Desired outcomes:

Patient will report a decrease in pain from 8 to 0 on the pain scale by discharge.

InterventionsRationals
InterventionsRationals
Assess level of pain using appropriate pain scale. Assess pain 30 minutes before and after pain medication is given.Using an appropriate age pain rating scale will help the healthcare providers monitor the level of pain and adjust pain medications as needed.
Administer pain medications as prescribed and indicated.Analgesics are helpful in relieving pain and helping in the recovery process.
Have patient maintain limited bedrest and activityThis will help to minimize pancreatic secretions and pain.
Incorporate nonpharmacologic measures to assist with control of pain.Ideally, the use of comfort measures will distract the patient from pain and may increase the effectiveness of pharmacological measures.

2. Risk for Infection related to development of inflammatory process or worsening Ulcerative Colitis.

Desired outcomes:

By discharge, the patient will remain free signs and symptoms of infection.

InterventionsRationals
InterventionsRationals
Assess vital signs including temperature every 4 hours and as needed. Report any abnormal findings to the healthcare provider.Fever is often one of the first signs of infection.
Assess mental status and level of consciousnesses every 4-6 hours.Mental status changes, confusion, or any deterioration from baseline can signify infection.
Report and note any abnormal laboratory values (i.e. elevated WBC count) to the healthcare provider.Certain abnormal laboratory results could be an indicator of infection.

Other possible nursing diagnosis:

Risk for imbalanced fluid volume

Impaired gas exchange

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

 

 

 

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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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