ulcerative colitis

Ulcerative Colitis Nursing Diagnosis Interventions and Care Plans

Ulcerative Colitis NCLEX Review Care Plans

Nursing Study Guide on Ulcerative Colitis

Ulcerative colitis is a medical condition that involves the inflammation and ulcer formation in the lining of the colon (large intestine) and rectum.

It is a type of inflammatory bowel disease (IBD) that can have progressive symptoms over time and could be both debilitating and life-threatening if left uncontrolled.

There is no cure for ulcerative colitis yet, so the treatment is aimed at the reduction of signs and symptoms of this condition, and the prevention of complications.

Signs and Symptoms of Ulcerative Colitis

  1. Diarrhea that could have blood or pus
  2. Abdominal pain and cramping
  3. Rectal bleeding and/or rectal pain
  4. Tenesmus – increased urgency to defecate but inability to move bowels; accompanied by cramping rectal pain
  5. Inability to defecate despite urgency
  6. Weight loss
  7. Fatigue
  8. Fever

Children’s growth may also be affected by ulcerative colitis.

Types of Ulcerative Colitis

There are different types of ulcerative colitis depending on the affected location:

  1. Pancolitis – affecting the entire colon and includes severe bloody diarrhea and significant weight loss
  2. Left-sided colitis – inflammation extending from the rectum to the sigmoid and descending colon; includes pain on the left abdominal area
  3. Proctosigmoiditis – inflammation involving the sigmoid colon and rectum
  4. Ulcerative proctitis – inflammation that is on the anus and not extending to the rest of the colon; includes rectal bleeding as the main symptom

Causes and Risk Factors of Ulcerative Colitis

The exact cause of ulcerative colitis is still unknown, but there are a few suspected conditions that may aggravate it.

Diet and stress are two risk factors that can make Ulcerative colitis worse, but not necessarily cause it.

Some research studies are focused on the nature of ulcerative colitis being an autoimmune condition.

The immune system is the body’s way to protect itself by attacking foreign bodies like viruses and bacteria.

This process sometimes fails due to certain factors, making the body attack its own cells. Cells in the digestive tract may be mistakenly attacked, causing ulcerative colitis.

Another cause thought to explain ulcerative colitis is heredity. It is noted that family history is apparent in some, but not all, people with ulcerative colitis.

Statistics suggest that ulcerative colitis equally affects men and women. Its risk factors include the following:

  1. Age. Ulcerative colitis is typically diagnosed in people below 30 years of age. However, it can affect people at any age until after the age 60.
  2. Race or ethnicity. People of Ashkenazi Jewish descent poses the highest risk of getting ulcerative colitis. Their other white counterparts are also at high risk of getting it. Other races are recorded to develop it too.
  3. Family History. People with immediate family members with ulcerative colitis are recorded to have higher risk of developing the disease. 

Complications of Ulcerative Colitis

Further problems could develop if ulcerative colitis is left untreated.

These complications can range from a simple dehydration to a more life-threatening condition as thrombosis and toxic megacolon.

The most common and possible complications related to ulcerative colitis are as follows:

  1. Severe bleeding
  2. A hole in the wall of the large intestines or perforated colon
  3. Severe dehydration
  4. Bone loss (osteoporosis)
  5. Inflammation of skin, joints, and eyes
  6. Increased risk of colon cancer
  7. Rapidly swelling colon (toxic megacolon)
  8. Increased risk of blood clots in arteries and veins

Treatment of Ulcerative Colitis

There is a wide array of treatment options for patients with ulcerative colitis.

Treatments usually involve pharmacologic therapy and surgical procedures. Alternative treatments are also widely available.

Medications

Anti-inflammatory drugs. These are the first line of treatment for people with ulcerative colitis.

5-Aminosalicylates can be given by mouth or as suppository depending on the affected part of the colon.

On the other hand, corticosteroids are commonly prescribed if other treatments cause no response.

Immune system suppressors. These drugs work by prohibiting inflammatory response through suppressing the immune system.

They usually work better in combination with other drugs.

They usually require regular checking of the liver and pancreatic functions. Cyclosporines, like corticosteroids, are not indicated for long term use due to their side effects.

However, it is also the choice of drug when other treatments fail to work.

Biologics. Also called monoclonal antibodies, these drugs are usually prescribed to people with ulcerative colitis who cannot tolerate other treatments.

They work by stopping proteins in the body from causing inflammation.

Other medications can be used to treat symptoms related to ulcerative colitis. Examples are anti-diarrheal drugs, pain relievers, antispasmodics, and iron supplements.

Surgery

Surgery can be considered to treat ulcerative colitis. It usually involves a procedure called proctocolectomy or the removal of the entire colon and rectum.

A more sophisticated procedure called ileoanal anastomosis can be done to prevent the patient from needing an external pouch to collect stool.

It involves the attachment of the small intestines directly into the anus.

Lifestyle changes. It is widely believed that dietary changes can help manage the symptoms related to ulcerative colitis.

Limitations in dairy products can help manage diarrhea and abdominal pain.

Small frequent feeding can help pain related to feeding more tolerable.

Drinking plenty of fluids can prevent dehydration from diarrhea.

Stress management

It has been established that stress does not cause ulcerative colitis but can aggravate its symptoms.

Hence stress management is an accepted way to control flare ups. Exercising, biofeedback, and regular relaxation and breathing techniques can be done to control stress.

Nursing Care Plans for Ulcerative Colitis

Nursing Care Plan 1

 Nursing Diagnosis: Diarrhea related to inflammation of bowel as evidenced by loose, watery stools, abdominal cramping and pain, increased urgency to defecate, tenesmus, and increased bowel sounds

Desired Outcome: The patient will be able to return to a more normal stool consistency and frequency.

InterventionsRationales
1. Commence a stool chart. Use a standardized stool assessment tool such as Bristol stool chart.To monitor the patient’s bowel pattern.
2. Administer medications for ulcerative colitis as prescribed.To help decrease the frequency of stools and alleviate diarrhea, the doctor may prescribe: Anti-inflammatory drugs- first line of treatment for people with ulcerative colitis Immune system suppressors- work by prohibiting inflammatory response through suppressing the immune system Biologics- work by stopping proteins in the body from causing inflammationAnti-diarrheals and antispasmodics  
Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Avoid cold drinks. Check if the patient is in any fluid restriction before doing so.To help ensure that the patient will not have dehydration due to severe diarrhea. Cold drinks can increase intestinal motility.
Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and avoid high fiber, high fat foods.To relieve abdominal pain and cramping, alleviate diarrhea, and to promote healthy food habits. To avoid flare ups of ulcerative colitis. High fiber and high fat foods can cause irritation in the intestines.
Start the patient on a nothing by mouth status, and gradually progress to clear liquids, followed by bland diet, and the low residue diet. The patient can then have a low fat/residue, low fiber diet on a long-term basis, as recommended by the dietitian.Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. Gradual progression from NBM up to a low fat and low fiber diet can help manage the symptoms of Ulcerative colitis.  

Nursing Care Plan 2

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to altered absorption of nutrients secondary to Ulcerative colitis, as evidenced by diarrhea, abdominal pain and cramping, weight loss, nausea and vomiting, and loss of appetite

Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

InterventionRationale
Explore the patient’s daily nutritional intake and food habits (e.g. mealtimes, duration of each meal session, snacking, etc.)To create a baseline of the patient’s nutritional status and preferences.
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term nutrition and weight goals related to Ulcerative colitis.To effectively monitory the patient’s daily nutritional intake and progress in weight goals.
Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and high fiber, high fat foods.To relieve abdominal pain and cramping, alleviate diarrhea, and healthy food habits. Caffeine is a stimulant of gastric acid production, which can worsen the condition.  
Refer the patient to the dietitian.To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed Ulcerative colitis.  
Start the patient on a nothing by mouth status, and gradually progress to clear liquids, followed by bland diet, and the low residue diet. The patient can then have a low fat, low fiber diet on a long-term basis.Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. Gradual progression from NBM up to a low fat and low fiber diet can help manage the symptoms of Ulcerative colitis.  

Other Nursing Diagnoses:

  • Acute Pain
  • Ineffective Coping
  • Deficient Knowledge
  • Risk for Deficient Fluid Volume
  • Anxiety

Quiz for Ulcerative Colitis 5 Questions

Results

#1. Ulcerative colitis

Ulcerative colitis It is a type of inflammatory bowel disease (IBD) that can have progressive symptoms over time and could be both debilitating and life-threatening if left uncontrolled.

#2. Ulcerative colitis affects

Statistics suggest that ulcerative colitis equally affects men and women.

#3. What is Pancolitis?

Pancolitis – affecting the entire colon and includes severe bloody diarrhea and significant weight loss.

#4. True or False: Corticosteroids are commonly prescribed if other treatments cause no response.

Corticosteroids are commonly prescribed if other treatments cause no response.

#5. Limiting the following can help manage diarrhea and abdominal pain?

Limitations in dairy products can help manage diarrhea and abdominal pain.

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Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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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