Which is an appropriate nursing goal for the client who has ulcerative colitis? the client:

Summary

Ulcerative colitis is a relapsing chronic disease that has an unpredictable course. A relapse in the condition requires timely intervention and expert monitoring. A severe flare-up will often necessitate admission to hospital. This article provides an overview of the medical management of severe ulcerative colitis and the nursing interventions required.

Keywords

Gastrointestinal disorders, incontinence, inflammatory bowel disease, ulcerative colitis

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Aims and intended learning outcomes

This article aims to provide nurses with a comprehensive overview of the assessment and management of a patient presenting with a severe exacerbation of ulcerative colitis. After reading this article and completing the time out activities you should be able to

* Provide an overview of ulcerative colitis, including the causes and treatments.

* Describe the assessment and relevant investigations required for a patient presenting with a severe flare-up of the condition.

* Outline the medical management of a patient diagnosed with a severe flare-up of ulcerative colitis.

Discuss the nursing care of a patient with severe ulcerative colitis and give the rationale for each intervention.

Introduction

Ulcerative colitis and Crohn's disease are classified under the umbrella term of inflammatory bowel disease (IBD). While both conditions are similar, in terms of symptoms and treatments, there are also many differences between the two. Clinical guidelines for IBD, including the management of severe ulcerative colitis, have been produced by the British Society of Gastroenterology (BSG) (Carter et al 2004). However, these guidelines have not been reviewed to take into account emerging evidence and to ensure that practice is up to date. More recently, the IBD Standards Working Group (2008) has developed service standards for patients with IBD.

An IBD nurse-led service has been shown to reduce the admission rate of patients with IBD by 20 % (Nightingale et al 2000), and patients with the condition are generally more independent and mobile than other patients on the ward. These trends may reinforce a tendency to underestimate the severity of the disease. However, severe ulcerative colitis is potentially life-threatening and this patient group requires timely intervention and expert monitoring. Advances in medical therapy and expert surgical input have reduced the mortality rate to less than 1% (Truelove and Witts 1955).

Patients with severe ulcerative colitis who do not respond to intravenous corticosteroids have the option of either second-line medical therapies such as ciclosporin or anti-TNF therapy, or colectomy. Where surgery is indicated, this should be done in a timely fashion.

A delay in surgical intervention generally leads to poor patient outcomes. The UK IBD Audit in 2006 recorded 25 deaths that were directly linked to ulcerative colitis, with 15 of these cases involving patients who had undergone surgery (UK IBD Audit Steering Group 2007).

Overview of ulcerative colitis

Inflammation in ulcerative colitis affects the superfcial mucosa...

Ulcerative Colitis NCLEX Review and Nursing Care Plans

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 Diagnosis for Ulcerative Colitis

Nursing Care Plan for Ulcerative Colitis 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.

Nursing Care Plan for Ulcerative Colitis 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.

More Nursing Diagnosis for Ulcerative Colitis

Quiz for Ulcerative Colitis 5 Questions

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. (2022). 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

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