Ulcerative Colitis Signs and symptoms The disease is marked by periods of exacerbations and remissions Diarrhea ->10-20 liquid

stools a day Lower left Quad Pain -> Rebound tenderness to Right lower Quad Pain Intermittent tenesmus Rectal Bleeding ->anemia-> decreased hematocrit, decreased hemoglobin Anemia-> Pallor Weight Loss, Vomiting, and Diarrhea-> lead to anemia, nutrient deficiencies, decreased protein, electrolyte imbalance, decreased hematocrit, decreased hemoglobin, increased WBC-> fever, dehydration, hypocalcaemia Fever Dehydration Cramping (?) Urgent need to defecate OTHER: skin lesions-> erythema nodosum Eye lesion-> uveitis Joint abnormalities-> arthritis Liver disease-> Assessment Pallor, Tachycardia Tachypnea Hypotension Auscultate for bowel sounds, Palpate for abdominal distention, tenderness, Check if stool is positive for blood (r/o parasites, dysentery) Fever CBC will show decreased hematocrit, hemoglobin, decreased albumin, and electrolyte imbalances. Barium Enema will show mucosal irregularities, fecal strictures, fistula, shortening of colon, dilation of bowel loops. Sigmoidoscopy or colonoscopy will show will show friable, inflamed mucosa with exudate, and ulcerations. Therapeutic Management Goals: Reduce Inflammation Suppress inappropriate immune responses, Providing rest for bowel -> healing take place, Improve quality of life, Preventing or minimizing complications,

Oral fluids, low residue, high protein, high calorie diet with supplemental vitamin therapy, and iron replacement, -> nutritional needs, reduce inflammation, and control pain and diarrhea, fluid and electrolyte imbalance from dehydration, corrected by IV therapy, or oral fluids, Avoid foods that exacerbate the diarrhea, milk often causes diarrhea w/ lactose intolerance, cold foods and smoking are avoided. TPN may be necessary. Pharmacologic Therapy Sedatives Antidiarrheal Antiperistaltic

Used to rest the bowel, and continued until stool approaches normal frequency and consistency

Used to rest the bowel, and continued until stool approaches normal frequency and consistency

Aminosalicylate: eg. sulfasalazine (Azulfidine), Mild/Moderate inflammation which re used to prevent or reduce recurrences in long-term maintenance regimens Sulfa-free aminosalicylate: mesalamine (Asacol, Pentasa) are effective in preventing and treating recurrence of inflammation Antibiotics Metronidazole (Flagyl):are used for secondary infections -> abseccess, perforation, and peritonitis Corticosteroids: Used to treat severe and fulminant disease and can be administered orally (eg. prednisone (Deltasone) in outpatient treatment or parenteral eg; hydrocortisone (Solu-Cortef) in hospitalized patients. Topical (i.e rectal administration) corticosteroids hydrocortisone enema, budenoside (Entocort) are also widely used in treatment of distal colon disease When the dosage of corticosteroidsis reduced, or is stopped, the symptoms, the symptoms of disease may return. If corticosteroids are continued, adverse sequelae such as hypertension, fluid retention, cataracts, hirituism, and adrenal suppression, poor wound healing and loss of bone density may occur. Immunomodulators Azathioprine (AZA) 6-mercaptopurine Methotrexate Cyclosporine

Used in patients with severe disease who have not responded favorably to other therapies these medications are useful in maintenance regimens to prevent relapses. Newer biologic therapies using monoclonal antibiodies are being studied including natalizumb (Tysabri) for treating Crohns disease and infliximab (Remicade) for treating ulcerative colitis. Initial reports from clinical trials appear promising for both these agents athough the adverse effects of natalizumb may seriously limit its therapeutic effect. Nursing Interventions Maintaining Normal Elimination Pattern Identify any relationship between diarrhea and certain foods, activities, or emotional stressors. Identifying precipitating factors the frequency of bowel movements and the character consistency and amount of stool passed. Provide ready access to a bathroom, commode, and bedpan; keep the environment clean and odor free, (room deodorizers). It is important to administer antidiarrheal medications as prescribed, to record the frequency and consistency of stools. After therapy is initiated, encourage bed rest to decrease peristalsis.

Relieve Pain Ask about onset, before or after meals, during the night or before elimination is the pattern constant or intermittent, is it relieved with medications anticholinergics 30min before meals as prescribed to intestinal motility and analgesics for pain Position changes, local application of heat vide diversional activities and local application of Heat to reduce pain. Maintaining Fluid Intake Maintain an accurate record of I&O to detect fluid volume deficit. Monitor daily weights for fluid gains and losses Assess the patients for signs of fluid volume deficit. (Dry skin, mucous membranes, decreased skin turgor, oligouria, temperature, increase hematocrit, elevated urine specific gravity, hypotension) Encourage oral intake of fluids Monitor IV rate Maintain Optimal Nutrition Parenteral nutrition when symptoms of IBD are severe.

Accurate Input and Output

When parent has stabilized and oral feedings started, they should be high in protein and low in fat and residue. Note any intolerance: Nausea and vomiting, diarrhea, or abdominal distention Promoting Rest Recommend intermittent rest periods to conserve energy, reduce peristalsis, and reduce caloric needs. If on bed rest encourage patient to preform active exercise keeping the patient informed. rage stress reduction measures:

Breathing exercises

Preventing Skin breakdown xamine patients skin frequently care after each BM skin barrier Pressure relieved devices Monitor for Complications Serum electrolytes monitored daily dysrhythmias or changes in LOC immediately. Monitor rectal bleeding and administer blood component therapy and volume expanders as prescribed to prevent hypovolemia. Monitor blood pressure for hypotension an frequent hemoglobin and hematocrit levels Monitor for signs and symptoms of perforation( acute increase of abdmonial pain, rigid abdomen, vomiting, hypotension abdominal distention, decreased absent bowel sounds, change in mental status,fever, tachycardia, hypotension, dehydration, and electrolyte imbalance. Patient Teaching Do not abruptly stop medications especially corticosteroids Provide information about nutritional management; high protein, high calorie, and high vitamin, diet Review ileostomy care with the patient Encourage patient to keep record of foods that irritate the bowel Drink 8 glasses of water per day

Smeltzer S. C., Bare B. G. (2010). Brunner and Suddarths Textbook of Medical-Surgical

Nursing 12 ed Wilkins. th Ed. Lippincott Williams and _: 1) Assessment Findings, 2) Therapeutic Management, 3) Nursing Interventions, and 4) References. Oh sweet Lorraine Add king of anything Mirrors Get Lucky Radioactive Royals Gorilla