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02.06 Nursing Care and Pathophysiology for Ulcerative Colitis(UC)

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Pathophysiology: Ulcerative colitis is chronic inflammation and ulcers in the digestive tract on the innermost lining.

Overview

  1. Chronic inflammation of mucosa and submucosa in colon and rectum
  2. Progresses upward from rectum to cecum

Nursing Points

General

  1. Results in poor absorption of nutrients
  2. Edema + lesions + ulcers
    1. Possible perforation
  3. Exacerbation and remission episodes

Assessment

  1. 10-20 liquid stools per day
    1. Blood and mucus
  2. Malnutrition
  3. Dehydration
  4. Electrolyte imbalances
  5. Anorexia

Therapeutic Management

  1. Medications
    1. Corticosteroids
    2. Salicylates
    3. Immunomodulators
    4. Antidiarrheals
  2. Maintain NPO during acute phase
  3. Administering IV fluids and electrolytes
  4. Reduce intestinal activity
  5. Diet therapy
    1. Low residue
    2. High protein
    3. High calorie
    4. Vitamins and iron
    5. Avoid foods that may exacerbate symptoms
      1. Raw vegetables and fruits
      2. Nuts
      3. Popcorn
      4. Whole-grains
      5. Cereals
      6. Spicy

Nursing Concepts

  1. Fluid & Electrolytes
    1. Weigh daily
    2. Maintain accurate I&O
    3. Monitor & replace electrolytes
  2. Nutrition
    1. Encourage diet adherence
    2. Nutrient/Calorie dense foods
    3. Keep NPO in acute exacerbations
  3. Elimination
    1. Monitor stools for blood
    2. Administer Antidiarrheals
    3. Monitor for bowel perforation
      1. Rigid abdomen
      2. Pain & guarding
    4. Perform perineal care

Patient Education

  1. Appropriate dietary needs
  2. Medication instructions and side effects
  3. s/s to report to provider

Reference Links

Study Tools

Video Transcript

In this lesson we’re going to look specifically at Ulcerative Colitis and how we care for these patients.

In the inflammatory bowel disease lesson, we talked in more detail about the patho, so let’s just review. Ulcerative Colitis is an inflammatory condition that affects the colon and the rectum. You can see the patient develops edema, lesions, and ulcers in the lining of the colon. That means they struggle to absorb nutrients and fluids like they should. Not to mention, these ulcers can bleed. So these patients tend to have 10-20 bloody stools every day. UC can have periods of remission and exacerbation where patients feel fine one day and the next they can’t leave the bathroom.

Assessment findings will include abdominal pain, usually lower left quadrant pain. You can see how ulcerated the inner lining of the colon can be – this is where all of our nutrient and fluid absorption is going to happen – so if it’s damaged like this, patients can’t absorb like they should. We’ll see significant dehydration and lab work will show malnutrition and electrolyte imbalances. They will also very likely lose weight or be very thin. Also, as you can imagine, if you’re hurting and having multiple bouts of bloody diarrhea every day – you will likely lose your appetite or just not want to eat for fear of aggravating your symptoms. So we see anorexia a lot in this patients.

As far as therapeutic management, we talked about these specific medications in the inflammatory bowel disease intro lesson, but we’ll give anti-inflammatories and immunomodulators as well as antidiarrheals to manage symptoms. We want to monitor and administer IV fluids and electrolytes because we expect significant dehydration and electrolyte abnormalities. In acute exacerbations, we’ll keep them NPO with the goal of bowel rest and reducing the amount of activity within the colon. The other major thing we can do for patients with UC is adjust their diet. We want to make sure that whatever food they are taking in is high protein, high calorie, and nutrient dense. We also encourage them to supplement vitamins and iron that they may be lacking. And then we want them eating a low residue diet and avoiding things that are irritating and high residue. So they should eat fully cooked fruits and vegetables instead of raw, and take the skin off things like apples or potatoes. They should avoid popcorn and nuts and opt for white bread instead of whole grains. And then spicy foods can be very irritating so we want them to definitely avoid those.

As we discussed in the inflammatory bowel disease intro lesson, our top nursing priorities are fluid & electrolytes, nutrition, and elimination. We want to get daily weights and maintain accurate intake and output measurements so that we can keep them properly hydrated. And we’ll monitor and replace electrolytes as needed. We encourage them to eat those nutrient dense, low fiber foods. Sometimes you have to help them find what they like and can tolerate. And we do keep them NPO in acute exacerbations – sometimes they may even require TPN if it goes on for a while. In terms of elimination, we’ll monitor their stools for blood and administer antidiarrheal medications. We also want to perform really good perineal care and use barrier wipes or barrier cream to prevent irritation and breakdown around the anus. We also know that these patients are at risk for perforation if those ulcerations go through the full thickness of the bowel wall, so we are sure to monitor for that. If they do have a perforation, we’ll see a rigid abdomen that’s firm to the touch, plus severe pain and guarding. If we don’t address this, it can lead to peritonitis and sepsis. Make sure you check out the care plan and case study attached to this lesson to see more detailed nursing interventions and rationales.

So let’s recap. We know that Ulcerative Colitis is inflammation of the colon that leads to edema and ulcerations and causes 10-20 bloody stools a day. Patients experience diarrhea, malnutrition, and electrolyte imbalances because their colon can’t absorb like it’s supposed to. We use anti-inflammatory meds and IV fluids plus bowel rest during acute exacerbations. We want to encourage high calorie, high protein, low residue diet choices and provide vitamin supplements as needed. And remember we prioritize fluid & electrolyte status, nutrition, and elimination needs for these patients.

So, that’s it for ulcerative colitis. Make sure you check out all the resources attached to this lesson to learn more. Now, go out and be your best selves today. And, as always, happy nursing!

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