Ulcerative Colitis

Introduction:

An inflammatory disease of the large intestine that affects the mucosal layer begin-
ning in the rectum and colon and spreading into the adjacent tissue. There are ulcer-
ations in the mucosal layer of the intestinal wall, and inflammation and abscess
formation occur. Bloody diarrhea with mucous is the primary symptom. There are
periods of exacerbations and remissions. Symptom severity may vary from mild to
severe. The exact cause is unknown, but there is increased incidence in people with
northern European, North American, or Ashkenazi Jewish origins. The peak inci-
dences are from mid-teen to mid-twenties and again from mid-fifties to mid-sixties.

PROGNOSIS

Patients with ulcerative colitis may have an increase in symptoms with each flare-
up of the disease. Malabsorption of nutrients can cause weight loss and health
problems. Some patients will need surgery to resect the affected area of the large
intestine, resulting in a colostomy, ileal reservoir, ileoanal anastomosis, or ileoanal
reservoir. There is an increased risk of colon cancer in patients with ulcerative coli-
tis. The patient is also at risk for developing toxic megacolon or perforating the
area of ulceration.

SIGNS AND SYMPTOMS
• Weight loss
• Abdominal pain
• Chronic bloody diarrhea with pus due to ulceration
• Electrolyte imbalance due to diarrhea
• Tenesmus—spasms involving the anal sphincter; persistent desire to empty
bowel

TREATMENT
• Keep stool diary to identify irritating foods.
• Low-fiber, high-protein, high-calorie diet.
• Administer antidiarrheal medications:
• loperamide
• diphenoxylate hydrochloride and atropine
• Administer salicylate medications to reduce inflammation within the intes-
tinal mucosa:
• sulfasalazine
• mesalamine
• olsalazine
• balsalazide
• Administer corticosteroids during exacerbations to reduce inflammation:
• prednisone
• hydrocortisone
• NPO for bowel rest during exacerbations.
• Administer anticholinergics to reduce abdominal cramping and discomfort:
• dicyclomine
• Surgical resection of affected area of large intestine.

NURSING DIAGNOSES

• Acute pain
• Diarrhea
• Impaired skin integrity

NURSING INTERVENTION

• Monitor intake and output.
• Monitor stool output, frequency.
• Weigh patient regularly.
• Sitz bath.
• Vitamin A & D ointment or barrier cream applied to skin.
• Witch hazel to soothe sensitive skin.
• Monitor for toxic megacolon (distended and tender abdomen, fever, elevated
WBC, elevated pulse, distended colon).
• Teach home care for new ostomy patients or refer to enterostomal therapist
for education:
• Teach proper skin care of perianal area to avoid skin breakdown.
• Avoid fragranced products which can be irritating.
• Teach dietary modification, and which foods to avoid.
• Teach medication use, schedule, and side effects.
• Teach importance of follow-up care.
• Teach wound care for postoperative patients.
• Disturbed body image