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75 Cards in this Set

  • Front
  • Back
Define ulcerative colitis?
a group of bowel diseases of unknown etiology, characterized by remissions and exacerbations ("flare-ups")...a chronic inflammatory process
What part of the body does ulcerative colitis affect?
mucosal lining of colon or rectum
What can ulcerative colitis result in?
loose stools containing
blood and mucus
poor absorption of vital
thickening of colon wall
Ulcerative colitis is characterized by?
diffus inflammation of
intestinal mucosa which
results in a loss of surface
epithelium with ulceration
and possible abscess
Where does ulcerative colitis generally begin?
rectum and proceeds proximally toward cecum
What happens in the acute stage?
beings in rectum proceeding to cecum causing epithelial cell damage and loss, leaving areas of ulceration, redness, and bleeding
What happens in the chronic stage?
fibrosis and retraction of bowel results in muscle hypertrophy, deposition of fat and fibrous tissue, and a narrower and shorter colon...may lead to increased risk of colon cancer
Complications of UC are? (8)
intestinal perforation with
resultant peritonitis and
fistula (erosion
into neighboring organs)
toxic megacolon
increased risk of colon
abscess formation
bowel obstruction
extraintestinal clinical
manifestations, such as
Features that set UC apart from Crohn's disease? (5)
peak incidence at age
common complications
Etiology of UC is ______.
Peak incidence of UC is?
15-25 yr and 55-65 yr and affects men and women equally and appears to run in families
How many stools per day with UC?
about 10-20 liquid, bloody stools per day
Common complications of UC?
nutritional deficiencies
What cultural group has a high risk of UC?
Jewish origin
How does hemorrhage/perforation occur in UC?
lower GI bleeding results from erosion of bowel wall
How do abscesses form with UC?
localized pockets of infection develop in ulcerated bowel lining
How does toxic megacolon form in UC?
paralysis of colon causes dilation and subsequent bowel obstruction
Why does malabsorption occur in UC?
essential nutrients cannot be absorbed through the diseased intestinal wall, causing anemia and malnutrition (most common in Crohn's disease)
How does bowel obstruction occur in UC?
obstruction results from toxic megacolon or cancer
Where do fistulas occur in UC?
usually track between the bowel and bladder..pyuria and fecaluria result
What can develop with UC if present 7-10 yrs or longer?
colorectal cancer...accounts for about one-third of all deaths related to UC
What are some extraintestinal complications of UC?
hepatic and biliary disease
(esp cholelithiasis)
oral and skin lesions
ocular disorders (ex: iritis)
When assessing patient for acute UC, ask about the following symptoms?
<abdominal pain?
<diarrhea with up to 10 to 20
liquid, bloody stools per
tenesmus (uncontrollable
what is usual bowel
elimination pattern?
color, consistency, and
character of stools?
presence or absence of blood
in all stools?
does diarrhea occur around
mealtime, pain, emotiona
distress, or activity?
does patient experience
extraintestinal symptoms
such as <arthritis>, mouth
sores, vision problems,
and <skin disorders>
increased or localized
rebound tenderness as found
in peritonitis?
possible febrile and
tachycardia may indicate
complications such as
peritonitis, dehydration,
bowel perforation
Having UC can be VERY TAXING on the patient's _________ status.
psychosocial.... due to
blood in diarrhea and the uncontrollability of diarrhea...activities at home may become restricted...dependent on a bathroom...eating becomes associated with cramping and pain plus increased stools...mealtimes become unpleasant...frequent trips to doctors....vigilant monitoring of colonic mucosa for dysplastic (irregular) changes is anxiety provoking
What two lab results might be low due to chronic blood loss?

reflects anemia and chronic
disease state
What might increase as a result of inflammatory disease?
WBC and ESR (erythrocyte sedimentation rate)
What electrolytes may be depleted secondary to frequent diarrheal stools and malabsorption resulting from diseased bowel?
chloride concentrations
What might be found in patient's with extensive UC disease?
hypoalbuminemia (decreased serum albumin)
To differentiate UC from viral and bacterial dysenteries, the following studies should be performed?
examine stools for occult
blood, ova (eggs),
parasites and specimens
for culture
What radiographic study is done to differentiate UC from Crohn's disease?
barium enemas with air early disease, b.e. will show incomplete filling as a result of inflammation and fine ulcerations along the bowel contour...these ulcerations appear deeper in more advanced disease
Priority nursing diagnoses for patients with UC are? (2)

Diarrhea related to?

Acute and Chronic Pain related to?
inflammation of bowel mucosa

inflammation and ulceration of bowel mucosa and accompanying skin irritation
The primary collaborative problem is Potential for?
GI bleeding
A common nursing diagnosis for UC is?
Imbalanced Nutrition: Less Than Body Requirements related to?
inability to absorb food due to biologic factors
A common nursing diagnosis for UC is?
Disturbed Body Image related to?
biophysical factors and possible surgery
A common nursing diagnosis for UC is?
Activity Intolerance related to?
generalized weakness
A common nursing diagnosis is Ineffective Coping related to?
high degree of threat and uncertainty
A common nursing diagnosis is
Risk for Deficient Fluid Volume related to?
Interventions for diarrhea include?
monitor skin in perianal area
for irritation and
get stool cultures
antidiarrheal med rx
weigh daily
have patient record color,
volume, frequency, and
consistency of stools
Ulcerative colitis is a form of ______ ________ ________
(so is Crohn's disease)
inflammatory bowel disease
What should patient eliminate from diet?
gas-forming and spicy foods
What food should the patient eliminate on a trial basis?
foods containing lactose
Patient's diet should be high in the following? (3)
low fiber, high-protein, high-calorie
What might patient do to rest the bowel?
go NPO
go liquid diet
Nonsurgical management of UC includes?
drug and diet therapy
physical and emotional rest
What is one of the primary treatments for UC?
the salicylate compound sulfasalazine (Azulfidine, PMS-Sulfasalazine)...may inhibit prostaglandin synthesis to reduce inflammation...may reduce recurrence of disease...may treat acute exacerbations of mild to moderate severity...take 2 to4 g daily...take with full glass of water and increase fluids throughout day...take after meals to prevent GI on lookout for adverse reactions such as blood dyscrasias (ex: leukopenia and anemia)
Other 5-aminosalicylic acid ages used besides Azulfidine and PMS-Sulfasalazine are?
mesalamine (Asacol, Pentasa,
olsalazine (Dipentum)is a
maintenance drug
balsalazide (Colazal)is used
for acute bouts

all used for antiinflammatory effects...don't crush, break, or chew tablets

sometimes mesalaminen suppositories can be used
Examples of corticosteroids that may be used during exacerbation of disease are?
prednisone (Deltasone, Winpred)...may taper off over a 2-3 month period after discharge due to longterm ill effects of using steroids
Immunosuppressive drugs are not effective alone, but combined with _________ are effective.

monitor blood counts and note signs of infection with this combo
Antidiarrheal drugs are administered cautiously because?
may precipitate colonic dilation and toxic megacolon
Common antidiarrheal drugs include? (3)
diphenoxylate hydrochloride
atropine sulfate (Lomotil)
loperamide (Imodium)
A non-first-line drug which may be used for toxic megacolon or other severe complications is?
infliximab (Remicade)

more commonly used for Crohn's disease
The main objective when choosing a diet for a UC patient is to avoid?
hyperactive bowel activity...NPO or TPN is advised...or elemental formulas such as Vivonex which is absorbed in the upper bowel, thus minimizing bowel stimulation....low fiber diet is good
If following a low fiber diet, avoid what kinds of food?
whole-wheat grains
fresh fruits
fresh vegetables
The following food items should be avoided?
caffeinated beverages

(rest is good as it will reduce intestinal activity)
Alternative therapies for UC besides diet include?
herbs, such as flaxseed
vitamin C
Surgical management involves a colectomy (total proctocolectomy)...
indications for this are?

(about 1/4 of UC clients will undergo this)
(an ileostomy may be performed, surgeon would consult with an ET or enterostomal therapist)
bowel perforation
toxic megacolon
colon cancer
failure of conventional
Preop care for a total proctolectomy includes prescription of?
an oral or parenteral antibiotic, such as neomycin sulfate (Mycifradin), as a bowel antiseptic...mechanical cleansing of bowel with enemas or laxatives may be required
During a total proctocolectomy, with a traditional ileostomy, what is removed and what is closed?

The surgeon brings the end of the terminal ileum out through the abdominal wall and forms a?
stoma, or ostomy...usually placed in the right lower quadrant of abdomen, below belt line
Normally, the liquid that comes out of the ileostomy post-op is what color?
loose, dark green, containing some blood
At some point after total proctocolectomy with ileostomy, the small intestine begins to take over what the _____ _______ used to do. (which is to absorb sodium and water)
large intestine
Following proctocolectomy with ileostomy, what happens to stools?
stool volume decreases...becomes thicker (pastelike)...turns yellow green or yellow brown...there is usually a sweet odor or little odor at all...if there's a foul odor, there may be blockage or infection
The priority for a person wearing a pouch systems is?
prevention of skin problems due to output of proteolytic enzymes and bile salts
Skin barriers used to prevent skin irritation in pouch systems includes?
gelatin or pectin
What surgical procedure might be done besides the traditional proctocolectomy with ileostomy?
Lock's ileostomy or ileal reserve or continent ileostomy (all the same thing) internal pouch that is drained by catheter...nursing care the same as for traditional type except immediately postop, an indwelling Foley catheter is placed in the pouch, which is connected to low intermittent suction and irrigated as ordered
Initially, a stoma holds only ___ to ____ mL; over time, the pouch capacity reaches _____ to _____ mL

Another surgical procedure is a total colectomy with ileoanal anastomosis. What is removed?
colon and rectum...ileum is sutured into the anal canal...the main complication occurring in 20% of clients is nocturnal leakage of stool...nursing care is same as colectomy....provide careful perineal care
In young adults, to spare the rectal sphincter and eliminate the need for an ostomy, what procedure might be done?
an ileoanal reservoir or J pouch may be created
How might the nurse help the UC patient manage pain?
use antidiarrheal medications
diet teaching
meal planning
teaching scrupulous skin care
music therapy
guided imagery

(all are used to decrease abdominal discomfort)
Use antidiarrheal medications carefully because?
toxic megacolon may develop
What might the physician prescribe to provide relief from pain and cramping that may occur with diarrhea?
anticholinergics, such as dicyclomine (Bentyl, Bentylol)

(DON'T give opioids as they can mask symptoms of life-threatening complications)
What can a nurse teach the patient regarding perineal skin care?
use mild soap and warm water
after each b.m.
frequent sitz baths may be
use barrier creams, vitamin
A and D ointment, aloe
creams, medicated foam
use of medicated foam
applications, medicated
wipes with witch hazel
(Tuck's) instead of using
toilet tissue
The primary responsibility of the nurse is to monitor the UC patient for?
s&s of GI bleeding...all stools are monitored for blood...notify doctor IMMEDIATELY if this occurs, as surgical intervention may be necessary (prepare for blood transfusion and blood products)
Besides the primary responsibilty of nurse to monitor for GI bleeding in stools, what are other interventions?
monitor H & H
monitor electrolyte values
fluid volume depletion
electrolyte imbalances
severe abdominal pain
changes in mental status
of elderly
Home care management of UC patient includes?
management of skin or joint
problems due to extra-
intestinal manifestations
reduce or control abdominal
pain, cramping, diarrhea
ongoing respiratory care
incision care
ostomy care
pain management
diet teaching to avoid
teaching concerning
immunosuppressive drugs..
report infection signs
help patient understand the
signs of colonic dilation
and perforation and to
report them to HCP
educate about ostomy care...
add salt and water to
diet as ileostomy promotes
loss of these elements
help with psychologic issues
of ostomy including sex,
self-image, self-esteem