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75 Cards in this Set
- Front
- Back
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Define ulcerative colitis?
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a group of bowel diseases of unknown etiology, characterized by remissions and exacerbations ("flare-ups")...a chronic inflammatory process
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What part of the body does ulcerative colitis affect?
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mucosal lining of colon or rectum
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What can ulcerative colitis result in?
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loose stools containing
blood and mucus poor absorption of vital nutrients thickening of colon wall |
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Ulcerative colitis is characterized by?
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diffus inflammation of
intestinal mucosa which results in a loss of surface epithelium with ulceration and possible abscess formation |
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Where does ulcerative colitis generally begin?
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rectum and proceeds proximally toward cecum
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What happens in the acute stage?
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beings in rectum proceeding to cecum causing epithelial cell damage and loss, leaving areas of ulceration, redness, and bleeding
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What happens in the chronic stage?
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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
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Complications of UC are? (8)
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intestinal perforation with
resultant peritonitis and fistula (erosion into neighboring organs) formation toxic megacolon hemorrhage increased risk of colon cancer abscess formation malabsorption bowel obstruction extraintestinal clinical manifestations, such as arthritis |
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Features that set UC apart from Crohn's disease? (5)
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location
etiology peak incidence at age stools common complications |
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Etiology of UC is ______.
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unknown
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Peak incidence of UC is?
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15-25 yr and 55-65 yr and affects men and women equally and appears to run in families
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How many stools per day with UC?
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about 10-20 liquid, bloody stools per day
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Common complications of UC?
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hemorrhage
perforation fistulas nutritional deficiencies |
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What cultural group has a high risk of UC?
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Jewish origin
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How does hemorrhage/perforation occur in UC?
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lower GI bleeding results from erosion of bowel wall
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How do abscesses form with UC?
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localized pockets of infection develop in ulcerated bowel lining
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How does toxic megacolon form in UC?
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paralysis of colon causes dilation and subsequent bowel obstruction
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Why does malabsorption occur in UC?
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essential nutrients cannot be absorbed through the diseased intestinal wall, causing anemia and malnutrition (most common in Crohn's disease)
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How does bowel obstruction occur in UC?
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obstruction results from toxic megacolon or cancer
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Where do fistulas occur in UC?
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usually track between the bowel and bladder..pyuria and fecaluria result
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What can develop with UC if present 7-10 yrs or longer?
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colorectal cancer...accounts for about one-third of all deaths related to UC
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What are some extraintestinal complications of UC?
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arthritis
hepatic and biliary disease (esp cholelithiasis) oral and skin lesions ocular disorders (ex: iritis) |
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When assessing patient for acute UC, ask about the following symptoms?
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<abdominal pain?
cramping? urgency? <diarrhea with up to 10 to 20 liquid, bloody stools per day? tenesmus (uncontrollable straining)? <anorexia? <fatigue? 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 tenderness? rebound tenderness as found in peritonitis? possible febrile and tachycardia may indicate complications such as peritonitis, dehydration, bowel perforation |
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Having UC can be VERY TAXING on the patient's _________ status.
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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 |
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What two lab results might be low due to chronic blood loss?
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hematocrit
hemoglobin reflects anemia and chronic disease state |
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What might increase as a result of inflammatory disease?
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WBC and ESR (erythrocyte sedimentation rate)
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What electrolytes may be depleted secondary to frequent diarrheal stools and malabsorption resulting from diseased bowel?
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sodium
potassium chloride concentrations |
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What might be found in patient's with extensive UC disease?
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hypoalbuminemia (decreased serum albumin)
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To differentiate UC from viral and bacterial dysenteries, the following studies should be performed?
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examine stools for occult
blood, ova (eggs), parasites and specimens for culture |
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What radiographic study is done to differentiate UC from Crohn's disease?
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barium enemas with air contrast..in 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
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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 |
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The primary collaborative problem is Potential for?
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GI bleeding
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A common nursing diagnosis for UC is?
Imbalanced Nutrition: Less Than Body Requirements related to? |
inability to absorb food due to biologic factors
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A common nursing diagnosis for UC is?
Disturbed Body Image related to? |
biophysical factors and possible surgery
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A common nursing diagnosis for UC is?
Activity Intolerance related to? |
generalized weakness
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A common nursing diagnosis is Ineffective Coping related to?
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high degree of threat and uncertainty
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A common nursing diagnosis is
Risk for Deficient Fluid Volume related to? |
diarrhea
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Interventions for diarrhea include?
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monitor skin in perianal area
for irritation and ulceration get stool cultures antidiarrheal med rx weigh daily have patient record color, volume, frequency, and consistency of stools |
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Ulcerative colitis is a form of ______ ________ ________
(so is Crohn's disease) |
inflammatory bowel disease
(IBD) |
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What should patient eliminate from diet?
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gas-forming and spicy foods
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What food should the patient eliminate on a trial basis?
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foods containing lactose
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Patient's diet should be high in the following? (3)
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low fiber, high-protein, high-calorie
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What might patient do to rest the bowel?
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go NPO
go liquid diet |
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Nonsurgical management of UC includes?
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drug and diet therapy
physical and emotional rest |
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What is one of the primary treatments for UC?
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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 discomfort...be on lookout for adverse reactions such as blood dyscrasias (ex: leukopenia and anemia)
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Other 5-aminosalicylic acid ages used besides Azulfidine and PMS-Sulfasalazine are?
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mesalamine (Asacol, Pentasa,
Salofalk) 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 |
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Examples of corticosteroids that may be used during exacerbation of disease are?
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prednisone (Deltasone, Winpred)...may taper off over a 2-3 month period after discharge due to longterm ill effects of using steroids
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Immunosuppressive drugs are not effective alone, but combined with _________ are effective.
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steroids
monitor blood counts and note signs of infection with this combo |
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Antidiarrheal drugs are administered cautiously because?
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may precipitate colonic dilation and toxic megacolon
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Common antidiarrheal drugs include? (3)
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diphenoxylate hydrochloride
atropine sulfate (Lomotil) loperamide (Imodium) |
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A non-first-line drug which may be used for toxic megacolon or other severe complications is?
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infliximab (Remicade)
more commonly used for Crohn's disease |
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The main objective when choosing a diet for a UC patient is to avoid?
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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
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If following a low fiber diet, avoid what kinds of food?
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whole-wheat grains
nuts fresh fruits fresh vegetables |
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The following food items should be avoided?
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caffeinated beverages
pepper alcohol smoking (rest is good as it will reduce intestinal activity) |
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Alternative therapies for UC besides diet include?
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herbs, such as flaxseed
sleenium vitamin C biofeedback hypnosis yoga acupuncture ayurveda |
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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 hemorrhage colon cancer failure of conventional treatment |
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Preop care for a total proctolectomy includes prescription of?
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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
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During a total proctocolectomy, with a traditional ileostomy, what is removed and what is closed?
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removed:
colon rectum anus closed: anus |
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The surgeon brings the end of the terminal ileum out through the abdominal wall and forms a?
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stoma, or ostomy...usually placed in the right lower quadrant of abdomen, below belt line
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Normally, the liquid that comes out of the ileostomy post-op is what color?
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loose, dark green, containing some blood
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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)
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large intestine
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Following proctocolectomy with ileostomy, what happens to stools?
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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
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The priority for a person wearing a pouch systems is?
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prevention of skin problems due to output of proteolytic enzymes and bile salts
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Skin barriers used to prevent skin irritation in pouch systems includes?
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gelatin or pectin
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What surgical procedure might be done besides the traditional proctocolectomy with ileostomy?
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Lock's ileostomy or ileal reserve or continent ileostomy (all the same thing)...an 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
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Initially, a stoma holds only ___ to ____ mL; over time, the pouch capacity reaches _____ to _____ mL
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50-75
500-700 |
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Another surgical procedure is a total colectomy with ileoanal anastomosis. What is removed?
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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
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In young adults, to spare the rectal sphincter and eliminate the need for an ostomy, what procedure might be done?
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an ileoanal reservoir or J pouch may be created
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How might the nurse help the UC patient manage pain?
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use antidiarrheal medications
diet teaching meal planning teaching scrupulous skin care biofeedback music therapy guided imagery (all are used to decrease abdominal discomfort) |
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Use antidiarrheal medications carefully because?
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toxic megacolon may develop
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What might the physician prescribe to provide relief from pain and cramping that may occur with diarrhea?
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anticholinergics, such as dicyclomine (Bentyl, Bentylol)
(DON'T give opioids as they can mask symptoms of life-threatening complications) |
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What can a nurse teach the patient regarding perineal skin care?
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use mild soap and warm water
after each b.m. frequent sitz baths may be helpful use barrier creams, vitamin A and D ointment, aloe creams, medicated foam applications use of medicated foam applications, medicated wipes with witch hazel (Tuck's) instead of using toilet tissue |
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The primary responsibility of the nurse is to monitor the UC patient for?
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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)
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Besides the primary responsibilty of nurse to monitor for GI bleeding in stools, what are other interventions?
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monitor H & H
monitor electrolyte values VS fever? tachycardia? fluid volume depletion electrolyte imbalances severe abdominal pain changes in mental status of elderly |
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Home care management of UC patient includes?
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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 bloating 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 |
