Ulcerative Colitis

Ulcerative Colitis
An immunologically Inflammatory Bowel Disease
Cause ?
Unknown. Perhaps:
Genetic; Risk factors include a family history of the disease.
Bacterial Infection
Allergic reaction to food, milk
Overproduction of enzymes
Autoimmune disorders

Location:
The disease starts in the rectum and sigmoid colon and often extends upward to the entire colon.

This inflammatory disease attacks the mucosa and submucosa in the colonic area

Identifying signs and symptoms
Diarrhea; recurrent, bloody (sometimes with mucosa and pus) diarrhea with asymtomatic remissions (10-20 liquid stools a day).
Fever (during the acute attack)
Weight loss, dehydration
Abdominal pain

The progression of ulcerative colitis
Severity ranges from a mild locally disorder …
To a fulminate disease that may cause a perforated colon progressing to a potentially fatal peritonitis and toxemia

Show the pictures of how the disease progresses




Symptoms and (first) signs of perforated colon and peritonitis
Fever
Serve abdominal pain
Abdominal rigity and tenderness
Cool and clammy skin
Toxic Megacolon (the inflammatory process extends to the muscular is inhibiting its ability to contract and resulting in colonic pain)
Abdominal distention, decreased bowel sounds
High mortality rate

Other effects on the body
Skin: Erythema Nodosum, Pyoderma Gangrenosum
Eyes: Uveitis
Joints: Frequently swollen, erythematous and tender
Liver: Changes in structure and function (7 %)
Kidneys: Renal Stones
Blood: Anemia
The goals of medical treatment
Replace nutritional losses and blood volume
Control inflammation
Prevent complications as infections, malnutrition, pain

Medical Treatment
Adrenal Corticosteroids

Antibiotics

Antidiarrheal, Antiperistaltistics and Sedatives

General Managements (acute phase) I.V Fluids, TPN and Blood Replacement
Surgery (15-20 % of the patients)
Surgery is the treatment of the last resort if the patient has toxic megacolon

Or if the disease fails to respond to drugs or other supportive measures

Or if the patient finds the symptoms unbearable
Nursing Interventions
Nutrional Status: Assess for Dehydration
Monitor for signs and symptoms of electrolyte imbalances
Measure the patients general status: Fever, Pulse, Fluid intake and output
Pain: Location and the Nature of the pain
Gastro Intestinal: Diarrhea, Bowel Sounds
the appearance of stools
Nursing Interventions
Create an calm and clean (odourfree) environment
Protect the skin: Change position, air mattress, sheepskin, barrier cream, squirt bottle.
Lots of emotional support: Being attentive, encurage the patient to express his/her feelings. Calm enviroment.
Nursing interventions
Reducing Anxiety: The information should be tailored to the patients level of and desire for details
If surgery is the consequence of the disease show pictures of ileostomy the illustrations may help the patient to visual how it looks like
Balance Activity and Rest
What does it mean to have Ulcerative Colitis for the patients ?
Role- Identification as a child/ patient or as an adult
Nurses focus not only on the disease/physiological effects but also on the adolescents living conditions before the onset of the disease.
Example of questions to ask;
Ask the patient to describe an ordinary week.
How have the living conditions changed and what feelings do he/she have about the new situation.
And from that teach and prepare the patient.
Involve patient in care and treatment
Family patterns patients interaction with other family members (communication)