Image result for ulcerative colitis Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.

2.  Ulcerative colitis is a recurrent ulcerative &
inflammatory disease of the mucosal &
submucosal layers of the colon & rectum.
 The peak incidence is between 30 & 50 years
of age.
 10% to 15% of the patients develop carcinoma
of the colon.

3. ETIOLOGY
 Genetic predisposition.
 Environmental factors may trigger disease (viral
or bacterial pathogens, dietary).
 Immunologic imbalance or disturbances.
 Defect in intestinal barrier causing
hypersensitive mucosa & increased
permeability.
 Defect in repair of mucosal injury, which may
develop into a chronic condition.

4. Etiological factors
superficial mucosa of colon
diffuse inflammations, or shedding of the colonic
epithelium.
Bleeding occurs
ulcerations.
(The mucosa becomes edematous & inflamed. )
The disease process usually begains in the rectum
& spreads proximally to involve the entire colon.

5.  Diarrhea
 painful straining
 Increased bowel sounds
 There often is weight loss, fever, dehydration,
hypokalemia, anorexia, nausea & vomiting, iron-
deficiency anemia
 Crampy abdominal pain.
 Anal area may be irritated & reddened; left lower
abdomen may be tender on palpation.
 There is tendency for the patient experience
remissions & exacerbations.
 Increased risk of developing colorectal cancer.
 May inhibit extracolonic manifestations of eye
(irritis), joint (polyarthritis), & skin complaints
(erythema nodosum, pyoderma gangrenosum).

6. DIAGNOSTIC EVALUATION:-
Diagnosis is based on
a combination of laboratory,
radiologic, endoscopic, & histologic
findings.
Laboratory Tests:-
 Stool examination to rule out
enteral pathogens; fecal analysis
positive for blood during active
disease.
 Complete blood count- hemoglobin
& hematocrit may be low due to
bleeding; WBC may be increased.
 Elevated erythrocyte sedimentation
rate (ESR).
 Decreased serum levels of
potassium, magnesium, & albumin

7. Other Diagnostic Tests:-
 Barium enema
to assess
extent of
disease &
detect
Pseudopolyps,
carcinoma, &
strictures.

8.  Flexible proctosigmoidoscopy/colonoscopy
findings reveal mucosal erythema & edema,
ulcers, inflammation that begins distally in the
rectum & spreads proximally for variable
distances.
 CT scan can identify complications such as
toxic megacolon.
 Rectal biopsy –
differentiates from other inflammatory
diseases or cancer.

9. General Measures:-
 Bed rest, I.V. fluid replacement, clear liquid diet.
 For patients with severe dehydration &
excessive diarrhea, fluid may be recommended
to rest the intestinal tract & restore nitrogen
balance.
 Treatment of anemia- iron supplements for
chronic bleeding, blood replacement for
massive bleeding.

10. Drug Therapy
 Sulfasalazine (Azulfidine)- mainstay drug for acute &
maintenance therapy. Given orally & is systemically
absorbed.
 Oral salicylates, such as mesalamine (Pentasa),
olsalazine (Dipentum
 Mesalamineenema available for protosigmoiditis;
suppository for proctitis.
 Corticosteroids- treated with 5-aminosalicylic acid
preparations to benefit from their potential steroid-
sparing effects.
 Immunosuppressive drugs- purine analogues, 6-
mercaptopurine, azathioprine may be indicated when
patient is refractory or dependent on corticosteroids.
 Antidiarrheal medications may be prescribed to control
diarrhea, rectal urgency & cramping, abdominal pain;

11. I. Noncurative approaches (possible
curative, reconstructive procedure at later
date):
a)Temporary loop colostomy for
decompression if toxic megacolon present
without perforation.
b)Subtotal colectomy, ileostomy, &
Hartmann’s pouch.
c)Colectomy with ileorectal anastomosis.

12. Loop colostomy Colostomy
Hartmann’s pouch

13. . Reconstructive procedures –
curative:
II. Reconstructive procedures – curative:
a)Total proctocolectomy with permanent end-
ileostomy.
b)Total proctocolectomy with continent
ileostomy
c) Total colectomy with ileal reservoir- anal (or
ileal reservoir-distal rectal) anastomosis –
procedure of choice. Multiple reservoir
shapes can be surgically created; however,
the J-shaped pouch (reservoir) is the easiest
to construct.
d)The ultimate surgical goal is to remove the
entire colon & rectum to cure patient of

14. COMPLICATIONS
 Perforation, hemorrhage
 Toxic megacolon- fever, tachycardia, abdominal
distention, peritonitis, leukocytosis, dilated colon
on abdominal X-ray – life-threatening
 Abscess formation, stricture, anal fistula
 Malnutrition, anemia, electrolyte imbalance
 Skin lesions (erythema nodosum, pyoderma
gangrenosum)
 Arthritis, ankylosing spondylitis
 Colon malignancy
 Liver disease (sclerosing colagitis)
 Eye lesions (conjunctivitis)
 Growth retardation in prepubertal children
 Possible infertility in females.

15. NURSING MANAGEMENT
Assessment
Nursing
Diagnosis
Planning
Implementation
Evaluation

16. Assessment
 Review nursing history for patterns of fatigue &
over-work, tension, family problems that may
exacerbate symptoms.
 Assess food habits & use of any dietary or herbal
supplements used as alternative therapies that
may have a bearing on triggering symptoms (milk
intake may be a problem). Many patient use
vitamins, herbs & homeopathic remedies without
realizing the effect on bowel function.
 Determine number & consistency of bowel
movements, any rectal bleeding present.
 Listen for hyperactive bowel sounds; assess
weight.

17. Nursing Diagnoses
 Chronic pain r/t disease process
 Imbalanced Nutrition: less than body
requirement r/t diarrhea, nausea & vomiting
 Deficient fluid volume r/t diarrhea & loss of fluid
& electrolytes
 Risk for infection r/t disease process, surgical
procedures
 Ineffective coping r/t fatigue, felling of
helplessness, & lack of support system.

18. Nursing Intervention
Promoting Comfort:-
 Follow prescribe treatment of reducing or eliminating
food & fluid & instituting parenteral feeding or low reside
diets to the intestinal tract.
 Give sedatives & tranquilizers, as prescribed, not only to
provide general rest , but also to slow peristalsis.
 Be aware of skin breakdown around anus.
 Cleanse the skin gently after each bowel movement.
 Apply a protective emollient such as petroleum jelly etc.
 Relieve painful rectal spasms
 Report any evidence of sudden abdominal distention
 Reduce physical activity
 Provide commode or bathroom next to bed because
urgency of movement may be problem.

19. Achieving Nutritional Requirements:-
 Maintain acutely ill patient on parenteral
replacement of vitamins, fluids, & electrolytes.
 When resuming oral fluids & food, select those
that are nonirritating to the mucosa.
 Avoid dairy products if patient is lactose
intolerant.
 Provide a well-balanced, low-residue, high
protein diet to correct malnutrition.
 Determine which foods the patient can tolerate,
& modify diet plan accordingly.
 Possible avoids cold fluids, which may increase
intestinal motility.
 Administer prescribed medications for
symptomatic relief of diarrhea.

20. Maintain fluid Balance:-
 Maintain accurate intake & output records
 Check weight daily
 Monitor serum electrolytes, & report
abnormalities.
 Observer for decrease skin turgor, dry
skin, oliguria, decreased temperature,
weakness, increase hemoglobin,
hematocrit, BUN, & specific gravity, which
all are signs of fluid loss leading to
dehydration.

21. Minimizing Infection & Complications:-
 Give antibacterial drugs as prescribed.
 Administer corticosteroids as prescribed.
 Provide conscientious skin care after
severe diarrhea.
 Administer prescribed therapy to correct
existing anemia.
 Observe for signs of colonic perforation &
hemorrhage – abdominal rigidity,
distention, hypotension, tachycardia.

22. Providing Supportive Care:-
 Recognise psychological needs of the patient.
- Fear, anxiety, & discouragement.
- Hypersensitivity may be evident.
 Acknowledge patient’s complaints.
 Encourage the patient to talk; listen & offer
psychological support.
 Answer questions about the permanent or temporary
ostomy, if appropriate.
 Initiate patient education about living with chronic
disease.
 Include the patient as a part of the health care team to
provide continuity of care.
 Offer educational & emotional support to family
members
 Refer for psychological counseling, as needed.

23. Home Care Considerations:-
Pouchitis:-
 Patient undergoing one of the continent restorative
procedure (Kock, or ileal reservoir & anal
anastomosis) must be alert for a common late
postopaerative complication called pouchitis.
 The symptoms include increased stool output,
cramps & malaise.
 It is thought to be related to stasis within the
pouch/ reservoir & usually responds to
metronidazole .
 Assess for these symptoms & notify health care

24. Food Blockage:-
 Patient with a temporary or permanent ileostomy must
be alert for signs & symptoms of a food blockage.
- This is a mechanical blockage of undigested foodstuffs
at the level of the fascia.
- It is most likely to occur in the first 6 weeks
postoperatively when the bowel is edematous.
 Symptoms may include spurty, watery stoolwith strong
odor, decreased or no stool output, abdominal
discomfort, cramping or bloating, & stomal swelling.
Nausea & vomiting are late symptoms & requires
immediate attention.
 Treatment includes:
- Avoiding solid foods & drinking clear liquids when
symptoms occur. Patient with ileostomies must never
take laxatives.
- Applying a pouching system with a larger opening to

25. - Gently massaging the abdomen around the stoma
& pulling the knees to chest & rocking the body
back & forth.
- A warm shower or bath may help with relaxation.
- If the blockage lasts for more than 2 to 3 hours or if
nausea/vomiting occurs, seek medical attention
immediately
 It is best to instruct the patient how to prevent a
food blockage by limiting certain foods the first
few months after surgery – Chinese vegetables,
skins & seeds, fatty meats, been hulls, popcorn &
other foods that do not digest well.
 Instruct the patient to avoid problem foods, chew
food well, drink plenty of fluids while eating, eat
possible problem foods in small amounts, &
reintroduce problem foods slowly into the diet.

27. Patient Education & Health
Maintenance:-
 Teach patient about chronic aspect of ulcerative
colitis & each component of care prescribed.
 Encourage self-care in monitoring symptoms,
seeking annual checkup, & maintaining health.
 Alert patient to possible postoperative problems
with skin care, aesthetic difficulties, & surgical
revisions.
 Encourage patient to share experiences with
others undergoing similar procedures.

28. ASSIGNMENT
Q. Write the Nursing Care Plan of Patient with
ulcerative colitis?

29. BIBLIOGRAPHY
1. Richard Hatchett & David thompson.med-surg.
nursing.first edition(2002); publish by churchil
Livingstone sydney P.N 552-560.
2. Shaffer’s.Medical-Surgical.seven editions. BI
publications New Delhi (2002). P.N. 439-444.
3. Lippincott. Manual of nursing practice. Eight edition
(2006). P.N. 673-677.
4. Brunner & Suddarth’s.Medical-Surgical nursing.10th
edition.Lippincott williams & wilkins publication (2004).
P.N. 1042-1054.
5. www.google.com.
6. www.pubmed.com.