Ulcerative colitis (UC) is an inflammatory bowel disease affecting the rectum and extending proximally toward the colon. The specific cause is unknown, but there is a genetic predisposition. There may also be a higher incidence among Jewish populations. Peak incidence often occurs between 15-30 years of age. Although food and stress do not cause UC, they may worsen symptoms.
With ulcerative colitis, the immune system believes that the cells that line the colon, and good gut bacteria, are the invaders. Instead of protecting, white blood cells damage the colon’s lining. The colon or large intestine’s lining becomes irritated, inflamed, edematous, and vulnerable to ulcers that may perforate. As scar tissue grows, flexibility and the capacity to absorb nutrients are lost.
In this article:
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- Diarrhea
- Dysfunctional Gastrointestinal Motility
- Ineffective Tissue Perfusion
- Risk for Deficient Fluid Volume
Nursing Process
Patients with ulcerative colitis require ongoing observation and lifelong treatment to prevent relapses. Every one to two years, surveillance colonoscopies should be performed because of the possibility of colorectal cancer. Additionally, because patients are treated with biological agents, they should receive screenings for skin malignancies.
Teach the patient the value of medication adherence to prevent a recurrence. Regular vaccines, hand washing, and cancer screening should be encouraged. Inform the patient on what foods to eat and what not to eat, particularly if they have a stoma. The nurse should also remain active in assessing emotional concerns such as depression and low self-esteem.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section, we will cover subjective and objective data related to ulcerative colitis.
Review of Health History
1. Ask about the patient’s general symptoms.
Bloody diarrhea, whether or not mucus is present, is a common feature of ulcerative colitis. Depending on the severity of the condition, other symptoms may include:
- Rectal bleeding
- Tenesmus (urgency to pass stools)
- abdominal discomfort and cramping
- Rectal pain
- Fatigue
- Loss of appetite
2. Determine the type of ulcerative colitis.
Types of ulcerative colitis:
- Ulcerative proctitis
- Location: localized to the rectum
- Symptom: rectal bleeding
- Proctosigmoiditis
- Location: rectum and the sigmoid colon (lower part of the colon)
- Symptoms: bloody diarrhea, abdominal cramps, abdominal pain, tenesmus
- Left-sided colitis
- Location: Left side colon
- Symptoms: left side abdominal cramps, bloody diarrhea, and weight loss
- Pancolitis
- Location: entire colon
- Symptoms: severe bloody diarrhea, abdominal cramps, abdominal pain, fatigue, and significant weight loss
3. Interview about changes in bowel habits.
Ulcerative colitis flares may cause abdominal pain and cramping with bowel urgency. Stools are typically loose and may contain blood or pus.
4. Identify the risk factors.
Non-modifiable risk factors:
- Ethnicity: The prevalence is particularly high among Caucasians and those of Jewish ancestry.
- Age: Adults are more likely to suffer from ulcerative colitis—the primary onset peaks between 15 and 30 years of age. There is a second, lesser peak of occurrence between 50 and 70.
- Family history: Risk increases if a first-degree relative, such as a parent, sibling, has ulcerative colitis.
Modifiable risk factors:
- Smoking: Research shows that smoking may have a protective effect against UC, as the disease is less common in smokers than nonsmokers.
5. Review NSAID use.
Non-steroidal anti-inflammatory drugs (NSAIDs) are linked to ulcerative colitis.
6. Ask about the history of appendectomy.
This history can help rule out ulcerative colitis. Before age 20, appendectomy is linked to a lower incidence of ulcerative colitis.
Physical Assessment
1. Perform an abdominal examination.
Although abdominal examination results could be normal, abdominal tenderness is likely present during a flare. Other findings include:
- Voluntary or involuntary guarding
- Rebound tenderness (a sign of advanced colitis and potential perforation)
- Palpable mass (indicating blockage or megacolon)
- Enlarged spleen (a sign of primary sclerosing cholangitis or autoimmune hepatitis with portal hypertension)
2. Regularly monitor for weight loss.
Weight loss is a frequent finding in ulcerative colitis caused by pain, diarrhea, and inflammation.
3. Listen for bowel sounds.
Bowel sounds in ulcerative colitis can be hypoactive, hyperactive, or normal. Obstructions may cause high-pitched tinkling.
4. Perform a perianal examination.
In UC patients, a perianal examination should not show any signs of fistula or abscesses. Persistent diarrhea can result in perianal erythema, fissuring, or hemorrhoids.
5. Assess for extraintestinal manifestations.
Patients with ulcerative colitis may experience extraintestinal (outside the intestines) symptoms, including:
- Joint pain
- Red, swollen, and painful eyes
- Skin rashes
- Liver impairment
- Delayed growth
6. Perform a complete physical assessment.
- General: Fever, weight loss, fatigue
- HEENT: episcleritis (inflammation of the thin layer between the conjunctiva and sclera), uveitis
- Gastrointestinal: Abdominal pain, bloody stools, tenesmus (feeling the need to defecate after emptying the bowels)
- Musculoskeletal: joint pain in the large joints (such as hips, knees, and ankles), inflamed joints of the spine (ankylosing spondylitis), osteoporosis
- Integumentary: pallor, poor skin turgor, jaundice, erythema nodosum
7. Note for delayed growth and development in pediatric patients.
Growth failure is a potential complication of UC found in children. Causes include inflammation and the immune response, malnutrition, and the use of steroids. Children may experience a delay in puberty and sexual maturation.
8. Check for stool characteristics.
In UC, bloody stools are typical. Bloody stools may be bright crimson, pink, maroon, or occasionally black. Pus and mucus may also be observed.
Diagnostic Procedures
1. Diagnose clinically with supportive findings.
Endoscopy and biopsy results confirm the clinical diagnosis of ulcerative colitis. Imaging results also detect the presence of acute flares.
2. Send stool samples for testing.
- White blood cells in the stool signal an infectious process. Parasites and viruses can signal other causes.
- Fecal calprotectin is correlated with an increase in neutrophils in the colon. The presence of protein calprotectin can differentiate between an inflammatory bowel disease like UC and IBS.
3. Assess for inflammatory causes via blood samples.
- Complete blood count with a metabolic panel assesses for vitamin B12 or iron deficiency anemia common with UC. Hypoalbuminemia and decreased electrolyte levels are seen with malnutrition and dehydration.
- Special serology (perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA)) are present in the majority of ulcerative colitis patients, regardless of disease activity.
- C-reactive protein (CRP) or erythrocyte sedimentary rate (ESR) increases as the severity of the inflammation worsens in ulcerative colitis.
4. Schedule the patient for an imaging scan.
Imaging scans make the gut regions visible to identify inflammation.
- Computed tomography (CT) enterography/magnetic resonance enterography (MRE) rules out small intestine inflammation. It is more sensitive than traditional imaging tests for detecting intestinal inflammation. A radiation-free option is MRE.
- CT scan of the abdomen may be carried out if ulcerative colitis is suspected and can differentiate UC from Crohn’s disease.
- Plain X-rays rule out significant complications such as a megacolon or a perforated colon and are useful as a first-line imaging modality.
- Double-contrast barium enema can detect early mucosal changes.
5. Visualize the colon.
- A colonoscopy should be performed during a suspected flare to assess for inflammation and mucosal changes. Tissue samples are collected during the procedure for laboratory analysis to diagnose UC.
- Flexible sigmoidoscopy is as efficient as a colonoscopy to assess UC activity and treatment effectiveness.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you’ll learn more about possible nursing interventions for a patient with ulcerative colitis.
Treat the Inflammation
1. Induce and maintain remission.
UC consists of flares and remissions. Treatment aims to improve the quality of life for those with ulcerative colitis by reducing symptoms and maintaining a state of remission.
2. Administer anti-inflammatory medications as prescribed.
The initial line of treatment for ulcerative colitis is frequently anti-inflammatory medications. 5-aminosalicylates are the first-line treatment. If remission is not achieved within two weeks, oral or rectal glucocorticoids may be given. All of these medications, except glucocorticoids, can be used to maintain remission.
- 5-aminosalicylates (sulfasalazine, mesalazine) are given depending on the affected part of the colon and may be taken via oral, intravenous, or suppository route.
- Corticosteroids (prednisone and budesonide) are prescribed for moderate to severe ulcerative colitis resistant to other therapies. Immune suppression is a function of corticosteroids, so they are generally not administered long-term due to adverse effects.
3. Suppress the immune system.
Immunosuppressants like cyclosporine, tacrolimus, and infliximab suppress inflammatory triggers in autoimmune diseases like UC. A combination of these drugs usually works better.
4. Consider biologics.
Biologics focus on immune system protein production. These are prescribed for those with severe ulcerative colitis who do not respond to or tolerate other treatments.
5. Manage specific symptoms.
Other medications relieve ulcerative colitis symptoms. Before taking any over-the-counter drugs, remind the patient to consult the healthcare provider.
- Antidiarrheals are given for severe diarrhea. They should not be taken without first consulting the healthcare provider. Some drugs could increase the risk of toxic megacolon.
- Pain relievers such as acetaminophen are advised for minor pain, but not ibuprofen, naproxen sodium, or diclofenac sodium, as these medications can exacerbate symptoms and worsen the condition.
- Antispasmodics are occasionally prescribed to treat cramps.
- Iron supplements are given for potential iron deficiency anemia and intestinal bleeding.
6. Remove the affected area.
As ulcerative colitis only affects the colon, a colectomy is curative. The preferred surgery is proctocolectomy with ileal pouch-anal anastomosis (IPAA), although proctocolectomy with ileostomy is an option for individuals ineligible for IPAA. Indications for surgery include:
- Intractable fulminant colitis
- Toxic megacolon
- Perforation
- Uncontrollable bleeding
- Unbearable drug side effects
- Strictures
- Unresectable high-grade or multifocal dysplasia
- Malignancy
- Infant growth retardation
7. Avoid relapse.
Maintenance therapy is necessary for all patients to avoid relapse. Each patient will require an individualized drug regimen that works to manage their symptoms.
Prevent Flare-ups
1. Establish a healthy gut.
Probiotics can promote remission by maintaining a healthy balance of bacteria in the gut.
2. Stay away from trigger foods.
Each person will react differently to dairy, fiber, sugar, spicy foods, caffeine, and alcohol. Keep track of the foods that result in abdominal pain, bloating, gas, and diarrhea.
3. Advise on small meals.
Eating during a flare may seem unpleasant. Prevent malnutrition by incorporating small meals and snacks instead of large meals.
4. Prevent dehydration.
Advise the patient to get enough liquids every day, especially water. Carbonated drinks produce gas, while alcohol stimulates the intestines and can exacerbate diarrhea.
5. Consult a dietitian.
A dietician who specializes in IBD nutrition guides the patient in all dietary elements of the disease.
Establish Regular Elimination
1. Monitor elimination patterns.
Mild UC causes less than four bowel movements daily, while moderate-severe UC results in over four stools daily. All may produce rectal bleeding. Monitor closely for changes in bowel frequency, color, smell, and characteristics.
2. Avoid straining.
Educate patients on how to defecate properly, including how to squat and avoid straining. Increase the consumption of fluids and fiber to keep bowel movements regular without constipation or diarrhea.
3. Monitor for the development of complications.
Keep an eye out for symptoms of complications like bleeding, fecal impaction, or intestinal obstruction.
Assist With Coping
1. Cope with stress.
Inflammatory bowel disease is not directly caused by stress. However, stress can worsen the symptoms and possibly induce flare-ups. Create outlets to effectively manage stress, like exercising, meditation, walking, and journaling.
2. Teach about UC.
Educating patients about ulcerative colitis is the best way to help them feel more in control. Patients can make the best care decisions for themselves if they have the correct information.
3. Support the pediatric patient.
Children require the support of the entire family. To assist the child in coping with the challenges of ulcerative colitis, seek the support of a family counselor.
4. Carry a bathroom access card.
Patients with IBD may feel less anxiety about traveling or socializing when they have direct access to a bathroom. Bathroom access cards can be downloaded online for free and presented discreetly to allow access to a bathroom.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for ulcerative colitis, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for ulcerative colitis.
Acute Pain
Acute pain associated with ulcerative colitis is a common cause of poor quality of life.
Nursing Diagnosis: Acute Pain
Related to:
- Inflammation of the intestines
- Hyperactive bowels (hyperperistalsis)
- Persistent diarrhea
- Irritation in the anus
- Irritation in the rectum
- Fistula formation
- Joint arthralgias
- Scleritis
As evidenced by:
- Complaints of abdominal pain
- Reports of abdominal cramping
- Facial grimacing
- Guarding behaviors
- Distraction behaviors
- Restlessness
- Self-focusing
Expected outcomes:
- Patient will report relief from abdominal cramping.
- Patient will report two strategies to relieve abdominal pain.
- Patient will be able to manifest a calm and well-rested appearance.
Assessment:
1. Assess for abdominal pain.
Investigate complaints of abdominal pain or cramping caused by ulcerative colitis, and note the location, duration, and severity (0–10 scale). Document any changes in the characteristics of pain.
2. Auscultate for bowel sounds.
Colitis causes increased peristalsis, producing increased bowel sounds, abdominal cramping, and pain.
3. Note nonverbal cues.
Observe nonverbal cues of abdominal cramping or pain, such as restlessness, facial expression, guarding, and distraction behaviors.
4. Identify triggering factors.
Stress can aggravate abdominal pain. Fatty and spicy foods, and foods high in sugar, caffeine, alcohol, and carbonated drinks can also worsen the pain and cramping.
Interventions:
1. Position the patient comfortably.
The left side of the abdomen or the rectum often hurts in colitis. Certain positions can worsen ulcerative colitis pain depending on which side of the intestinal tract is inflamed.
2. Instruct on appropriate medications.
Administer acetaminophen for mild colitis pain. Antispasmodic medications can relieve abdominal cramps. In contrast, do not give ibuprofen, naproxen, or diclofenac, as they can exacerbate abdominal discomfort.
3. Administer opioids and adjuvants.
Severe colitis pain may require opioid narcotics. Antidepressants are recommended adjuvant analgesics.
4. Encourage psychotherapy.
Cognitive behavioral therapy can be useful as a complementary treatment when pain is chronic and cannot be completely relieved. CBT can also improve quality of life.
5. Encourage the patient to avoid triggering factors.
Stress and improper diet trigger exacerbation of symptoms. Stress management and an appropriate diet can help prevent inflammation, abdominal pain, and cramping due to colitis.
6. Relieve rectal pain.
Rectal pain and skin irritation are common with frequent loose stools. Offer a warm sitz bath for comfort and clean the rectal area with soft, cool wipes.
Diarrhea
Diarrhea associated with ulcerative colitis can be caused by inflammation of the colon and the presence of toxins. It leads to persistent contraction and malabsorption of the colon, producing frequent bowel movements. Ulcers may form when inflammation damages the lining of the gut, causing bloody diarrhea.
Nursing Diagnosis: Diarrhea
Related to:
- Inflammation of the lining of the colon
- Frequent bowel movements
- Persistent contraction of the colon
As evidenced by:
- Loose and watery stools
- Bloody stools (bright red, maroon, or black stools)
- Stool with pus or mucus
- Foul-smelling stool
- Abdominal pain
- Abdominal cramping
- Tenesmus (urgency to pass stools)
- Pain in the rectum
- Increased bowel sounds upon auscultation
- Weight loss
- Dehydration
Expected outcomes:
- Patient will report a decrease in frequency and urgency to less than three stools per day.
- Patient will be able to demonstrate bowel sounds within normal limits upon auscultation.
- Patient will be able to pass stool without blood or mucus.
Assessment:
1. Analyze the onset and pattern of bowel movements.
Note the onset of symptoms, triggering factors, and frequency of diarrhea. Assess the patient’s baseline to monitor for flares.
2. Assess the characteristics of stools.
Note the color and characteristics (if there is any presence of blood or mucus).
3. Obtain a sample for stool culture.
Although it is nonspecific, fecal calprotectin testing correlates with increased neutrophils in the colon to rule out a noninflammatory bowel illness.
Interventions:
1. Gradually change the diet as ordered.
Maintain NPO status followed by diet changes from clear liquids to a low-fiber diet as prescribed and tolerated during the acute phase of colitis. Not giving anything by mouth at the start of diarrhea will help decrease bowel movements.
2. Assist the patient in creating a meal plan.
A low-fiber and high-protein diet supplemented with vitamins and iron supplements is recommended. Avoid foods that cause gas, dairy products, raw fruits and vegetables, whole grains, nuts, pepper, alcohol, and caffeine-containing items.
3. Administer medications as prescribed.
This includes a combination of medications such as salicylate compounds, corticosteroids, immunosuppressants, and antidiarrheals.
- Anti-inflammatory (salicylate compounds) medications are the first line of treatment for ulcerative colitis.
- Time-limited corticosteroid treatment induces remission. Steroids have anti-inflammatory and immunosuppressive properties.
- Immunosuppressants block the immunological response causing the body to release substances that cause inflammation.
- Antidiarrheals give stool more volume, and a fiber supplement helps ease mild to moderate diarrhea. Loperamide is for more severe diarrhea.
4. Prepare the patient for surgery.
Surgery may be needed if symptoms become worse and more complicated. Surgery includes the removal of the entire colon and rectum, and an internal pouch connected to the anus will enable bowel movements without a bag. A pouch may sometimes be appropriate—instead, creating a stoma in the abdomen. A bag attached to the stoma will collect the stool.
5. Refer to an IBD specialist.
Inflammatory bowel disease (IBD) refers to conditions that affect the tissues in your digestive tract and are long-lasting (chronic). Ulcerative colitis is a type of IBD. A specialist role can evaluate and follow patients receiving therapy and offer professional advice and expertise on all aspects of inflammatory bowel disease.
6. Refer the patient to a dietitian or nutritionist.
Following the recommended diet will help prevent colitis flare-ups. A dietician can educate about food recommended for colitis and help tailor a specialized diet for the patient.
Dysfunctional Gastrointestinal Motility
Ulcerative colitis is associated with colonic motor abnormalities like lack of intestinal contractility, neuromuscular dysfunction, and increased propulsive contractile waves due to its inflammatory process.
Nursing Diagnosis: Dysfunctional Gastrointestinal Motility
Related to:
- Disease process
- Inflammatory process
- Medications
- Malnutrition
- Imbalanced fluid and electrolytes
As evidenced by:
- Diarrhea
- Abdominal pain
- Abdominal cramping
- Nausea
- Vomiting
- Altered bowel sounds
- Tenesmus
- Malnutrition
- Dehydration
- Weight loss
Expected outcomes:
- Patient will maintain an appropriate weight for age and gender and report having an appetite.
- Patient will experience no more than three formed bowel movements per day.
Assessment:
1. Assess and monitor laboratory values.
C-reactive protein is measured in patients with ulcerative colitis as this is a sensitive acute-phase marker that would be elevated in the first 6 hours of the inflammatory process.
2. Assess the patient’s stool characteristics and bowel patterns.
Ulcerative colitis is associated with blood and mucoid stools. The patient often exhibits tenesmus, or the unpleasant and urgent sensation of defecating, and lower abdominal colicky pain that can be relieved with defecation.
3. Assess the effect on the patient’s appetite and weight.
Symptoms associated with UC (diarrhea, abdominal pain, nausea) can prevent the patient from having a strong appetite and may result in weight loss.
Interventions:
1. Administer medications as indicated.
Aminosalicylates are often prescribed to treat ulcerative colitis. They are taken either orally or rectally to reduce the inflammation in the intestines and improve motility problems.
2. Administer antidiarrheals.
Severe diarrhea associated with UC can be treated with loperamide to slow bowel motility. Use this medication with caution as it can increase the risk of toxic megacolon.
3. Administer enteral feedings as indicated.
Enteral nutrition is preferred over parenteral nutrition for malnourished patients with UC due to its stimulatory effects on the GI system.
4. Encourage the patient to avoid medications that can worsen symptoms.
It is crucial to review the patient’s medications and their side effects and encourage them to avoid NSAIDS like ibuprofen and naproxen, as these can worsen symptoms of ulcerative colitis.
5. Encourage the patient to perform light activities with adequate rest periods.
Light physical activities like walking will not aggravate the patient’s motility problems associated with ulcerative colitis. During exacerbations, allow the patient to rest and promote comfort to reduce intestinal activity and promote gastrointestinal healing.
Ineffective Tissue Perfusion
Ulcerative colitis causes inflammation and ulcerations in the inner lining of the large intestines, rectum, and colon, resulting in decreased gastrointestinal tissue perfusion.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Intestinal inflammation
- Disease process
- Intestinal or rectal bleeding
- Obstruction
As evidenced by:
- Abdominal pain
- Abdominal cramping
- Abdominal distension
- Anemia
- Rectal bleeding
- Bloody stools
- Weight loss
- Fluid and electrolyte imbalance
- Malnutrition
- Fatigue
Expected outcomes:
- Patient will demonstrate hemoglobin, RBC, and iron levels within acceptable limits.
- Patient will not experience rectal bleeding or bloody stools.
Assessment:
1. Assess diagnostic imaging results.
A colonoscopy is indicated to diagnose ulcerative colitis. Classic endoscopic findings in patients with ulcerative colitis include loss of normal vascular pattern, erythema, erosions, granularity, ulcerations, and bleeding.
2. Assess and monitor for signs and symptoms of possible complications.
Recurrent ulcerative colitis can lead to complications like GI bleeding, severe dehydration, perforation, and cancer that compromise gastrointestinal tissue perfusion.
3. Assess laboratory test results.
If intestinal bleeding is present, decreased hematocrit and hemoglobin are observed. Anemia is also common with UC, which is evident through low ferritin, iron, total-iron binding capacity (TIBC), and mean cellular volume (MCV) levels.
Interventions:
1. Administer medications as ordered.
Aminosalicylates help reduce inflammation in patients with ulcerative colitis, allowing the damaged intestinal tissues to heal and improving perfusion in the intestines. Immunomodulators or biologics may be required to control severe UC. Steroids are necessary to reduce inflammation during an acute flare.
2. Treat and prevent anemia.
Vitamin B12, RBC count, and iron levels that are low will need supplementation through oral or IM routes. Intestinal bleeding may require blood transfusions if hemoglobin levels are concerningly low.
3. Administer intravenous fluids and electrolytes.
Fluid resuscitation via intravenous therapy is provided as this can help improve hemodynamics and promote GI tissue perfusion, especially if bleeding complications are present. Loss of electrolytes is also common with UC and should be supplemented.
4. Treat rectal bleeding.
Anal fissures and hemorrhoids can cause rectal bleeding and are common in UC. Steroid suppositories can reduce inflammation in the rectal area. A warm sitz bath can alleviate discomfort.
5. Educate on when to seek assistance for bleeding.
If UC is controlled or in remission, blood should not be observed. Bloody stools or blood on toilet paper is a sign that a change in treatment may be needed. The patient should be instructed to contact their gastroenterologist.
Risk for Deficient Fluid Volume
The risk for deficient fluid volume associated with ulcerative colitis can result from persistent diarrhea and excessive fluid loss.
Nursing Diagnosis: Risk for Deficient Fluid Volume
Related to:
- Persistent diarrhea
- Excessive fluid loss
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Patient will be able to verbalize dehydration signs and symptoms.
- Patient will verbalize two strategies to prevent dehydration.
- Patient will manifest fluid and electrolyte balance within normal limits as evidenced by electrolytes within expected limits.
Assessment:
1. Monitor for fluid intake and output.
Record the fluid intake and output of the patient. Maintain accurate documentation of loose stools.
2. Review electrolytes.
Dehydration and electrolyte imbalances can result from severe or persistent diarrhea. Review laboratory findings (urinalysis) and blood tests (particularly the serum sodium and potassium levels) to determine any imbalances caused by ulcerative colitis.
3. Assess for signs and symptoms of dehydration.
Examine the patient for the following signs and symptoms of dehydration:
- Increased thirst
- Headache
- Weakness
- Poor skin turgor
- Flushed skin
- Dry mouth
- Low blood pressure
- Rapid heart rate
Interventions:
1. Prevent dehydration.
Diarrhea can cause dehydration. Therefore, it is best to first address the underlying cause by controlling the fluid loss and managing diarrhea.
2. Hydrate the patient.
Administer prescribed amounts of fluids and electrolytes intravenously.
3. Encourage increased oral fluids.
Promote an increase in oral fluids if tolerated and not contraindicated in ulcerative colitis. Encourage the patient to sip water, electrolyte drinks, broths, and soups. Oral fluid can replenish insensible fluid losses, increase bodily fluids, and moisten the mouth.
4. Implement the recommended diet.
Follow the prescribed diet for the patient, whether in the acute or exacerbation phase of colitis. Proper diet and avoidance of triggering food may help decrease the risk of deficient fluid volume caused by diarrhea.
5. Ask the patient to list the preventive measures for dehydration.
Advise the patient of the following preventive measures:
- Drink recommended fluid intake
- Consume foods high in water content (such as fruits and vegetables when not in a flare)
- Eliminate or use alcohol in moderation
- Limit consumption of caffeinated beverages (such as coffee, tea, and carbonated drinks)
References
- Cleveland Clinic. (2020, April 23). Ulcerative colitis: Symptoms, treatment & living with it & diagnosis. Retrieved March 2023, from https://my.clevelandclinic.org/health/diseases/10351-ulcerative-colitis#symptoms-and-causes
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
- Lynch, W. D., & Hsu, R. (2022, June 11). Ulcerative colitis – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. Retrieved March 2023, from https://www.ncbi.nlm.nih.gov/books/NBK459282/
- Mayo Clinic. (2020, November 7). Inflammatory bowel disease (IBD) – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/symptoms-causes/syc-20353315
- Mayo Clinic. (2022, September 16). Ulcerative colitis – Diagnosis and treatment – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/diagnosis-treatment/drc-20353331
- National Center for Biotechnology Information. (2022, June 11). Ulcerative colitis – StatPearls – NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK459282/
- Silvestri, L. A., & Silvestri, A. E. (2022). Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Elsevier Inc.
- Sultan, M. (2022, November 30). Ulcerative colitis in children differential diagnoses. Diseases & Conditions – Medscape Reference. Retrieved March 2023, from https://emedicine.medscape.com/article/930146-differential
- WebMD. (2004, July 9). Ulcerative colitis treatments and surgery. Retrieved January 2, 2023, from https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/digestive-diseases-ulcerative-colitis-treatment
- WebMD. (2022, October 18). Reason for my stomach cramps and diarrhea. Retrieved March 2023, from https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/cm/causes-uc
