Ulcerative Colitis

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Ulcerative Colitis

•U.C. is characterized by remissions and exacerbations of inflammation in the colon and/or rectum. •Chronic process affects the intestinal mucosal lining.
•Causes a loss of surface epithelium, ulcerations and possible abscess formation. •Results in loose stools containing blood and mucus, malabsorption, thickening of colon wall. •Symptoms: abdominal pain, diarrhea, and rectal bleeding.

•Disease begins in rectum proceeds toward cecum.
•Acute: epithelial cell damage and loss, ulcerations, redness, bleeding. Chronic: Fibrosis and retraction of the bowel, muscle hypertrophy, deposition of fat and fibrous tissue, narrower shorter colon.

•Colon Cancer
•Intestinal perforation with resultant peritonitis and fistula formation •Toxic megacolon
•Increased risk of colon cancer
•Abscess formation
•Bowel obstruction
•Extraintestinal clinical manifestations: arthritis, hepatic and biliary disease, oral and skin lesions, ocular disorders.

•Exact etiology unknown
•Abnormal response to normal flora
•Defect in intestinal permeability
•Genetically inherited

•Incidence: Approx. 2-10 new cases per 100,000 persons.
•Prevalence: Approx. 40-100 cases per 100,000 people in the U.S. •Age: Peak incidence occurs between the ages of 15-25 and 55-65. •Sex: Females are more often affected then men. Geographic Distribution: There is a higher distribution of U.C. in Northern Europe and North America •Family History: You have a ten fold risk of having U.C. if you have a first degree relative with the disease •Cultural Considerations: U.C. is 4-5 times more common in the Jewish population specifically the Jewish European or Ashkenazi •Racial Considerations: U.C. is more common in whites although the incidence of black individuals with the disease is increasing

–Family History
–Previous and Current Therapy
–Diet History
–History of weight loss
•Ask about symptoms of acute Ulcerative Colitis which include: –Abdominal pain
–Diarrhea with up to 10-20 liquid bloody stools per day
–Mouth sores
–Vision problems
–Skin disorders

Physical Assessment
•Signs and Symptoms
-Abdominal Pain
-Bloody diarrhea
-Tenesmus (uncontrolled straining)

•Physical Exam
-vital signs (usually within normal limits)
-Abdominal distension along the colon, palpate for increased tenderness. Note any localized areas of abdominal pain or cramping over diseased bowel
-Client may be febrile and tachycardic

Psychosocial Examination
•Evaluate client's understanding of the illness.
•How it impacts his/her lifestyle.
•Encourage and support the client while exploring the following: -relationship of life events to disease exacerbation -Stress factors that produce symptoms
-Family, social support systems
-concerns of genetic basis

Laboratory Assessment
•Lab tests
-Hematocrit: May be low
-Hemoglobin: May be low
-WBC: Elevated
-ESR: Elevated
-Sodium, potassium, and chloride: may be depleted secondary to frequent diarrhea stools and malabsorption resulting from diseased bowel. -decreased serum albumin
-Stools are examined for occult blood, eggs, and parasites

Diagnostic tests
•Barium enemas with air contrast

Drug Therapy
•Salicylate compounds
Diet Therapy
•NPO (Severe symptoms)
•TPN (Slightly less symptoms)
•Low Fiber
•Reduction in lactose containing products
•Reduction in caffeinated beverages, spices and alcohol.
•Illeoanal Anastomosis

Nursing Diagnosis

Nursing Diagnosis Associated with U.C.
1.Imbalanced Nutrition: less than body requirements...
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