Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that affects the rectum and colon, extending proximally. While the exact etiology remains unclear, genetic predisposition and immune system dysfunction are considered key factors. It’s important to note that while diet and stress don’t initiate UC, they can exacerbate symptoms. In UC, the immune system mistakenly targets the colon lining and beneficial gut bacteria as foreign invaders. This misdirected immune response leads to white blood cell infiltration, causing inflammation, edema, and ulceration of the colon’s inner lining. These ulcers can potentially perforate, and as the body attempts to heal, scar tissue forms, diminishing the colon’s flexibility and nutrient absorption capacity.
This article provides a detailed overview of ulcerative colitis from a nursing perspective, focusing on nursing assessment, diagnosis, interventions, and care planning to optimize patient outcomes.
Nursing Process in Ulcerative Colitis Management
Managing ulcerative colitis requires ongoing nursing observation and lifelong treatment to prevent relapses and complications. Regular surveillance colonoscopies, typically every one to two years, are crucial due to the increased risk of colorectal cancer in UC patients. Furthermore, given the common use of biological agents in UC treatment, screening for skin malignancies is also recommended.
Patient education is paramount. Nurses play a vital role in emphasizing medication adherence to prevent disease recurrence. Guidance on vaccinations, hand hygiene, and recommended cancer screenings are essential components of patient teaching. Nutritional counseling, especially regarding dietary adjustments for patients with or without a stoma, is also crucial. Beyond the physical aspects, nurses should proactively assess and address emotional concerns such as depression and low self-esteem, which are frequently encountered by individuals living with chronic conditions like UC.
Nursing Assessment for Ulcerative Colitis
The initial phase of nursing care involves a thorough nursing assessment. This process encompasses gathering comprehensive physical, psychosocial, emotional, and diagnostic data. This section will detail both subjective and objective data collection pertinent to ulcerative colitis.
Review of Health History
1. Elicit General Symptom Information.
Bloody diarrhea, potentially with mucus, is a hallmark symptom of ulcerative colitis. The severity of UC dictates the symptom profile, which may include:
- Rectal bleeding: A common and often distressing symptom.
- Tenesmus: A persistent and urgent sensation to defecate, even after bowel emptying.
- Abdominal discomfort and cramping: Varying in intensity and location.
- Rectal pain: Discomfort in the rectal area, often associated with inflammation and frequent bowel movements.
- Fatigue: Systemic symptom reflecting the body’s inflammatory state.
- Loss of appetite: Reduced desire to eat, potentially contributing to weight loss and nutritional deficiencies.
2. Determine the Type of Ulcerative Colitis.
Classifying the type of UC is crucial for understanding the extent and potential symptoms:
- Ulcerative proctitis:
- Location: Confined to the rectum.
- Symptom: Primarily rectal bleeding.
- Proctosigmoiditis:
- Location: Affects the rectum and sigmoid colon (the lower segment of the colon).
- Symptoms: Characterized by bloody diarrhea, abdominal cramps, abdominal pain, and tenesmus.
- Left-sided colitis:
- Location: Involves the left side of the colon (descending colon).
- Symptoms: Left-sided abdominal cramps, bloody diarrhea, and potential weight loss.
- Pancolitis:
- Location: Encompasses the entire colon.
- Symptoms: Severe bloody diarrhea, abdominal cramps, abdominal pain, fatigue, and significant weight loss are typical.
3. Inquire About Changes in Bowel Habits.
UC flares often manifest as abdominal pain and cramping accompanied by bowel urgency. Stool consistency is typically loose, and blood or pus may be present.
4. Identify Non-Modifiable Risk Factors.
Understanding risk factors aids in patient risk assessment and awareness:
- Ethnicity: Higher prevalence observed in Caucasians and individuals of Jewish descent.
- Age: Peak onset typically occurs between 15 and 30 years of age, with a secondary, smaller peak between 50 and 70 years.
- Family history: Increased risk for individuals with a first-degree relative (parent, sibling) diagnosed with ulcerative colitis.
5. Review NSAID Use.
Non-steroidal anti-inflammatory drugs (NSAIDs) have been linked to UC exacerbation or development in susceptible individuals.
6. Ask About History of Appendectomy.
A history of appendectomy before age 20 is associated with a lower incidence of ulcerative colitis, although the exact mechanism is not fully understood.
Physical Assessment
1. Conduct a Thorough Abdominal Examination.
While abdominal examination findings may be normal, tenderness is commonly present during UC flares. Other potential findings include:
- Voluntary or involuntary guarding: Muscle contraction in response to palpation, indicating pain or inflammation.
- Rebound tenderness: Pain elicited upon rapid release of pressure during palpation, suggesting more advanced colitis or potential perforation.
- Palpable mass: May indicate blockage or toxic megacolon, a severe complication.
- Enlarged spleen (splenomegaly): Could be a sign of primary sclerosing cholangitis or autoimmune hepatitis with portal hypertension, conditions sometimes associated with IBD.
2. Monitor for Weight Loss Regularly.
Weight loss is a frequent finding in UC due to pain, diarrhea, and the inflammatory process impacting nutrient absorption.
3. Auscultate Bowel Sounds.
Bowel sounds in UC can be hypoactive (decreased), hyperactive (increased), or normal. High-pitched tinkling bowel sounds may indicate obstruction.
4. Perform a Perianal Examination.
In UC, perianal examination typically does not reveal fistulas or abscesses, which are more characteristic of Crohn’s disease. However, persistent diarrhea can lead to perianal erythema (redness), fissuring, or hemorrhoids.
5. Assess for Extraintestinal Manifestations.
UC can affect organs beyond the intestines, leading to extraintestinal symptoms, including:
- Joint pain (arthritis): Affecting various joints.
- Red, swollen, and painful eyes (uveitis, episcleritis): Inflammatory eye conditions.
- Skin rashes (erythema nodosum, pyoderma gangrenosum): Characteristic skin lesions.
- Liver impairment (primary sclerosing cholangitis): Inflammation of the bile ducts.
- Delayed growth (in children): Impact on growth and development.
6. Conduct a Complete Physical Assessment.
- General: Assess for fever, weight loss, and fatigue.
- HEENT (Head, Eyes, Ears, Nose, Throat): Check for episcleritis (inflammation between conjunctiva and sclera) and uveitis (inflammation of the uvea).
- Gastrointestinal: Evaluate for abdominal pain, bloody stools, and tenesmus.
- Musculoskeletal: Assess for joint pain, particularly in large joints (hips, knees, ankles), and signs of ankylosing spondylitis (spinal inflammation), and osteoporosis (reduced bone density).
- Integumentary: Observe for pallor (paleness), poor skin turgor (dehydration indicator), jaundice (yellowing of skin/eyes), and erythema nodosum (painful red nodules on shins).
7. Note Delayed Growth and Development in Pediatric Patients.
Growth failure is a significant complication of UC in children. Factors contributing to this include inflammation, immune response, malnutrition, and steroid use. Delayed puberty and sexual maturation may also occur.
8. Check Stool Characteristics.
Bloody stools are a hallmark of UC. The blood may appear bright red, pink, maroon, or, less commonly, black. Pus and mucus may also be present in the stool.
Diagnostic Procedures
1. Clinical Diagnosis with Supportive Findings.
Ulcerative colitis diagnosis is primarily clinical, supported by endoscopic and biopsy findings. Imaging studies help detect acute flares and complications.
2. Stool Sample Testing.
- White blood cells (WBCs) in stool: Indicate inflammation, although not specific to UC. Rule out infectious causes (parasites, viruses).
- Fecal calprotectin: Elevated levels correlate with neutrophil infiltration in the colon, helping differentiate IBD (like UC) from irritable bowel syndrome (IBS).
3. Blood Sample Analysis for Inflammatory Markers and Systemic Effects.
- Complete blood count (CBC) with metabolic panel: Assesses for anemia (vitamin B12 or iron deficiency, common in UC), hypoalbuminemia (low protein level), and electrolyte imbalances (due to malnutrition and dehydration).
- Special serology (p-ANCA and ASCA): Perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) are frequently present in UC, while anti-Saccharomyces cerevisiae antibodies (ASCA) are more associated with Crohn’s disease. These can aid in differentiating IBD types.
- C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR): Inflammatory markers that increase with UC disease activity and severity.
4. Imaging Scans to Visualize the Gut.
Imaging helps visualize the gut and identify inflammation and complications.
- Computed tomography (CT) enterography/magnetic resonance enterography (MRE): Rule out small intestine inflammation (more typical of Crohn’s). MRE is radiation-free. More sensitive than traditional imaging for intestinal inflammation.
- CT scan of the abdomen: Can differentiate UC from Crohn’s disease and assess for complications.
- Plain X-rays: Used as a first-line modality to rule out severe complications like toxic megacolon or perforated colon.
- Double-contrast barium enema: Can detect early mucosal changes in the colon.
5. Colon Visualization Procedures.
- Colonoscopy: Essential during suspected flares to assess inflammation, mucosal changes, and obtain tissue biopsies for definitive UC diagnosis.
- Flexible sigmoidoscopy: Similar to colonoscopy but examines only the rectum and sigmoid colon. Effective for assessing UC activity in these areas and monitoring treatment response.
Nursing Interventions for Ulcerative Colitis
Nursing interventions and comprehensive care are fundamental to patient recovery and long-term management of ulcerative colitis. This section outlines essential nursing interventions for patients with UC.
Treat the Inflammation
1. Induce and Maintain Remission.
UC is characterized by cycles of flares and remissions. Treatment aims to improve quality of life by alleviating symptoms and achieving and maintaining remission.
2. Administer Anti-inflammatory Medications as Prescribed.
Anti-inflammatory medications are typically the first-line treatment for UC. 5-aminosalicylates (5-ASAs) are often initiated. If remission is not achieved within two weeks, oral or rectal glucocorticoids may be considered. Importantly, 5-ASAs (excluding glucocorticoids) can be used for maintenance therapy to sustain remission.
- 5-aminosalicylates (sulfasalazine, mesalazine): Route of administration (oral, intravenous, or suppository) depends on the location of colon involvement.
- Corticosteroids (prednisone and budesonide): Prescribed for moderate to severe UC unresponsive to other therapies. Due to their immunosuppressive effects and potential long-term adverse effects, corticosteroids are generally not used for prolonged maintenance therapy.
3. Suppress the Immune System.
Immunosuppressants such as cyclosporine, tacrolimus, and infliximab work by suppressing inflammatory triggers in autoimmune diseases like UC. Combination therapy with these agents is often more effective.
4. Consider Biologics.
Biologic medications target specific proteins involved in the immune system’s inflammatory pathways. These are typically reserved for patients with severe UC who have not responded to or cannot tolerate conventional treatments.
5. Manage Specific Symptoms.
Various medications can alleviate specific UC symptoms. Patients should always consult with their healthcare provider before taking any over-the-counter medications.
- Antidiarrheals: Used for severe diarrhea, but should only be taken under medical supervision as some agents may increase the risk of toxic megacolon.
- Pain relievers: Acetaminophen is recommended for mild pain. NSAIDs like ibuprofen, naproxen sodium, and diclofenac sodium should be avoided as they can exacerbate UC symptoms.
- Antispasmodics: May be prescribed to manage abdominal cramps.
- Iron supplements: Administered to address potential iron deficiency anemia resulting from chronic intestinal bleeding.
6. Surgical Intervention to Remove Affected Area.
Since UC is confined to the colon, colectomy (surgical removal of the colon) can be curative. The preferred surgical procedure is proctocolectomy with ileal pouch-anal anastomosis (IPAA), which allows for bowel movements without a permanent stoma. Proctocolectomy with ileostomy is an alternative for patients not suitable for IPAA. Indications for surgery include:
- Intractable fulminant colitis (severe, rapidly worsening colitis)
- Toxic megacolon (severely dilated colon with systemic toxicity)
- Perforation (colon rupture)
- Uncontrollable bleeding
- Intolerable drug side effects
- Strictures (narrowing of the colon)
- Unresectable high-grade or multifocal dysplasia (precancerous changes)
- Malignancy (colon cancer)
- Infant growth retardation (severe impact on growth in children)
7. Prevent Relapse Through Maintenance Therapy.
Maintenance therapy is crucial for all UC patients to prevent disease relapse. Individualized drug regimens are necessary to effectively manage symptoms and maintain remission.
Prevent Flare-ups
1. Establish a Healthy Gut Microbiome.
Probiotics may help maintain remission by promoting a balanced gut bacteria environment.
2. Identify and Avoid Trigger Foods.
Individual food triggers vary. Common culprits include dairy, high-fiber foods, sugary foods, spicy foods, caffeine, and alcohol. Encourage patients to keep a food diary to track and identify foods that exacerbate symptoms like abdominal pain, bloating, gas, and diarrhea.
3. Recommend Small, Frequent Meals.
Eating may be challenging during a flare. Suggest small, frequent meals and snacks instead of large meals to prevent malnutrition.
4. Prevent Dehydration.
Adequate fluid intake, especially water, is crucial. Advise patients to avoid carbonated drinks (which can cause gas) and alcohol (which can stimulate the intestines and worsen diarrhea).
5. Consult a Registered Dietitian.
A dietitian specializing in IBD nutrition can provide personalized dietary guidance and support.
Establish Regular Elimination
1. Monitor Elimination Patterns.
Mild UC may involve fewer than four bowel movements daily, while moderate-severe UC can result in more than four. Rectal bleeding may occur in all severity levels. Closely monitor changes in bowel frequency, color, odor, and consistency.
2. Avoid Straining During Bowel Movements.
Educate patients on proper defecation techniques, including squatting and avoiding straining. Promote increased fluid and fiber intake (when appropriate and tolerated) to facilitate regular bowel movements without constipation or diarrhea.
3. Monitor for Complications.
Be vigilant for signs and symptoms of complications like bleeding, fecal impaction, or intestinal obstruction.
Assist With Coping
1. Manage Stress Effectively.
Stress does not directly cause IBD, but it can worsen symptoms and potentially trigger flares. Encourage stress management techniques such as exercise, meditation, walking, and journaling.
2. Educate Patients About UC.
Patient education empowers individuals to feel more in control of their condition. Providing accurate and comprehensive information enables patients to make informed decisions about their care.
3. Support Pediatric Patients and Families.
Children with UC require comprehensive family support. Recommend family counseling to assist children and families in coping with the challenges of this chronic condition.
4. Utilize Bathroom Access Cards.
Patients with IBD may experience anxiety related to restroom access, especially in public settings. Bathroom access cards can be downloaded online and discreetly presented to gain access to restrooms when needed.
Nursing Care Plans for Ulcerative Colitis
Once nursing diagnoses are identified, nursing care plans guide the prioritization of assessments and interventions to achieve both short-term and long-term care goals. The following are examples of nursing care plans for common nursing diagnoses related to ulcerative colitis.
Acute Pain
Acute pain is a frequent and debilitating symptom associated with ulcerative colitis, significantly impacting quality of life.
Nursing Diagnosis: Acute Pain
Related to:
- Inflammation of the intestines
- Hyperactive bowels (hyperperistalsis)
- Persistent diarrhea
- Anal irritation
- Rectal irritation
- Fistula formation (less common in UC, but possible)
- Joint arthralgias (joint pain)
- Scleritis (eye inflammation)
As evidenced by:
- Reports of abdominal pain
- Complaints of abdominal cramping
- Facial grimacing
- Guarding behaviors
- Distraction behaviors
- Restlessness
- Self-focusing
Expected Outcomes:
- Patient will report relief from abdominal cramping.
- Patient will verbalize two strategies to relieve abdominal pain.
- Patient will exhibit a calm and well-rested appearance.
Assessments:
1. Assess Abdominal Pain:
Investigate complaints of abdominal pain or cramping, noting location, duration, and severity (0-10 pain scale). Document any changes in pain characteristics.
2. Auscultate Bowel Sounds:
Colitis-induced increased peristalsis leads to hyperactive bowel sounds, abdominal cramping, and pain.
3. Observe Nonverbal Pain Cues:
Monitor for nonverbal cues of pain or cramping, such as restlessness, facial expressions, guarding, and distraction behaviors.
4. Identify Pain Triggering Factors:
Stress, fatty and spicy foods, and foods high in sugar, caffeine, alcohol, and carbonated drinks can exacerbate abdominal pain and cramping.
Interventions:
1. Position for Comfort:
Position the patient comfortably. The left side of the abdomen or the rectum is often affected in colitis. Certain positions may worsen pain depending on the inflamed area.
2. Educate on and Administer Appropriate Medications:
Administer acetaminophen for mild pain. Antispasmodic medications can alleviate abdominal cramps. Avoid NSAIDs like ibuprofen, naproxen, or diclofenac, as they can worsen abdominal discomfort.
3. Administer Opioids and Adjuvant Analgesics as Prescribed:
Severe colitis pain may require opioid analgesics. Antidepressants may be recommended as adjuvant analgesics for chronic pain management.
4. Encourage Psychotherapy:
Cognitive behavioral therapy (CBT) can be a valuable complementary therapy for chronic pain management and improving quality of life.
5. Educate on Avoiding Triggering Factors:
Stress management and dietary modifications can help prevent inflammation, abdominal pain, and cramping associated with colitis.
6. Provide Rectal Pain Relief Measures:
Rectal pain and skin irritation are common with frequent loose stools. Offer warm sitz baths for comfort and cleanse the rectal area with soft, cool wipes.
Diarrhea
Diarrhea in ulcerative colitis stems from colon inflammation and the presence of inflammatory mediators. This leads to persistent colonic contractions and malabsorption, resulting in frequent bowel movements. Ulceration of the gut lining further contributes to bloody diarrhea.
Nursing Diagnosis: Diarrhea
Related to:
- Inflammation of the colon lining
- Frequent bowel movements
- Persistent colon contractions
As evidenced by:
- Loose and watery stools
- Bloody stools (bright red, maroon, or black)
- Stool containing pus or mucus
- Foul-smelling stool
- Abdominal pain
- Abdominal cramping
- Tenesmus
- Rectal pain
- Hyperactive bowel sounds
- Weight loss
- Dehydration
Expected Outcomes:
- Patient will report a decrease in stool frequency and urgency to less than three stools per day.
- Patient will exhibit bowel sounds within normal limits upon auscultation.
- Patient will pass stool without blood or mucus.
Assessments:
1. Analyze Bowel Movement Onset and Pattern:
Note symptom onset, triggering factors, and diarrhea frequency. Assess the patient’s baseline bowel pattern to monitor for flares.
2. Assess Stool Characteristics:
Note stool color and characteristics, including the presence of blood or mucus.
3. Obtain Stool Sample for Culture and Fecal Calprotectin:
Fecal calprotectin testing helps differentiate IBD from noninflammatory bowel conditions. Stool culture helps rule out infectious etiologies.
Interventions:
1. Implement Gradual Dietary Changes as Ordered:
Maintain NPO status initially, followed by a progression from clear liquids to a low-fiber diet as prescribed and tolerated during acute flares. Initial NPO status helps reduce bowel movements.
2. Assist with Meal Planning:
Recommend a low-fiber, high-protein diet supplemented with vitamins and iron. Advise avoiding gas-producing foods, dairy products, raw fruits and vegetables, whole grains, nuts, pepper, alcohol, and caffeinated items.
3. Administer Medications as Prescribed:
Administer prescribed medications, which may include salicylate compounds, corticosteroids, immunosuppressants, and antidiarrheals.
- Anti-inflammatory (salicylate compounds) medications are first-line treatment.
- Corticosteroids induce remission through anti-inflammatory and immunosuppressive actions.
- Immunosuppressants modulate the immune response to reduce inflammation.
- Antidiarrheals (e.g., loperamide) help reduce stool frequency and volume, but use with caution.
4. Prepare Patient for Potential Surgery:
Surgery may be necessary for severe or complicated cases. Surgical options include colectomy with IPAA or ileostomy.
5. Refer to an IBD Specialist:
Referral to an IBD specialist ensures expert evaluation, treatment, and ongoing management of the condition.
6. Refer to a Dietitian or Nutritionist:
Dietary management is crucial for UC. A dietitian can provide tailored dietary education and support to prevent flare-ups and manage symptoms.
Dysfunctional Gastrointestinal Motility
Ulcerative colitis disrupts normal colonic motility due to inflammation, neuromuscular dysfunction, and altered contractile patterns.
Nursing Diagnosis: Dysfunctional Gastrointestinal Motility
Related to:
- Disease process (ulcerative colitis)
- 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 appropriate weight for age and gender and report adequate appetite.
- Patient will experience no more than three formed bowel movements per day.
Assessments:
1. Monitor Laboratory Values:
Monitor C-reactive protein (CRP) levels, an acute-phase marker elevated in inflammatory processes like UC.
2. Assess Stool Characteristics and Bowel Patterns:
Assess for bloody and mucoid stools, tenesmus, and lower abdominal colicky pain often relieved by defecation.
3. Assess Appetite and Weight:
Evaluate the impact of UC symptoms (diarrhea, pain, nausea) on appetite and weight, noting any weight loss.
Interventions:
1. Administer Medications as Indicated:
Administer prescribed aminosalicylates to reduce intestinal inflammation and improve motility issues.
2. Administer Antidiarrheals Cautiously:
Use antidiarrheals like loperamide with caution for severe diarrhea, as they may increase the risk of toxic megacolon.
3. Administer Enteral Feedings if Needed:
Enteral nutrition is preferred over parenteral nutrition for malnourished patients as it stimulates the GI system.
4. Educate on Avoiding Symptom-Worsening Medications:
Review patient medications and advise avoiding NSAIDs like ibuprofen and naproxen, which can exacerbate UC symptoms.
5. Encourage Light Activity and Rest:
Encourage light physical activity with rest periods. During exacerbations, promote rest and comfort to reduce intestinal activity and promote healing.
Ineffective Tissue Perfusion (Gastrointestinal)
Inflammation and ulceration in UC compromise gastrointestinal tissue perfusion in the colon, rectum, and large intestine.
Nursing Diagnosis: Ineffective Tissue Perfusion (Gastrointestinal)
Related to:
- Intestinal inflammation
- Disease process (ulcerative colitis)
- Intestinal or rectal bleeding
- Obstruction (less common, but possible)
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.
Assessments:
1. Review Diagnostic Imaging Results:
Review colonoscopy findings, which typically show loss of vascular pattern, erythema, erosions, granularity, ulcerations, and bleeding in UC.
2. Monitor for Complications:
Assess for signs and symptoms of complications like GI bleeding, severe dehydration, perforation, and cancer, which can compromise tissue perfusion.
3. Assess Laboratory Test Results:
Monitor hematocrit and hemoglobin levels for anemia due to intestinal bleeding. Assess ferritin, iron, TIBC, and MCV levels to evaluate iron deficiency anemia.
Interventions:
1. Administer Medications as Ordered:
Administer aminosalicylates to reduce inflammation and promote intestinal tissue healing and perfusion. Immunomodulators or biologics may be needed for severe UC. Steroids are used for acute flare-ups.
2. Treat and Prevent Anemia:
Administer iron, vitamin B12, and RBC count supplementation orally or IM as needed. Blood transfusions may be required for significant intestinal bleeding and low hemoglobin levels.
3. Administer Intravenous Fluids and Electrolytes:
Provide fluid resuscitation via IV therapy to improve hemodynamics and GI tissue perfusion, especially with bleeding. Replace electrolyte losses.
4. Treat Rectal Bleeding:
Manage rectal bleeding from anal fissures or hemorrhoids with steroid suppositories to reduce inflammation. Sitz baths can provide comfort.
5. Educate on When to Seek Assistance for Bleeding:
Instruct patients to report bloody stools or rectal bleeding to their gastroenterologist, as it may indicate a need for treatment adjustment.
Risk for Deficient Fluid Volume
Persistent diarrhea in ulcerative colitis poses a significant risk for deficient fluid volume due to 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 verbalize signs and symptoms of dehydration.
- Patient will verbalize two strategies to prevent dehydration.
- Patient will maintain fluid and electrolyte balance within normal limits.
Assessments:
1. Monitor Fluid Intake and Output:
Accurately record fluid intake and output, including documentation of loose stools.
2. Review Electrolyte Levels:
Monitor electrolyte levels (serum sodium and potassium) to detect imbalances resulting from diarrhea.
3. Assess for Dehydration Signs and Symptoms:
Assess for signs and symptoms of dehydration:
- Increased thirst
- Headache
- Weakness
- Poor skin turgor
- Flushed skin
- Dry mouth
- Hypotension (low blood pressure)
- Tachycardia (rapid heart rate)
Interventions:
1. Prevent Dehydration:
Address the underlying cause of fluid loss by managing diarrhea.
2. Hydrate the Patient:
Administer prescribed intravenous fluids and electrolytes.
3. Encourage Increased Oral Fluid Intake:
Promote increased oral fluid intake (water, electrolyte drinks, broths, soups) if tolerated and not contraindicated.
4. Implement Recommended Diet:
Adhere to the prescribed diet for the patient’s UC phase (acute or remission). Proper diet helps reduce diarrhea and fluid volume deficit risk.
5. Educate on Dehydration Prevention:
Advise patients on preventive measures:
- Drink recommended daily fluid intake
- Consume water-rich foods (fruits and vegetables when tolerated)
- Limit or avoid alcohol
- Limit caffeinated beverages
References
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