Nursing Diagnoses for Colitis: A Comprehensive Guide for Healthcare Professionals

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that primarily affects the rectum and colon. Characterized by inflammation and ulceration of the innermost lining of the large intestine, UC presents significant challenges for patients and requires comprehensive nursing care. Understanding the nuances of nursing diagnoses for colitis is crucial for healthcare professionals to provide effective, patient-centered care. This guide delves into the essential aspects of ulcerative colitis from a nursing perspective, encompassing assessment, diagnosis, interventions, and care planning, ensuring optimal outcomes and improved quality of life for individuals affected by this condition.

Understanding Ulcerative Colitis

Ulcerative colitis is defined as a chronic inflammatory condition that specifically targets the mucosal lining of the large intestine, starting in the rectum and potentially extending proximally throughout the colon. The inflammation in UC is continuous, unlike Crohn’s disease, another type of IBD that can affect any part of the gastrointestinal tract and is often patchy. This inflammation leads to edema, friability, and ulcerations of the colonic mucosa. Over time, repeated cycles of inflammation and healing can result in scar tissue formation, reducing the colon’s elasticity and absorptive capacity.

While the exact etiology of ulcerative colitis remains elusive, a combination of genetic predisposition, environmental factors, and immune system dysregulation is believed to play a significant role. Individuals with a family history of IBD are at a higher risk, and certain populations, such as those of Jewish descent, exhibit a higher incidence. Although stress and specific foods are not considered causative factors, they can exacerbate symptoms and trigger flare-ups in susceptible individuals. The typical onset of UC often occurs between the ages of 15 and 30, with a secondary, smaller peak incidence between 50 and 70 years of age.

The pathophysiology of ulcerative colitis involves an aberrant immune response where the body’s immune system mistakenly identifies the normal flora and the epithelial cells lining the colon as foreign invaders. This misdirected immune response leads to the activation of white blood cells, which then attack and damage the colonic mucosa. This inflammatory process results in the characteristic symptoms of UC, including bloody diarrhea, abdominal pain, and urgency. The damaged lining becomes susceptible to ulcer formation, which can, in severe cases, lead to complications such as bowel perforation. The chronic inflammation and subsequent repair processes can lead to the formation of scar tissue, further compromising the colon’s function.

Nursing Assessment for Ulcerative Colitis

A thorough nursing assessment is the cornerstone of effective care for patients with ulcerative colitis. This assessment involves gathering subjective and objective data to identify the patient’s needs and formulate appropriate nursing diagnoses for colitis.

Health History Review

A comprehensive health history is essential in identifying potential ulcerative colitis and understanding the patient’s specific experience with the disease.

1. General Symptom Inquiry: Initiate the assessment by inquiring about the patient’s general symptoms. Bloody diarrhea is a hallmark symptom of ulcerative colitis, often accompanied by mucus. Depending on the severity and extent of the inflammation, patients may report a range of symptoms, including:

• Rectal bleeding: Varying from mild streaks of blood to significant bleeding with bowel movements.
• Tenesmus: A persistent and urgent sensation of needing to defecate, even after the bowels have been emptied.
• Abdominal discomfort and cramping: Pain can range from mild discomfort to severe cramping, often localized in the lower abdomen.
• Rectal pain: Pain and soreness in the rectal area, especially with frequent bowel movements.
• Fatigue: Persistent tiredness and lack of energy, common due to inflammation, anemia, and poor nutrient absorption.
• Loss of appetite: Reduced desire to eat, potentially leading to weight loss and nutritional deficiencies.

2. Determining the Type of Ulcerative Colitis: Ulcerative colitis is classified based on the extent of colonic involvement, which influences the symptoms experienced. Understanding the type of UC helps in tailoring treatment and nursing care. The classifications include:

• Ulcerative Proctitis:
  • Location: Inflammation is confined to the rectum.
  • Symptom: Primarily rectal bleeding, which may be the only symptom.
• Proctosigmoiditis:
  • Location: Affects the rectum and sigmoid colon (the S-shaped part of the colon before the rectum).
  • Symptoms: Bloody diarrhea, abdominal cramps, abdominal pain, and tenesmus.
• Left-sided Colitis:
  • Location: Extends from the rectum and sigmoid colon to the descending colon (left side of the colon).
  • Symptoms: Left-sided abdominal cramps, bloody diarrhea, and unintentional weight loss.
• Pancolitis:
  • Location: Involves the entire colon, from the rectum to the cecum.
  • Symptoms: Severe bloody diarrhea, significant abdominal cramps and pain, fatigue, and substantial weight loss.

3. Bowel Habit Changes: Inquire about changes in bowel habits. Ulcerative colitis flares are often marked by increased bowel urgency, abdominal pain, and cramping. Stools are typically loose and may contain visible blood, pus, or mucus. Changes in frequency, consistency, and the presence of blood should be carefully documented.

4. Risk Factor Identification: Assess for both non-modifiable and modifiable risk factors that may contribute to the development or exacerbation of ulcerative colitis.

• Non-modifiable Risk Factors:
  • Ethnicity: Higher prevalence among Caucasians and individuals of Jewish ancestry.
  • Age: Peak onset between 15 and 30 years, with a secondary peak between 50 and 70 years.
  • Family History: Increased risk if a first-degree relative (parent, sibling, or child) has ulcerative colitis.
• Modifiable Risk Factors:
  • NSAID Use: Non-steroidal anti-inflammatory drugs (NSAIDs) have been linked to an increased risk of developing or worsening ulcerative colitis. Document the patient’s history of NSAID use.
  • History of Appendectomy: Interestingly, an appendectomy before the age of 20 has been associated with a lower incidence of ulcerative colitis. While not a modifiable risk factor in retrospect, it’s a relevant point in medical history.

Physical Assessment

The physical examination provides objective data to support the diagnosis and assess the severity of ulcerative colitis.

1. Abdominal Examination: Perform a thorough abdominal examination. While findings may be normal between flares, during an active flare, abdominal tenderness is common. Other potential findings include:

• Voluntary or involuntary guarding: Tensing of abdominal muscles in response to palpation.
• Rebound tenderness: Pain that increases upon sudden release of pressure during palpation, suggesting more advanced colitis or potential perforation.
• Palpable mass: May indicate a blockage or toxic megacolon, a severe complication of UC.
• Enlarged spleen (splenomegaly): Could suggest primary sclerosing cholangitis or autoimmune hepatitis, which can be associated with UC.

2. Monitoring for Weight Loss: Regularly monitor and document the patient’s weight. Unintentional weight loss is a frequent finding in ulcerative colitis due to pain, diarrhea, inflammation, and malabsorption.

3. Auscultation of Bowel Sounds: Listen to bowel sounds in all four quadrants of the abdomen. Bowel sounds in ulcerative colitis can be variable: hypoactive (decreased), hyperactive (increased), or normal. High-pitched tinkling bowel sounds may indicate an obstruction.

4. Perianal Examination: Conduct a perianal examination. In uncomplicated UC, there should be no signs of fistulas or abscesses in the perianal area (which are more characteristic of Crohn’s disease). However, persistent diarrhea can lead to perianal erythema (redness), fissuring, or hemorrhoids.

5. Assessment for Extraintestinal Manifestations: Ulcerative colitis is a systemic disease and can affect organs outside the intestines. Assess for extraintestinal symptoms, including:

• Joint pain (Arthralgia): Commonly affecting large joints.
• Eye problems: Red, swollen, and painful eyes, suggestive of episcleritis or uveitis.
• Skin rashes: Such as erythema nodosum or pyoderma gangrenosum.
• Liver impairment: Elevated liver enzymes may indicate liver involvement.
• Delayed growth: Especially in pediatric patients.

6. Complete Physical Assessment: Perform a comprehensive physical assessment, paying attention to the following systems and signs:

• General: Note any fever, weight loss, or fatigue.
• HEENT (Head, Eyes, Ears, Nose, Throat): Assess for episcleritis (inflammation of the sclera) and uveitis (inflammation of the uvea, the middle layer of the eye).
• Gastrointestinal: Document abdominal pain, bloody stools, and tenesmus.
• Musculoskeletal: Assess for joint pain, particularly in large joints (hips, knees, ankles), and signs of ankylosing spondylitis (inflammation of the spinal joints). Also, assess for signs of osteoporosis, a potential long-term complication.
• Integumentary: Observe for pallor (paleness), poor skin turgor (indicating dehydration), jaundice (yellowing of the skin and eyes, suggesting liver issues), and erythema nodosum (painful, red nodules on the shins).

7. Pediatric Growth and Development: In pediatric patients, be particularly vigilant for delayed growth and development. Growth failure is a significant complication of UC in children, resulting from inflammation, immune response, malnutrition, and steroid use. Children may also experience delayed puberty and sexual maturation.

8. Stool Characteristics: Thoroughly assess stool characteristics. Bloody stools are a hallmark of UC. The color of blood can vary from bright red to pink, maroon, or occasionally black (melena, indicating upper GI bleeding, though less common in UC, should be considered). Note the presence of pus and mucus in the stool.

Diagnostic Procedures

Diagnostic procedures are essential to confirm the diagnosis of ulcerative colitis and rule out other conditions.

1. Clinical Diagnosis with Supportive Findings: The diagnosis of ulcerative colitis is primarily clinical, based on the patient’s history, physical examination, and supportive findings from diagnostic tests, particularly endoscopy and biopsy. Imaging results can help detect acute flares and complications.

2. Stool Sample Analysis: Send stool samples for laboratory testing.

• White Blood Cells (WBCs) in Stool: Indicate inflammation, supporting the diagnosis of IBD and helping to rule out infectious causes of colitis. Testing for parasites and viruses can further exclude other infectious etiologies.
• Fecal Calprotectin: A protein released by neutrophils in the intestine when inflammation is present. Elevated fecal calprotectin levels are highly sensitive for differentiating inflammatory bowel disease (like UC and Crohn’s) from irritable bowel syndrome (IBS), a non-inflammatory condition.

3. Blood Sample Analysis: Assess for inflammatory markers and complications through blood tests.

• Complete Blood Count (CBC) with Metabolic Panel: Evaluates for anemia (vitamin B12 or iron deficiency), which is common in UC due to chronic blood loss and malabsorption. Hypoalbuminemia (low albumin levels) and decreased electrolyte levels may be seen in cases of malnutrition and dehydration.
• Special Serology (p-ANCA and ASCA): Perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) are frequently positive in ulcerative colitis, while anti-Saccharomyces cerevisiae antibodies (ASCA) are more commonly associated with Crohn’s disease. These serological markers can aid in differentiating between UC and Crohn’s, although they are not definitive.
• C-Reactive Protein (CRP) or Erythrocyte Sedimentation Rate (ESR): These are markers of systemic inflammation. Elevated CRP and ESR levels indicate the presence and severity of inflammation in ulcerative colitis and can be used to monitor disease activity.

4. Imaging Scans: Imaging techniques visualize the gut to identify inflammation and rule out other conditions.

• Computed Tomography (CT) Enterography/Magnetic Resonance Enterography (MRE): Specialized CT or MRI scans focused on the small intestine, primarily used to rule out Crohn’s disease, which often involves the small bowel. MRE is radiation-free and is often preferred, especially in younger patients and for repeated imaging. These scans are more sensitive than traditional imaging for detecting intestinal inflammation.
• CT Scan of the Abdomen: A standard CT scan of the abdomen can be used when ulcerative colitis is suspected and can help differentiate UC from Crohn’s disease and identify complications.
• Plain X-rays: Abdominal X-rays are useful as a first-line imaging modality to rule out significant complications such as toxic megacolon (severe colonic dilation) or bowel perforation.
• Double-Contrast Barium Enema: An older imaging technique, but can still be used to detect early mucosal changes in the colon.

5. Colon Visualization: Direct visualization of the colon is crucial for diagnosis and assessment.

• Colonoscopy: A colonoscopy is typically performed during a suspected flare to directly visualize the colon mucosa, assess the extent and severity of inflammation, and identify mucosal changes (erythema, ulcerations, granularity). Crucially, tissue biopsies are taken during colonoscopy for histological examination to confirm the diagnosis of UC and rule out dysplasia or malignancy.
• Flexible Sigmoidoscopy: Similar to colonoscopy but examines only the rectum and sigmoid colon. Sigmoidoscopy is often sufficient to assess UC activity, particularly in proctitis or proctosigmoiditis, and to monitor treatment effectiveness.

Alt text: Colonoscopy image displaying the inflamed and ulcerated mucosal lining characteristic of ulcerative colitis.

Nursing Interventions for Ulcerative Colitis

Nursing interventions are vital for managing ulcerative colitis, alleviating symptoms, and preventing complications. These interventions focus on treating inflammation, preventing flare-ups, establishing regular elimination patterns, and providing psychosocial support.

Treat the Inflammation

The primary goal of treatment in ulcerative colitis is to induce and maintain remission, thereby improving the patient’s quality of life.

1. Induce and Maintain Remission: Ulcerative colitis follows a course of flares (periods of active symptoms) and remissions (periods with minimal or no symptoms). Treatment strategies are designed to reduce inflammation during flares and prevent future exacerbations.

2. Administer Anti-inflammatory Medications: Anti-inflammatory medications are the cornerstone of UC treatment.

• 5-Aminosalicylates (5-ASAs): Such as sulfasalazine, mesalamine, balsalazide, and olsalazine, are often the first-line treatment for mild to moderate ulcerative colitis. They are available in oral, rectal (suppositories, enemas), and intravenous formulations, allowing for targeted delivery based on the location of inflammation.
• Corticosteroids: Like prednisone and budesonide, are potent anti-inflammatory agents used for moderate to severe ulcerative colitis, particularly when 5-ASAs are insufficient to achieve remission. Due to their potential for significant side effects with long-term use, corticosteroids are typically used for short-term flare management to induce remission, not for maintenance therapy.

3. Suppress the Immune System: Immunosuppressants are used to modulate the overactive immune response in UC.

• Immunomodulators: Including azathioprine, 6-mercaptopurine, and methotrexate, are steroid-sparing agents used to maintain remission and reduce corticosteroid dependence. They work by suppressing the immune system’s activity, reducing inflammation.
• Calcineurin Inhibitors: Cyclosporine and tacrolimus are potent immunosuppressants sometimes used for severe, refractory UC, particularly in hospitalized patients.

4. Consider Biologics: Biologic therapies are targeted medications that specifically block inflammatory pathways involved in UC.

• Anti-TNF Agents: Infliximab, adalimumab, and golimumab target tumor necrosis factor-alpha (TNF-α), a key inflammatory cytokine.
• Anti-Integrin Agents: Vedolizumab blocks integrin α4β7, preventing immune cells from migrating to the gut.
• Anti-IL-12/23 Agents: Ustekinumab targets interleukin-12 and interleukin-23, cytokines involved in inflammation.
• Janus Kinase (JAK) Inhibitors: Tofacitinib is a small molecule inhibitor of JAK enzymes, which are involved in inflammatory signaling pathways.

Biologics are typically reserved for patients with moderate to severe ulcerative colitis who have not responded adequately to conventional therapies or who are steroid-dependent.

5. Manage Specific Symptoms: In addition to anti-inflammatory and immunosuppressive therapies, medications are used to manage specific symptoms of ulcerative colitis.

• Antidiarrheals: Such as loperamide and diphenoxylate-atropine, can help reduce the frequency of bowel movements in severe diarrhea. However, they should be used cautiously and under medical supervision, as some antidiarrheals can increase the risk of toxic megacolon.
• Pain Relievers: Acetaminophen (paracetamol) is generally recommended for mild pain. NSAIDs like ibuprofen, naproxen, and diclofenac should be avoided as they can exacerbate UC symptoms and worsen inflammation.
• Antispasmodics: Medications like hyoscyamine or dicyclomine may be prescribed to relieve abdominal cramps and spasms.
• Iron Supplements: Iron deficiency anemia is common in UC due to chronic intestinal bleeding. Iron supplements, either oral or intravenous, are often necessary to replenish iron stores.

6. Surgical Intervention: Surgery may be necessary in cases of severe, refractory ulcerative colitis or complications.

• Colectomy: Since ulcerative colitis is confined to the colon, surgical removal of the colon (colectomy) is considered curative.
• Proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA): The preferred surgical procedure involves removing the entire colon and rectum and creating an internal pouch from the ileum (small intestine) that is connected to the anus, allowing for bowel movements through the anus without the need for a permanent stoma.
• Proctocolectomy with Ileostomy: Involves removing the entire colon, rectum, and anus, and creating a permanent ileostomy, where the end of the small intestine (ileum) is brought through an opening in the abdomen (stoma), and stool is collected in an external pouch. This is an option for patients who are not candidates for IPAA.

Indications for surgery include intractable fulminant colitis, toxic megacolon, perforation, uncontrollable bleeding, unbearable drug side effects, strictures, dysplasia, malignancy, and growth retardation in children.

7. Prevent Relapse: Maintenance therapy is crucial for all patients with ulcerative colitis to prevent disease relapse and maintain remission. The specific maintenance regimen is individualized based on disease severity, response to treatment, and patient factors. Maintenance medications often include 5-ASAs, immunomodulators, or biologics.

Prevent Flare-ups

Preventing flare-ups is a key aspect of long-term management of ulcerative colitis, focusing on lifestyle and dietary modifications.

1. Establish a Healthy Gut Microbiome: Probiotics may help promote remission by restoring and maintaining a healthy balance of gut bacteria. While research is ongoing, some studies suggest potential benefits of specific probiotic strains in UC.

2. Identify and Avoid Trigger Foods: Dietary triggers vary among individuals. Common trigger foods include dairy products, high-fiber foods, sugary foods, spicy foods, caffeine, and alcohol. Patients are advised to keep a food diary to track their dietary intake and identify foods that exacerbate their symptoms. Personalized dietary recommendations should be guided by a dietitian.

3. Recommend Small, Frequent Meals: Eating large meals during a flare-up can be uncomfortable and worsen symptoms. Advise patients to consume small, frequent meals and snacks to prevent malnutrition and reduce digestive workload.

4. Maintain Hydration: Adequate fluid intake is essential, especially during flares when diarrhea is prominent. Advise patients to drink plenty of fluids, particularly water. Carbonated drinks can cause gas and bloating, and alcohol can stimulate the intestines and worsen diarrhea, so these should be limited or avoided.

5. Consult a Registered Dietitian: A registered dietitian specializing in IBD nutrition can provide personalized dietary guidance, help patients identify trigger foods, ensure adequate nutrient intake, and develop a meal plan that supports disease management.

Establish Regular Elimination

Managing bowel elimination patterns is crucial for comfort and preventing complications.

1. Monitor Elimination Patterns: Regularly monitor and document bowel movement frequency, consistency, color, odor, and presence of blood or mucus. Mild UC may involve fewer than four bowel movements daily, while moderate to severe UC can result in more than four stools per day. Changes in bowel habits can indicate disease activity or complications.

2. Avoid Straining During Defecation: Educate patients on proper defecation techniques, including using a squatting position and avoiding straining, which can worsen hemorrhoids and anal fissures. Encourage increased fluid and fiber intake (when tolerated and not during acute flares) to promote regular bowel movements without constipation or excessive diarrhea.

3. Monitor for Complications: Be vigilant for signs and symptoms of complications related to altered bowel elimination, such as bleeding, fecal impaction, or intestinal obstruction.

Assist With Coping

The chronic nature of ulcerative colitis and its symptoms can significantly impact a patient’s psychological well-being.

1. Stress Management: While stress does not cause UC, it can exacerbate symptoms and trigger flare-ups. Help patients develop effective stress management strategies, such as regular exercise, meditation, walking, journaling, and relaxation techniques.

2. Patient Education: Educating patients about ulcerative colitis, its management, and self-care strategies empowers them and enhances their sense of control over their condition. Provide comprehensive information about the disease, treatment options, lifestyle modifications, and when to seek medical attention.

3. Support for Pediatric Patients and Families: Children with ulcerative colitis require comprehensive support, involving the entire family. Recommend family counseling and support groups to help children and their families cope with the challenges of UC, including social stigma, medication adherence, and body image issues.

4. Bathroom Access Card: For patients who experience urgency and frequent bowel movements, carrying a bathroom access card can alleviate anxiety when traveling or socializing. These cards, often available online from IBD organizations, discreetly communicate the need for urgent bathroom access.

Nursing Care Plans for Ulcerative Colitis

Nursing care plans are essential tools for organizing and delivering patient-centered care. Based on the assessment data and identified nursing diagnoses for colitis, care plans guide nursing interventions to achieve specific patient outcomes. Here are examples of nursing care plans for common nursing diagnoses associated with ulcerative colitis.

Acute Pain

Nursing Diagnosis: Acute Pain related to inflammation of the intestines, hyperactive bowels (hyperperistalsis), persistent diarrhea, irritation in the anus and rectum, fistula formation, joint arthralgias, and scleritis.

As evidenced by: Complaints of abdominal pain and cramping, facial grimacing, guarding behaviors, distraction behaviors, restlessness, and self-focusing.

Expected Outcomes:

• Patient will report relief from abdominal cramping within a specified timeframe (e.g., within 2 hours of intervention).
• Patient will verbalize two effective strategies to relieve abdominal pain (e.g., relaxation techniques, medication).
• Patient will demonstrate a calm and well-rested appearance, indicating reduced pain and discomfort.

Assessment:

1. Assess Abdominal Pain: Investigate complaints of abdominal pain or cramping, noting location, duration, severity (using a pain scale of 0-10), and characteristics. Document any changes in pain characteristics.
2. Auscultate Bowel Sounds: Assess bowel sounds for increased activity (hyperactive bowel sounds), which can indicate increased peristalsis and contribute to abdominal cramping and pain.
3. Observe Nonverbal Cues: Monitor for nonverbal cues of pain or cramping, such as restlessness, facial expressions (grimacing, furrowed brow), guarding behaviors, and distraction behaviors (moaning, pacing).
4. Identify Triggering Factors: Determine factors that exacerbate pain, such as stress, specific foods (fatty, spicy, sugary foods, caffeine, alcohol, carbonated drinks).

Interventions:

1. Position for Comfort: Assist the patient to find a comfortable position. The left lateral position or knee-chest position may relieve abdominal pressure. Note positions that worsen or alleviate pain.
2. Administer Appropriate Medications: Administer prescribed pain medications. Acetaminophen may be used for mild pain. Antispasmodics can relieve abdominal cramps. Avoid NSAIDs (ibuprofen, naproxen, diclofenac), which can worsen UC symptoms.
3. Administer Opioids and Adjuvants: For severe pain, opioid analgesics may be necessary. Adjuvant analgesics, such as antidepressants (e.g., tricyclic antidepressants), may be used for chronic pain management.
4. Encourage Psychotherapy: Recommend cognitive behavioral therapy (CBT) as a complementary therapy for chronic pain management. CBT can help patients develop coping mechanisms and improve their quality of life.
5. Educate on Trigger Avoidance: Educate the patient about stress management techniques and dietary modifications to avoid triggering factors that exacerbate pain and cramping.
6. Relieve Rectal Pain: For rectal pain and irritation associated with frequent stools, provide comfort measures such as warm sitz baths and gentle cleansing of the rectal area with soft, cool wipes. Consider topical anesthetic creams as prescribed.

Diarrhea

Nursing Diagnosis: Diarrhea related to inflammation of the lining of the colon and persistent contraction of the colon.

As evidenced by: Loose and watery stools, bloody stools (bright red, maroon, or black), stool with pus or mucus, foul-smelling stool, abdominal pain and cramping, tenesmus, rectal pain, increased bowel sounds, weight loss, and dehydration.

Expected Outcomes:

• Patient will report a decrease in stool frequency and urgency to less than three stools per day within 24-48 hours.
• Patient will demonstrate bowel sounds within normal limits upon auscultation, indicating improved bowel motility.
• Patient will pass stool without blood or mucus, signifying reduced inflammation and improved mucosal integrity.

Assessment:

1. Analyze Bowel Movement Onset and Pattern: Assess the onset, duration, frequency, and triggering factors of diarrhea. Establish the patient’s baseline bowel pattern to monitor for changes and flare-ups.
2. Assess Stool Characteristics: Document the color, consistency, odor, and presence of blood, mucus, or pus in stools.
3. Obtain Stool Sample for Culture: Collect stool samples for culture and fecal calprotectin testing as ordered to rule out infectious causes and assess for inflammatory markers.

Interventions:

1. Dietary Modifications: Implement dietary changes as prescribed. Maintain NPO status initially during severe diarrhea, followed by a gradual progression from clear liquids to a low-fiber, low-residue diet as tolerated during the acute phase. NPO status helps reduce bowel stimulation and allow the colon to rest.
2. Assist with Meal Planning: Collaborate with a dietitian to create a personalized meal plan. 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 caffeine-containing items.
3. Administer Medications: Administer prescribed medications, which may include a combination of salicylate compounds (5-ASAs), corticosteroids, immunosuppressants, and antidiarrheals.
   • Anti-inflammatory Medications (5-ASAs): First-line treatment to reduce colonic inflammation.
   • Corticosteroids: Short-term use to induce remission during flares due to their potent anti-inflammatory and immunosuppressive effects.
   • Immunosuppressants: To modulate the immune response and maintain remission.
   • Antidiarrheals: Use cautiously; fiber supplements may help with mild to moderate diarrhea. Loperamide may be used for more severe diarrhea, but monitor for signs of toxic megacolon.
4. Prepare for Surgery: Prepare the patient for potential surgical interventions if symptoms worsen or complications arise. Explain the types of surgeries (colectomy, IPAA, ileostomy) and their implications.
5. Refer to IBD Specialist: Refer the patient to a gastroenterologist specializing in IBD for comprehensive evaluation, treatment, and long-term management.
6. Refer to Dietitian/Nutritionist: Refer to a dietitian or nutritionist for specialized dietary counseling and education on managing UC through diet.

Dysfunctional Gastrointestinal Motility

Nursing Diagnosis: Dysfunctional Gastrointestinal Motility related to the disease process, inflammatory process, medications, malnutrition, and imbalanced fluid and electrolytes.

As evidenced by: Diarrhea, abdominal pain and cramping, nausea, vomiting, altered bowel sounds (hyperactive or hypoactive), tenesmus, malnutrition, dehydration, and weight loss.

Expected Outcomes:

• Patient will maintain an appropriate weight for age and gender, indicating improved nutritional status and gastrointestinal function.
• Patient will report having an appetite, reflecting improved gastrointestinal comfort and function.
• Patient will experience no more than three formed bowel movements per day, indicating improved bowel motility and control.

Assessment:

1. Monitor Laboratory Values: Assess and monitor laboratory values, particularly C-reactive protein (CRP), as it is a sensitive marker of inflammation and disease activity in UC.
2. Assess Stool Characteristics and Bowel Patterns: Thoroughly assess stool characteristics (presence of blood, mucus) and bowel patterns (frequency, urgency, consistency). Document episodes of tenesmus and associated lower abdominal colicky pain, noting if defecation provides relief.
3. Assess Appetite and Weight: Evaluate the impact of gastrointestinal symptoms on the patient’s appetite and weight. Monitor for weight loss, which can result from diarrhea, abdominal pain, nausea, and reduced food intake.

Interventions:

1. Administer Medications: Administer prescribed medications to improve gastrointestinal motility and reduce inflammation. Aminosalicylates are commonly used to reduce inflammation in the intestines and improve motility issues.
2. Administer Antidiarrheals: Administer antidiarrheals, such as loperamide, for severe diarrhea to slow bowel motility. Use with caution due to the risk of toxic megacolon.
3. Administer Enteral Feedings: If indicated for malnutrition, administer enteral nutrition (tube feeding) as preferred over parenteral nutrition (IV feeding) because enteral feeding stimulates the GI system and helps maintain gut function.
4. Medication Review: Review the patient’s medication list and identify any medications that may worsen gastrointestinal symptoms (e.g., NSAIDs). Encourage avoidance of NSAIDs like ibuprofen and naproxen.
5. Encourage Activity and Rest: Promote light physical activity, such as walking, which can aid in gastrointestinal motility without exacerbating symptoms. During exacerbations, encourage rest and promote comfort to reduce intestinal activity and facilitate gastrointestinal healing.

Ineffective Tissue Perfusion (Gastrointestinal)

Nursing Diagnosis: Ineffective Tissue Perfusion (Gastrointestinal) related to intestinal inflammation, disease process, intestinal or rectal bleeding, and obstruction.

As evidenced by: Abdominal pain and cramping, abdominal distension, anemia, rectal bleeding, bloody stools, weight loss, fluid and electrolyte imbalance, malnutrition, and fatigue.

Expected Outcomes:

• Patient will demonstrate hemoglobin, RBC, and iron levels within acceptable limits, indicating improved tissue oxygenation and reduced anemia.
• Patient will not experience rectal bleeding or bloody stools, signifying improved gastrointestinal tissue perfusion and reduced mucosal damage.

Assessment:

1. Assess Diagnostic Imaging Results: Review diagnostic imaging results, particularly colonoscopy reports, noting findings indicative of poor tissue perfusion, such as loss of vascular pattern, erythema, erosions, granularity, ulcerations, and bleeding.
2. Monitor for Complications: Assess and monitor for signs and symptoms of potential complications that can compromise gastrointestinal tissue perfusion, such as GI bleeding, severe dehydration, perforation, and signs of toxic megacolon.
3. Assess Laboratory Test Results: Evaluate laboratory results, particularly hematocrit, hemoglobin, ferritin, iron, total iron-binding capacity (TIBC), and mean corpuscular volume (MCV). Decreased hematocrit and hemoglobin indicate anemia due to intestinal bleeding. Low ferritin, iron, and MCV levels confirm iron deficiency anemia, common in UC.

Interventions:

1. Administer Medications: Administer prescribed medications to reduce inflammation and improve tissue perfusion. Aminosalicylates help reduce inflammation, allowing intestinal tissues to heal and improving perfusion. Immunomodulators or biologics may be needed for severe UC. Steroids are used for acute flare-ups to reduce inflammation rapidly.
2. Treat and Prevent Anemia: Treat anemia with iron supplements (oral or IM) and vitamin B12 supplementation as indicated by laboratory results. For significant intestinal bleeding and low hemoglobin levels, blood transfusions may be necessary.
3. Administer IV Fluids and Electrolytes: Administer intravenous fluids and electrolytes to improve hemodynamic stability and promote gastrointestinal tissue perfusion, especially if bleeding or dehydration is present. Replace electrolyte losses due to diarrhea and bleeding.
4. Treat Rectal Bleeding: Manage rectal bleeding associated with anal fissures and hemorrhoids, common in UC. Steroid suppositories can reduce inflammation in the rectal area. Warm sitz baths can alleviate discomfort and promote healing.
5. Educate on When to Seek Assistance: Educate the patient to recognize signs of recurrent bleeding (bloody stools, blood on toilet paper) and instruct them to contact their gastroenterologist if bleeding occurs, as it may indicate a need for treatment adjustment.

Risk for Deficient Fluid Volume

Nursing Diagnosis: Risk for Deficient Fluid Volume related to persistent diarrhea and 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 dehydration signs and symptoms, demonstrating knowledge of potential fluid volume deficit.
• Patient will verbalize two strategies to prevent dehydration, indicating understanding of preventive measures.
• Patient will maintain fluid and electrolyte balance within normal limits, as evidenced by electrolytes within expected ranges and stable vital signs.

Assessment:

1. Monitor Fluid Intake and Output: Accurately record and monitor the patient’s fluid intake (oral and intravenous) and output, including urine and liquid stools. Document the volume and frequency of loose stools to assess fluid loss.
2. Review Electrolytes: Regularly review electrolyte levels (serum sodium, potassium, urinalysis) to detect imbalances resulting from diarrhea and fluid loss.
3. Assess for Dehydration Signs and Symptoms: Assess for clinical signs and symptoms of dehydration:
   • Increased thirst
   • Headache
   • Weakness
   • Poor skin turgor (tenting)
   • Flushed skin
   • Dry mucous membranes (dry mouth)
   • Low blood pressure (hypotension)
   • Rapid heart rate (tachycardia)

Interventions:

1. Prevent Dehydration: Prioritize prevention of dehydration by addressing the underlying cause (diarrhea) and implementing strategies to minimize fluid loss. Manage diarrhea effectively with prescribed medications and dietary modifications.
2. Hydrate Patient (IV Fluids): Administer intravenous fluids and electrolytes as prescribed to replace fluid losses and correct electrolyte imbalances, particularly in cases of severe dehydration.
3. Encourage Oral Fluid Intake: Encourage increased oral fluid intake if tolerated and not contraindicated. Recommend sipping water, electrolyte-rich drinks (oral rehydration solutions), clear broths, and soups. Oral fluids help replenish insensible fluid losses and maintain hydration.
4. Implement Recommended Diet: Ensure the patient follows the prescribed diet for their phase of colitis (acute flare or remission). Proper dietary management can help reduce diarrhea and the risk of fluid volume deficit.
5. Patient Education on Prevention: Educate the patient about preventive measures for dehydration:
   • Drink the recommended daily fluid intake (individualized based on needs).
   • Consume foods with high water content (fruits and vegetables when not in a flare).
   • Limit or avoid alcohol consumption, as it can promote dehydration.
   • Limit caffeinated beverages (coffee, tea, carbonated drinks), which can have a diuretic effect.

References

Original article links embedded within the text are considered references.