I like the lippincott manual of nursing practice. I hope this helps:
Ulcerative colitis is a chronic idiopathic inflammatory disease of the mucosa and, less frequently, the submucosa of the colon and rectum. The exact cause of ulcerative colitis is unknown- some arugue Viral or bacterial organisms, others argue that it has an immunologic basis, others say psychosomatic. and others refer to a histamine mediated allergy. Who is right??? who knows! They also claim that there is a family history- with peak incidence between 20-40 years of age. Here is a very brief review:
1.Diarrhea (may be bloody or contain pus and mucus), tenesmus (painful straining), sense of urgency, and cramping
2.Multiple crypt abscesses of intestinal mucosa that may become necrotic and lead to ulceration
3.Increased bowel sounds; abdomen may appear flat, but as condition continues, abdomen may appear distended
4.There often is weight loss, fever, dehydration, hypokalemia, anorexia, nausea and vomiting, iron-deficiency anemia, and cachexia (general lack of nutrition and wasting with chronic disease)
6.The disease usually begins in the rectum and sigmoid and spreads upward, eventually involving the entire colon. Anal area may be excoriated and reddened; left lower abdomen may be tender on palpation.
7.There is a tendency for the patient to experience remissions and exacerbations.
8.Very high frequency of secondary and often multiple colon cancer
The Diagnostic Evaluation should include:
1.Stool examination to rule out bacillary or amebic dysentery; fecal analysis positive for blood during active disease.
2.Complete blood count--hemoglobin and hematocrit may be low due to bleeding, WBC may be increased; increased prothrombin time possible.
3.Flexible proctosigmoidoscopy and/or colonscopy with biopsy confirms diagnosis.
4.Barium enema x-ray to assess extent of disease and detect pseudopolyps, carcinoma, and strictures.
5.Decreased serum levels of potassium, magnesium, and albumin may be present.
Proper Medical Management:
1.Bed rest, IV fluid replacement, clear liquid diet.
2.For patients with severe dehydration and excessive diarrhea, hyperalimentation is recommended to rest the intestinal tract and restore nitrogen balance.
3.Treatment of anemia--iron supplements for chronic bleeding, blood replacement for massive bleeding.
Sulfasalazine (Azulfidine)--mainstay drug for acute and maintenance therapy. Dose-related side effects include vomiting, anorexia, headache, skin discoloration, dyspepsia, and lowered sperm count.
Oral salicylates, such as mesalamine (Pentasa), olsalazine (Dipentum)--appear to be as effective as sulfasalazine.
a. Nephrotoxicity can occur with mesalamine; diarrhea with olsalazine.
Mesalamine enema available for proctosigmoiditis; suppository for proctitis.
Corticosteroids--primary agent used in the management of inflammatory disease
a. Prednisolone (Delta-Cortef)--IV, to induce remission of acute severe disease.
b. Prednisone (Orasone)--orally, for moderate to severe disease.
c. Hydrocortisone (Cortef)--enema used for proctitis and left-sided colitis.
Antidiarrheal medications may be prescribed to control diarrhea, rectal urgency and cramping, abdominal pain; their use is not routine.
1. Surgery is recommended when patient fails to respond to medical therapy, if clinical status is worsening, for severe hemorrhage, or for signs of toxic megacolon.
2. Surgical procedures include:
a. Subtotal colectomy and ileostomy and Hartmann's pouch
b. Total proctocolectomy with end-ileostomy
c. Total colectomy with continent ileostomy (Kock or BCIR)
d. Total colectomy with ileal reservoir-anal anastomosis (Fig. 16-5).
3. The surgical goal is to remove entire colon and rectum to cure patient of ulcerative colitis.
Complications [because God knows, you always have to have those]:
1. Perforation, hemorrhage, toxic megacolon
2. Abscess formation, stricture, anal fistula
3. Malnutrition, anemia, electrolyte imbalance
4. Skin lesions (erythema nodosum, pyoderma gangrenosum)
5. Arthritis, ankylosing spondylitis
6. Colon malignancy
7. Liver disease
8. Eye lesions (uveitis, conjunctivitis)
1. Review nursing history for patterns of fatigue and overwork, tension, family problems that may exacerbate symptoms.
2. Assess food habits that may have a bearing on triggering symptoms (milk intake may be a problem).
3. Determine number and consistency of bowel movements, any rectal bleeding present
4. Listen for hyperactive bowel sounds, assess weight.