I have an Ulcerative Colitis patient to care for tomorrow. Questions about diet?

[Samian Q]

So tomorrow, I'm assigned to care for a patient on the med/surg floor with an admitting diagnosis of "Ulcerative Colitis with Exacerbation". Simple enough, right?

The patient's charts say their diet is "Soft, low fiber". So what should I be doing when their breakfast and lunch come in (other than measuring the Is and Os)? Am I supposed to puree any food? Or can they eat it as is?

[caroladybelle, BSN, RN]

The pt is on soft diet, low fiber not puréed. Thus the diet should be sent from kitchen as such with no other prep required. UC PTs do not require puréed.

Please review low fiber/low residue diets. This means just what it says, foods that are less fibrous and are more easily digestible, leaving less indigestible material behind. Puréed food has a different texture but can still result in significant left over residue. Things to avoid - very fibrous fruits and vegetables, hard raw veggies/fruits, foods with heavy "strings". Nuts and coorifice grains. These are quite challenging for a damaged colon to break down, and irritating to an inflamed bowel. Add in foods with small seeds, like berries, sesame seeds, or ground pepper. Rye bread, etc. Popcorn is a big issue with me because of those hard little hulls.

Do be aware that most experienced UC PTs know what they can and cannot tolerate. Many of us cannot drink whole milk, and/or diary products. Ask your pt if they know what foods trigger additional problems, pain, diarrhea.

(If a soft diet was ordered and you attempted to give me puréed, I would pitch a snit fit.... Puréed and soft are not the same thing)

[Samian Q]

Okay, great, thanks!

So let me ask something else: I looked on this pt's graphics specifically for the I&Os, and I saw something REALLY peculiar.

Every day the patient was getting fluids both orally and parenterally (i.e., through the IV). And the patient was evidently urinating quite normally, though I don't think output was being measured as the pt wasn't on any type of catheterization.

Here's the part I don't get. Where it talked about stools, the graphics had the circle-backslash "no" symbol q6h. Thus, were they not voiding at ALL via poop since Friday?

[caroladybelle, BSN, RN]

Is the pt admitted for a UC exacerbation or is it merely one if their issues?Most UC PTs admitted in acute exacerbation will have stool out, but not always, if they have been on bowel rest/certain meds.Second, if they are on an IV, in for UC exacerbation.... They should be on strict I/O. And catheters are not needed or required to monitor urine output.In school, please use correct terms. Voiding is generally used to refer to urine only , not stool ie poop.You would need to ask the staff caring for the pt why there have been no stools since Friday, and why no I/O.I am presuming this us a hospital pt???

[Samian Q]

Yeah, it's an exacerbation and yes, it's a hospital (med-surg) pt. As for the output, the graphics sheet said stuff like "x1" and "x2"... not sure what that means. I wonder why it didn't just have the amount of urine they peed out. Maybe they flushed the toilet lol.

[caroladybelle, BSN, RN]

While you will find that in many MedSurg units, your instructor will probably want things done the correct way. You need to measure output.

[Samian Q]

But what if they go to the toilet when I'm not in the room and void and then flush?

[sharpeimom]

My mom had UC and would void into a hat that had measurements on the sides. It fit down into the john and was held in place by the john seat.

UC patients will know their trigger foods. Tomato seeds were one of hers. Tomatoes were in season and my mom had invited a friend for dinner. On the menu were sliced tomatoes. She skinned, deseeded, checked for seeds, checked again, and put them on the table.

The next morning began with bloody diarrhea and a quick trip to the doctor. When no obvious cause could be

found, he did a quick check. He found half a tomato seed stuck to his glove finger!

[Samian Q]

Oh, I've used the hat before! But what if they forget or don't use it for urine output? What are you supposed to write on the graphics? Do you leave the output box blank?

[Nurse Kyles, BSN, RN]

Usually we will write void x1 on the I/O sheet if the patient voided and flushed without us being able to measure it. The only other time we will write that is if the patient had an incontinent void, and then we will write inc void x1 on the I/O sheet. If the patient is flushing before the urine can be measured, we must educate them (sometimes repeatedly) that they should leave the urine so that we can measure it. It is important to ensure there is a hat in the toilet, and have a urinal handy for men. We educate males that they should still void in the urinal even if they are ambulating to the bathroom to void. Most patients are compliant with the proper education.

[KelRN215, BSN, RN]

Oh, I've used the hat before! But what if they forget or don't use it for urine output? What are you supposed to write on the graphics? Do you leave the output box blank?

Then you write just as you saw on the I/O sheet. "x1" under the urine or stool column. If a patient is on strict I&O, all intake and output should be measured but it's not uncommon for a patient to forget.

[Samian Q]

Thanks so much!!