Biology

MAP 1

Ulcerative Colitis Concept Map

Student

Rasmussen College

Author Note

This paper is being submitted on September 5, 2013, for Ms. Carole Guye’s NUR2034C

Fundamentals of Professional Nursing.

ULCERATIVE COLITIS CONCEPT MAP 2

ULCERATIVE COLITIS (UC)

PATIENT TEACHING  Information about UC including acute

episodes, remissions and symptom mgmt.  Monitor for signs &symptoms of GI bleeding  Ostomy care management  Identify outpatient support groups  Self-management at home (Winkelman, 2013)

PATHOPHYSIOLOGY  Ulcerative Colitis (UC) usually begins in the rectum. It

may remain localized to the rectum (ulcerative proctitis) or extend higher, sometimes involving the entire colon. There is a sharp border between normal and affected tissue.

 It causes sores and inflammation of the lining, along with bleeding, pus, diarrhea and abdominal discomfort.

 Fistulas and abscesses do not occur  Toxic or fulminant colitis is when the ulcerations

extends through the intestinal wall, resulting in localized ileus and peritonitis. (Ulcerative Colitis, 2014 )

CAUSES  Not caused by stress or hypersensitivity to foods or

products but may trigger symptoms (Ulcerative Colitis, 2014)  Studies suggest caused by combination of heredity,

immune system, and environmental causes  Cause Unknown (What is Ulcerative Colitis, 2014)

NURSING CONSIDERATIONS  Ostomy or perineal wound care  Assess patient for pain pattern, occurrences  Monitor for signs/symptoms of GI bleeding  Monitor Vitals and Labs  Monitor pain and symptoms to maintain

comfort (Winkelman, 2013)

TREATMENTS & MEDICATIONS Treatments – No medical cure  Treatment goals to reduce symptoms:

1) Induce / maintain remission, 2) Improve quality of life, and 3) Individualize to treat patient

Diet & Nutrition  Avoid foods that aggravate UC

(What is Ulcerative Colitis, 2014)

Surgery  Total proctocolectomy with permanent

ileostomy – colon, rectum & anus removed  Total Colectomy – colon removal  Restorative Proctocolectomey with Ileal Pouch

Anal Anastomosis (RPC-IPAA) – create ileoanal reservoir

Medications  Route

– Enema – Rectal Foam – Suppository

– PO – IV

 Aminosalicylates – Reduce Inflammation – balsalazide – mesalamine – olsalazine – sulfasalazine

 Corticosteroids – Reduce immune system activity & Decrease inflammation – budesonide – hydrocortisone – methylprednisone – prednisone (Ulcerative Colitis, 2014)

 Immunomodulators – Decrease immune system activity – azathioprine – 6-mercaptopurine, or 6-MP

 Biologics – Decrease inflammation – adalimumab – golimumab – Infliximab – vedolizumab

 Other medications – Acetaminophen – mild pain – Antibiotics – prevent/treat infection – Loperamide – slow/stop diarrhea

(Ulcerative Colitis, 2014) – Cyclosporine – immunosuppresnt

(Cyclosporine, 2014)

SIGNS & SYMPTOMS  Bowel movements become looser and more urgent  Persistent diarrhea accompanied by abdominal pain

and blood in the stool (What is Ulcerative Colitis, 2014)  Anemia  Fever  Fatigue  Weight loss  Loss of appetite

 Skin lesions  Rectal Bleeding  Cramping abdominal pain  Growth failure in children  Loss of body fluid & nutrients

(Ulcerative Colitis, 2014)

DIAGNOSED  Physical Exam & Interview (health, diet, history)  Blood test – monitor anemia  Fecal matter – rule out bacterial/viral diarrhea causes  Sigmoidoscopy – see rectum/colon inflammation  Total Colonoscopy – visualize entire colon  Biopsy – sample of affect tissue removed for testing  Chromoendoscopy – blue spray during colonoscopy

to detect changes in lining (What is Ulcerative Colitis, 2014)  Computerized Tomography (CT) Scan – 3D image  Barium Enema X Ray – x-ray contrast (Ulcerative Colitis, 2014)

NURSING DIAGNOSES  Ineffective Coping r/t repeated episodes of diarrhea  Acute pain r/t abdominal cramp  Deficient fluid volume r/t frequent and loose stools  Impaired skin integrity r/t frequent stools, and

development of anal fissures  Imbalanced Nutrition: less than body requirements r/t

anorexia, decreased absorption of nutrients GI tract  Social Isolation r/t diarrhea (Ackley, 2014)

ULCERATIVE COLITIS CONCEPT MAP 3

References

Ackley, B. J. and Ladwig, G. B. (2014). Inflammatory Bowel Disease [Child and Adult].

Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (10th ed.).

Online: Mosby. Retrieved from Skyscape.

Ulcerative Colitis. (2014). National Digestive Disease Information and Kidney Diseases.

Retrieved from http://digestive.niddk.nih.gov/ddiseases/pubs/colitis/

What is Ulcerative Colitis? (2014). Crohn’s & Colitis Foundation of America. Retrieved from

http://www.ccfa.org/what-are-crohns-and-colitis/what-is-ulcerative-colitis/

Winkelman, C. (2013). Ulcerative Colitis. Clinical Company for Medical-Surgical Nursing:

Critical Thinking for Collaborative Care (7th ed.). Retrieved from Skyscape.

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