This document provides information on ulcerative colitis (UC) including objectives, pathophysiology, clinical manifestations, diagnostic tests, complications, medical management, nutritional therapy, pharmacologic therapy, indications for surgery, and the nursing process. The objectives are to understand UC pathophysiology, identify diagnostic tests for UC, and formulate nursing care. UC is an inflammatory disease of the colon and rectum characterized by ulcers, inflammation, and bleeding of the mucosa. Diagnostic tests include stool analysis, imaging, and endoscopy. Complications include toxic megacolon. Treatment involves reducing inflammation, immunosuppression, nutrition support, and sometimes surgery. The nursing process addresses pain, bowel dysfunction, nutrition, skin integrity, coping,

1. GIT Medical Nursing
by :
Dr. Alshazaly abdoalghfar
BSN, RN, MSN, CNE PhD.

2. Inflammatory Bowel Disease
(IBD)
Lecture 8
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3. Objectives
By the end of this lecture all of us well be able to
 Understand Inflammatory Bowel Disease and the
pathophysiology (UC).
 Identify the assessment and diagnostic test used to
confirm Inflammatory Bowel Disease (UC).
 Formulate the nursing process as a framework for care
of patients with Inflammatory Bowel Disease (CD, UC).

4. ULCERATIVE COLITIS
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5. ULCERATIVE COLITIS
 Is a recurrent ulcerative and inflammatory disease of the mucosal
and submucosal layers of the colon and rectum.
 The incidence is between 30 and 50 years of age.
 It is a serious disease, accompanied by systemic complications
and a high mortality rate.
 Eventually, 10% to 15% of the patients develop carcinoma of the
colon.

6. Pathophysiology
 UC affects the superficial mucosa of the colon and is
characterized by multiple ulcerations, diffuse inflammations, and
Bleeding occurs as a result of the ulcerations, The mucosa
becomes edematous and inflammed.
 Abscesses form
 The disease process usually begins in the rectum and spreads
proximally to involve the entire colon.
 Eventually, the bowel narrows, shortens, and thickens .

8. Clinical Manifestations
The predominant symptoms of ulcerative colitis are
1. lower left quadrant abdominal pain.
2. Diarrhea, anorexia, weight loss, fever, vomiting, and dehydration.
3. Rectal bleeding
6. Cramping and feeling of an urgent need to defecate (passage of
10 to 20 liquid stools each day).
7. Hypocalcaemia and anemia
8. Others:
 skin lesions (erythema nodosum), eye lesions (uveitis), joint abnormalities
(arthritis), and liver disease
9. Rebound tenderness may occur in the right lower quadrant.

9. Diagnostic test :-
1. Stool analysis is positive for blood.
2. CBC
3. Abdominal x-ray studies are useful for determining the cause
of symptoms.
4. Sigmoidoscopy or colonoscopy (Endoscopy may reveal friable,
inflamed mucosa with exudate and ulcerations.)
5. Barium enema
6. CT scanning

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Ulcerative colitis. Double-contrast barium enema study shows pseudopolyposis of the
descending colon

12. Complications
Complications of ulcerative colitis include
1. toxic mega colon
2. Colonic perforation associated with a high mortality rate (15% to
50%)
3. Osteoporotic fractures

14. Medical management:-
Aim of medical treatment:
 Reducing inflammation
 suppressing inappropriate immune responses
 providing rest for a diseased bowel so that healing may take place,
 improving quality of life
 preventing or minimizing complications.
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15. NUTRITIONAL THERAPY
 Provide high-protein, high-calorie diet with vitamin and iron
supplements.
 Balance fluid and electrolyte.
 Avoid exacerbate diarrhea food.
 Cold foods and smoking are avoided (increase intestinal
motility).
 Parenteral nutrition (PN) may be indicated.
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16. Parenteral nutrition (PN)
 Is a ready and mixed IV nutrients to improve nutritional status,
maintain muscle mass, promote weight gain, and enhance the
healing process.
 Components:
1. water 30-40 ml/kg/day.
2. amino acid 1-2 g/kg/day.
3. carbohydrate 4-5 mg /kg/min.
4. fatty acid 20-30 total calories.
5. minerals such as ( calcium 15mcg, magnesium 20meq, potassium
100meq , sodium 100meq).
6. vitamins such as (Vitamin A 4000iu, thiamin 3mg, vitamin K 200mcg)
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17. PHARMACOLOGIC THERAPY
1. Sedation and antidiarrheal medications such as:
 loperamide
 cholestyramine powder, 3 times per day.
 Side effect: constipation.
2. Anti-inflammatory drug such as:
 Aminosalicylate formulations such as sulfasalazine
3. Corticosteroids are used to treat severe disease such as:
 Prednisone, orally, topically and injections.
4. Immunosuppressive Agents such as:
 Methotrexate tab 1,5 mg/kg/day, cyclosporine tab 2,5-5
mg/kg/day
5. Surgery.
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18. INDICATIONS FOR SURGERY
 Obstruction, severe perianal disease unresponsive to medical
therapy, difficult fistulas, major bleeding, severe disability
 30 % relapse rate

19. NURSING PROCESS

20. Assessment
 Takes a health history
 Discuss dietary patterns, including the amounts of alcohol,
caffeine, and nicotine containing products used daily and
weekly.
 Assess patterns of bowel elimination
 Note allergies and food intolerance
 Observe skin and stool
 Examine the abdomen for pain, tenderness, distention and rectal
bleeding.
 Auscultating the abdomen for bowel sounds and their
characteristics

21. ND 1:
Acute abdominal pain related to increased peristalsis and GI inflammation.
Goal:
 The client will be free from pain
Intervention:
 Assess the pain level and character
 Position changes, local application of heat
 Administers anticholinergic medications as prescribed 30 minutes before
meal.
 Administers analgesics as prescribed for pain

22. ND 2:
 Impaired bowel elimination pattern ( Diarrhea ) related to the
inflammatory process
Goal:
 Maintain normal bowel elimination pattern .
Intervention:
 Determines if there is a relationship between diarrhea and certain
foods, activity, or emotional stress.
 Identifying precipitating factors, the frequency of bowel movements,
and the character, consistency, and amount of stool passed is
important.
 Provide safe and ready access to a bathroom
 Administer antidiarrheal medications as prescribed

23. ND 3:
 Fluid volume deficit related to anorexia, nausea, and diarrhea
secondary to infection.
Goal:
 To maintain normal fluid status
Intervention:
 Keeps an accurate record of intake ,output .
 Monitors daily weights for fluid gains or losses and assesses the
patient for signs of fluid volume deficit.
 Encourage oral intake of fluids and to monitor the intravenous flow
rate.
 initiates measures to decrease diarrhea (e.g. dietary restrictions,
stress reduction, antidiarrheal agents).
 Give small frequent meals in attractive way

24. ND 4:
 Imbalanced nutrition less than body requirements, related to dietary
restrictions, nausea, and malabsorption evidence by low HB, decrease
Weight
Goals:
 Maintenance of optimal nutrition and weight
Intervention:
 Parenteral nutrition (PN) is used when the symptoms of IBD are severe.
 Elemental feedings high in protein and low in fat and residue are
instituted after PN therapy.
 If oral foods are tolerated, small, frequent, low-residue feedings are
given.
 Restrict activity to conserve energy, reduce peristalsis, and reduce
calorie requirements

25. ND 5:
Activity intolerance related to low intake evidence by fatigue
Goal:
 Avoidance of fatigue
Intervention:
 Recommends intermittent rest periods during the day.
 Encourage activity within the limits of the patient’s capacity.
 Bed rest for a patient who is febrile, has frequent diarrheal stools, or is
bleeding.
 perform active exercises to maintain muscle tone and prevent
thromboembolic complications
 Performs passive exercises and joint range of motion if the pt unable to
perform active exercise.

26. ND 6:
 Ineffective coping related to repeated episodes of diarrhea.
Goal:
 promoting effective coping
Intervention:
 Pt may feel isolated, helpless, and out of control, understanding and
emotional support are essential.
 Develop a relationship with the patient that supports all attempts to cope
with these stresses
 encouraging the patient to talk and express his or her feelings and to
discuss any concerns
 Used stress relaxation techniques
 Professional counseling

27. ND 7:
 Risk for impaired skin integrity related to malnutrition and diarrhea
Goals:
 To maintain normal skim integrity.
Intervention:
 Examines the patient’s skin frequently, especially the perianal skin.
 Perianal care, including the use of a skin barrier, is important after each
bowel movement.
 Gives immediate attention to reddened or irritated areas over a bony
prominence and uses pressure-relieving devices to prevent skin
breakdown.
 Avoid dryness by lubricate patient body.

28. ND 8:
 Risk for ineffective therapeutic regimen management related to insufficient
knowledge concerning the process and management of the disease.
Goals:
 learning about the disease process and therapeutic regimen, and
avoidance of complications.
Intervention:
 Serum electrolyte levels are monitored daily, and electrolyte
replacements are administered as prescribed.
 It is important to monitor the blood pressure for hypotension and to obtain
coagulation and hematocrit and hemoglobin profiles frequently.
 Vitamin K may be prescribed to increase clotting factors.
 Monitors the patient for indications of perforation and obstruction and
toxic mega colon.

29. Thank you
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