Ulcerative Colitis: comprehensive nursing care plan

 Ulcerative Colitis : Overview & Comprehensive Nursing Care Plan :

Definition

Ulcerative Colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by continuous inflammation and ulceration of the colon and rectum’s mucosal layer. Unlike Crohn’s disease, which can affect any part of the gastrointestinal tract, UC is limited to the large intestine and progresses in a continuous pattern without healthy tissue between inflamed areas.

The disease course is marked by periods of active disease (flares) and periods of remission. The severity can range from mild, with few symptoms, to severe and fulminant, which can be life-threatening.

Etiology (Causes)

The exact cause remains unknown, but several contributing factors are identified:

• Genetic predisposition: Family history of IBD increases risk.

• Immune system dysfunction: Abnormal immune response against the intestinal flora.

• Environmental factors: Diet high in fats, low fiber, pollution, or Westernized lifestyle.

• Psychological stress: Can exacerbate symptoms.

• Infections: Certain bacterial or viral triggers.

Pathophysiology

1. Inflammatory response begins in the rectum and extends proximally in a continuous pattern.

2. Mucosal ulcers develop, leading to bleeding, diarrhea, and loss of absorptive surface.

3. The colon wall becomes edematous and friable with superficial erosions.

4. Chronic inflammation causes pseudopolyps, narrowing of the colon, and impaired water absorption.

5. Severe cases may lead to toxic megacolon or perforation.

Diagnostic Evaluation

• Laboratory Tests:
• Complete Blood Count (CBC): To check for anemia (from chronic blood loss) and leukocytosis (indicating active inflammation).
• Inflammatory Markers: Elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP).
• Albumin: Often low due to malnutrition and protein-losing enteropathy.
• Stool Studies: Fecal calprotectin and lactoferrin are sensitive markers for intestinal inflammation. Stool cultures are essential to rule out infectious causes (e.g., C. difficile, Salmonella, Shigella).
• Endoscopy with Biopsy: This is the gold standard for diagnosis.
• Sigmoidoscopy/Colonoscopy: Reveals a characteristic picture: erythematous, friable, granular mucosa with loss of vascular pattern; superficial ulcers; and pseudopolyps. Biopsies confirm chronic inflammation, crypt abscesses, and architectural distortion.
• Imaging:
• Abdominal X-Ray: Useful in acute flares to assess for toxic megacolon (colon diameter >6 cm) or free air indicating perforation.
• CT/MRI Enterography: Can assess the extent of disease and complications, but is less specific than endoscopy.

Clinical Manifestations

Category	Common Symptoms
Gastrointestinal	Bloody diarrhea (10–20 stools/day), mucus in stool, abdominal pain, urgency to defecate
Systemic	Fatigue, weight loss, anorexia, fever
Complications	Anemia, dehydration, electrolyte imbalance, toxic megacolon, colon perforation
Extraintestinal	Arthritis, skin lesions (erythema nodosum), liver disease, eye inflammation (uveitis)

Medical Management

Goals: Reduce inflammation, control symptoms, promote healing, and prevent relapse.

1. Pharmacologic Therapy

Drug Class	Examples	Purpose
Aminosalicylates (5-ASA)	Sulfasalazine, Mesalamine	Reduce inflammation
Corticosteroids	Prednisolone, Hydrocortisone	Control acute flare-ups
Immunosuppressants	Azathioprine, Cyclosporine	Maintain remission
Biologic Agents	Infliximab, Adalimumab	Target specific immune pathways
Antidiarrheals	Loperamide (use cautiously)	Reduce frequency of stools
Antibiotics	Metronidazole	Prevent secondary infections

2. Dietary Management

• Low-residue, high-protein, high-calorie diet
• Avoid milk, caffeine, alcohol, spicy foods
• Encourage small, frequent meals
• Adequate hydration and electrolyte replacement

3. Surgical Management

Indicated for complications or failure of medical therapy:

• Total proctocolectomy with ileostomy
• Restorative proctocolectomy (J-pouch)

🔹 Complications

• Massive hemorrhage
• Perforation of colon
• Toxic megacolon
• Increased risk of colorectal cancer
• Nutritional deficiencies (iron, protein, vitamin B12)

Nursing Care Plan for Ulcerative Colitis

Assessment Data

• Subjective: Reports of abdominal pain, diarrhea with blood, urgency, fatigue
• Objective: Pallor, dehydration, weight loss, tachycardia, abnormal bowel sounds

🧾 Nursing Diagnosis, Goals, and Interventions

Nursing Diagnosis	Goals / Expected Outcomes	Nursing Interventions	Rationale	Evaluation
1. Diarrhea related to intestinal inflammation	Patient will have reduced frequency of stools and improved consistency	- Monitor frequency, color, and amount of stool - Administer prescribed medications (5-ASA, steroids) - Maintain fluid and electrolyte balance - Provide low-residue diet	To assess disease progression and prevent dehydration	Bowel movements become less frequent; no signs of dehydration
2. Fluid Volume Deficit related to diarrhea and blood loss	Maintain adequate hydration and stable vitals	- Monitor intake/output - Assess for signs of dehydration - Provide oral rehydration or IV fluids - Monitor hemoglobin and electrolytes	Diarrhea leads to fluid and electrolyte loss	Hydration maintained; normal electrolyte balance
3. Imbalanced Nutrition: Less than body requirements	Patient maintains or gains weight and shows improved nutrition	- Assess dietary intake and weight - Provide high-protein, high-calorie diet - Avoid foods that irritate bowel - Consult dietitian	Promotes healing and prevents malnutrition	Weight stabilizes or increases
4. Acute Pain related to bowel inflammation and cramping	Patient verbalizes relief from pain	- Assess pain using a scale - Provide prescribed analgesics or antispasmodics - Encourage relaxation techniques - Position for comfort	Pain control improves comfort and rest	Pain level decreases; patient appears relaxed
5. Anxiety related to chronic illness and uncertain prognosis	Patient expresses decreased anxiety and understanding of condition	- Provide emotional support and education - Encourage expression of feelings - Involve patient in care decisions	Anxiety may worsen symptoms; understanding promotes coping	Patient verbalizes reduced anxiety and demonstrates coping
6. Risk for Impaired Skin Integrity related to frequent stools	Maintain intact perianal skin	- Clean perianal area gently after each stool - Apply protective ointments - Encourage use of soft wipes	Frequent diarrhea causes skin irritation	Skin remains intact; no redness or breakdown

🧘‍♀️ Health Teaching & Patient Education

• Explain nature of disease and treatment compliance
• Encourage adequate rest and stress management (yoga, meditation)
• Educate on dietary restrictions and importance of hydration
• Advise regular medical follow-up and colon screening
• Inform about signs of complications (bleeding, fever, severe pain)

🩸 Evaluation

• Reduction in diarrhea and pain
• Normal hydration and nutrition status
• Improved understanding and adherence to therapy
• Maintenance of skin integrity
• Emotional adaptation to chronic illness