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Nanda Nursing Diagnosis For Ulcerative Colitis

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Diarrhea Nursing Care Plans

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A registered nurse should prepare a nursing care plan for diarrhea. The care plans include administering medication as prescribed, monitoring the patients hydration status by checking weight, urine output, skin turgor, and mucous membranes. Nursing care also involves monitoring the frequency and consistency of stools.

You may need to supplement the patients diet with extra fluids or try a BRAT diet . The patient should also avoid eating foods high in sugar, such as fruit juices or sugary sodas, until they feel better because it will worsen diarrhea.

The patient should instead drink clear liquids like water or broth to keep them from becoming dehydrated. Dehydration could lead to serious health issues, including heart failure, if not treated early enough. Keeping the patient hydrated will also maintain a good skin turgor.

Preventive measures to help patients avoid diarrhea are good eating habits and sufficient fluid intake. Meals should include fruits, whole grains, and lots of vegetables with additions of lean meat, poultry, or fish. This diet should also be supplemented with additional vitamins and minerals. A good fluid intake is necessary for the digestive system to work effectively. Eight glasses of water a day is recommended, along with 4-8 ounces of fruit juice each day and a sufficient amount of milk, tea, or coffee in moderation.

Procedure For Permanent Colostomy

This procedure is done when the damaged bowel cannot be restored after surgery, as in the case of colon cancer. In this procedure, the surgeon will create a stoma at the level of the damaged section of the colon and rectum and then staple or suture the remaining ends together. The stoma will be sealed from about 4-12 inches below the exit site. The goal is to divert stool away from the damaged area and prevent the accumulation of stool at the opening from the intestine to the skin surface.

Potential complications for permanent colostomy are infection at the site of an open wound, skin breakdown, stomal stenosis and fecal accumulation at the opening from the intestine to the skin surface.

This is a specific technique of undertaking a colostomy. The aim is to prevent fecal matter from leaking out of the stoma. This technique helps reduce pain, swelling and other complications after surgery.

Bowel technique procedure has a low risk of complications.

What Can Happen If I Have Diarrhea

Acute diarrhea is uncomfortable but rarely dangerous in healthy adults and children. However, diarrheal stools may contain viruses and bacteria that spread infections. For example, the bacterium Escherichia coli causes about 9% of all foodborne infections in the United States. If there is severe diarrhea with vomiting, dehydration can occur. This occurs when there is excessive water loss from your body due to diarrhea and/or vomiting. Severe dehydration may be life-threatening.

  • Avoid eating contaminated food- If food poisoning is suspected to be a cause of your diarrhea, contact a local health department or call your doctor for instructions.
  • Maintain hygiene -Keep hands clean by washing with soap and warm water for 20 seconds.

Follow these steps to prevent dehydration:

1. Drink plenty of water and other liquids. Water is important because your body loses water when you have diarrhea. Fluids that contain electrolytes are also helpful.

2. Avoid coffee and tea while you have diarrhea because they may worsen the problem by irritating the bowel wall, causing pain and inflammation, and increasing fluid loss.

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Image result for ulcerative colitisUlcerative colitis is an inflammatory bowel disease that causes inflammation and ulcers in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine and rectum. Symptoms usually develop over time, rather than suddenly.

Image result for ulcerative colitisUlcerative colitis is an inflammatory bowel disease that causes inflammation and ulcers in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine and rectum. Symptoms usually develop over time, rather than suddenly.

Diagnosis Of Inflammatory Bowel Disease

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The diagnosis of IBD comes after studying the results of imaging studies and endoscopic procedures. Also, physicians may perform stool sampling to rule out other possible causes like infections.

  • Endoscopic Procedures
  • Colonoscopy This is a procedure to examine the entire colon. It involves the insertion of a thin, flexible camera through the anus into the colon. It can also be used to obtain tissue samples for biopsy. It is the study of choice for the diagnosis of ulcerative colitis.
  • Flexible sigmoidoscopy this procedure is similar to colonoscopy. However, instead of studying the entire colon, only the sigmoid, or the last part of the colon, is assessed. This may be favored over full colonoscopy in cases where the colon is severely inflamed.
  • Upper endoscopy This test also uses a thin, flexible camera that is inserted in the mouth to assess the esophagus, stomach, and first part of the intestines called duodenum.
  • Capsule endoscopy this test is mostly used to diagnose Crohns disease. IT involves swallowing a small capsule containing a camera. Images are then transmitted to a recorder that can be worn on the belt.
  • Balloon-assisted enteroscopy this procedure is performed when the results of capsule endoscopy come back inconclusive. It is similar to a simple endoscopy however, this procedure uses additional equipment called overtube. This piece of equipment allows doctors to reach further down the intestines.

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Inflammatory Bowel Disease Nursing Care Plans

Inflammatory bowel disease is an idiopathic disease caused by a dysregulated immune response to host intestinal microflora. It results from a complex interplay between genetic and environmental factors. Similarities involve chronic inflammation of the alimentary tract and periods of remission interspersed with episodes of acute inflammation. There is a genetic predisposition for IBD, and patients with this condition are more prone to the development of malignancy.

The two major types of inflammatory bowel disease are ulcerative colitis and Crohn disease .

Ulcerative colitis : A chronic condition of unknown cause usually starting in the rectum and distal portions of the colon and possibly spreading upward to involve the sigmoid and descending colon or the entire colon. It is usually intermittent , but some individuals have continuous symptoms. Cure is effected only by total removal of colon and rectum/rectal mucosa.

Regional enteritis : May be found in portions of the alimentary tract from the mouth to the anus but is most commonly found in the small intestine . It is a slowly progressive chronic disease of unknown cause with intermittent acute episodes and no known cure. UC and regional enteritis share common symptoms but differ in the segment and layer of intestine involved and the degree of severity and complications. Therefore, separate databases are provided.

Inflammatory Bowel Disease Nursing Care Plans Diagnosis And Interventions

Inflammatory Bowel Disease NCLEX Review and Nursing Care Plans

Inflammatory bowel disease is an umbrella term to describe two inflammatory disorders of the digestive tract: ulcerative colitis and Crohns disease. IBD is a long-term condition characterized by diarrhea, rectal bleeding, abdominal pain, fatigue, and weight loss.

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Nursing Interventions For Colostomy

Colostomy irrigation is advised by the dietitian to be done at a frequency of 3 times per day in some cases, 2 times per day in others. Depending on the type of colostomy created, irrigation can be done with either saline or water solution.

The colostomy wound site should be cleaned with antibacterial soap and water prior to each irrigation session. The amount of fluid to be drained depends on the length of time between irrigations or the degree of diarrhea present.

Saline solution is recommended for a return type colostomy rather than tap water for its antibacterial action.

After irrigation, saline solution is used to clean the colostomy opening and surrounding skin surface.

After cleaning, a wafer-like dressing may be applied directly over the top of the wound opening for a permanent colostomy site. If gauze dressing is being used, it should be applied in such a way that an air hole is left open to prevent skin breakdown from continuous pressure.

A collection device may be needed for patients when bowel movements are infrequent or when circumstances such as the need to pass stool from the colon prevents evacuation of stool.

Patient respiration should be checked for 15 seconds after each irrigation session to prevent fluid from entering the lungs.

The patient needs to understand that their dietitian may prescribe 24 ounces of specific fiber supplement twice per day. This will depend on the amount and consistency of stool passed and the time between irrigations comes.

Types Of Ulcerative Colitis

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There are different types of ulcerative colitis depending on the affected location:

  • Pancolitis affecting the entire colon and includes severe bloody diarrhea and significant weight loss
  • Left-sided colitis inflammation extending from the rectum to the sigmoid and descending colon includes pain on the left abdominal area
  • Proctosigmoiditis inflammation involving the sigmoid colon and rectum
  • Ulcerative proctitis inflammation that is on the anus and not extending to the rest of the colon includes rectal bleeding as the main symptom
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    Types Of Inflammatory Bowel Disease

  • Ulcerative colitis refers to a condition that involves inflammation and/or ulceration of the superficial lining of the large intestine and rectum. The areas involved are continuous and not patchy.
  • Crohns disease refers to an inflammatory condition affecting the deeper layer of the intestinal lining from the mouth to the anus. The involved areas appear patchy.
  • Inflammatory bowel disease can occur at any age. However, it is more commonly diagnosed in people between the age of 15 to 40 years. This condition can be mild to severe that can cause serious complications.

    Risk For Deficient Fluid Volume Inflammatory Bowel Disease Nursing Care Plan : Nursing Interventions & Rationale

    Nursing InterventionsRationale
    Monitor I& O. Note number, character, and amount of stools estimate insensible fluid losses, e.g., diaphoresis. Measure urine specific gravity observe for oliguria. Provides information about overall fluid balance, renal function, and bowel disease control, as well as guidelines for fluid replacement.
    Assess vital signs . Hypotension , tachycardia, fever can indicate response to and/or effect of fluid loss.
    Observe for excessively dry skin and mucous membranes, decreased skin turgor, slowed capillary refill. Indicates excessive fluid loss/resultant dehydration.
    Weigh daily.

    Inflammatory bowel disease results froma complex interplay between genetic and environmental factors. Similarities involve chronic inflammation of the alimentary tract and periods of remission interspersed with episodes of acute inflammation.

    Ulcerative colitis : A chronic condition of unknown cause usually starting in the rectum and distal portions of the colon and possibly spreading upward to involve the sigmoid and descending colon or the entire colon. It is usually intermittent , but some individuals have continuous symptoms. Cure is effected only by total removal of colon and rectum/rectal mucosa.

    Here are 7 Nursing Care Plan for inflammatory bowel disease

  • Disease process/prognosis, therapeutic regimen, and potential complications are understood.
  • Plan in place to meet needs after discharge.
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    Treatment Of Ulcerative Colitis

    There is a wide array of treatment options for patients with ulcerative colitis.

    Treatments usually involve pharmacologic therapy and surgical procedures. Alternative treatments are also widely available.

    Medications

    Anti-inflammatory drugs. These are the first line of treatment for people with ulcerative colitis.

    5-Aminosalicylates can be given by mouth or as suppository depending on the affected part of the colon.

    On the other hand, corticosteroids are commonly prescribed if other treatments cause no response.

    Immune system suppressors. These drugs work by prohibiting inflammatory response through suppressing the immune system.

    They usually work better in combination with other drugs.

    They usually require regular checking of the liver and pancreatic functions. Cyclosporines, like corticosteroids, are not indicated for long term use due to their side effects.

    However, it is also the choice of drug when other treatments fail to work.

    Biologics. Also called monoclonal antibodies, these drugs are usually prescribed to people with ulcerative colitis who cannot tolerate other treatments.

    They work by stopping proteins in the body from causing inflammation.

    Other medications can be used to treat symptoms related to ulcerative colitis. Examples are anti-diarrheal drugs, pain relievers, antispasmodics, and iron supplements.

    Surgery

    A more sophisticated procedure called ileoanal anastomosis can be done to prevent the patient from needing an external pouch to collect stool.

    Nursing Interventions For Ulcerative Colitis

    Nanda nursing diagnosis
    • Monitor VS, patients bowel movements , keep patient hydrated, monitor daily weights , focus on GI assessment
    • Signs and symptoms of toxic megacolon: abdominal distention, fever, diarrhea, abdominal pain, dehydration, tachycardia, hypoactive or absent bowel sounds
    • Signs and Symptoms of peritonitis: distention or abnormal bloating, increased heart rate, tachypnea, pain
    • May be NPO with IV hydrationadvance diet per MD order as symptoms subsidewill typically start with clear, fulls, and then solids
    • Diet Education:
    • Watch foods that can cause a flare-up or should be avoidedduring a flare-up:
    • High-fiber foods
    • Food hard to digest like: nuts, raw vegetables or fruits
    • Allergen type foods: dairy or certain foods that the person may be intolerant too like wheat, fish
    • Avoid spicy, high-fat foods, gluten, gas causing foods like onions, beans etc.
  • Foods to eat during flare-up or to prevent one:
  • Low fiber , high-protein and stay hydrated
  • Importance about regular screening of colon cancer
  • If patient had surgery, educate about ostomy placement: know the nursing pre and post care, how to provide ostomy care
  • Administering Medications per MD order:

    Goal: control flare-ups and maintain remission

    • Medications prescribed depend on the severity of the disease .
    • Combination of medications are used if patient has moderate to severe case.

    Anti-inflammatory: decrease the inflammation in the bowel

    Immunosuppressors: Azathioprine/Imuran risk for infection and cancer, no live vaccines

    Surgery:

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    Nclex Review For Ulcerative Colitis

    What is Ulcerative Colitis? It is one of the two types of inflammatory bowel diseases that causes inflammation and ulcers in the inner lining of the COLON and RECTUM .

    Important take away: Remember it affects the COLON/RECTUM and INNER LINING only. It is different from Crohns Disease that can affect any part of the GI tract and the whole bowel wall.

    Key Points:

    • No cure managed with diet and medications
    • Happens over time or suddenly
    • Tends to start in the rectum and over time moves throughout the large intestine in a uniform fashion
    • Patient will experience periods of flare-ups and remission
    • Cause is unknown at this time but seems to be autoimmune that is triggered by the following:
    • Environment
    • Genetic factors make more susceptible

    Causes And Risk Factors Of Ibs

    The cause of IBS is unknown however, the following notions are believed to affect the development of IBS:

  • Muscle contractions in the intestine. Hyperactive intestinal contractions may contribute to diarrhea, while weak contractions may lead to constipation.
  • Nervous system discrepancies. Problems in the nervous system due to poor neurologic signals can cause the body to overreact and thus manifest as abdominal pain, diarrhea or constipation.
  • Severe infection. Developing gastroenteritis will result in the activation of the inflammatory response and in turn contribute to IBS.
  • Changes in microbiologic flora in the gut. Research indicates that transient gut flora of people with IDS might differ from healthy patients
  • The following risk factors may increase the chances of developing IBS:

  • Food certain types of food may trigger bouts of IBS and they include dairy products, citrus fruits, cabbage, beans, and carbonated drinks.
  • Stress it has been observed that most people experience more frequent symptoms of IBS when under or during increased periods of stress
  • Patients below the age of 50
  • The female gender
  • Mental health issues anxiety, depression
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    Treatment Of Inflammatory Bowel Disease

    The treatment goal for IBD is to reduce inflammation and control the symptoms. Treatment includes medication use and surgery.

  • Medications. There are several groups of medications used to manage IBD, such as:
  • Anti-inflammatory drugs anti-inflammatory drugs such as steroids and aminosalicylates are the first choice of treatment for IBD.
  • Immune system suppressors drugs that suppress the immune system are also used to treat IBD.
  • Biologics These are newer drugs used for the treatment of IBD. They act to neutralize the protein that causes inflammation.
  • Antibiotics antibiotics are useful when infection is suspected in cases of perianal Crohns disease.
  • Supplements people with IBD may also be prescribed supplements to support nutrition. Malnutrition is common in IBD since the intestine is mostly responsible for nutrient absorption.
  • Surgery. Surgical procedures are usually the last resort of treatment for IBD. The surgical procedure varies depending on the areas affected by the disease. Surgery doesnt cure the condition, but it can greatly relieve the symptoms. Surgery often involves the removal of the diseased portion of the intestines and establishing a connection between the healthy intestinal regions. It may also include the closure of fistula and/or drainage of abscess.
  • Complications Of Inflammatory Bowel Disease

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  • Complications From Any Type of IBD
  • Colon cancer. IBD increases the risk of developing colon cancer. Screening for this type of cancer typically begins between 8-10 years of having IBD.
  • Inflammation of the skin, eyes, and joints. Conditions such as arthritis, skin lesions, and uveitis are often associated with IBD flare-ups.
  • Side-effects from IBD medications. Some of the drugs used to treat IBD are related to the development of cancer. Also, medications like corticosteroids can cause high blood pressure, high blood sugar levels, and an increased risk for osteoporosis.
  • Primary sclerosing cholangitis. IBD is also associated with the development of primary sclerosing cholangitis where there is inflammation that causes scarring of the bile ducts resulting to further complications such as liver damage.
  • Blood clots. IBD also increases the risk of clots forming and blocking veins and arteries.
  • Anal fissure. This refers to a small tear in the tissue surrounding the anus. It can get infected and cause further problems like pain during defecation and perianal fistula formation.
  • Toxic megacolon. This refers to the overdistention and dilation of the colon accompanied by bloating, fever, pain, and sometimes, shock.
  • Perforation of the colon. This can occur secondary to toxic megacolon. However, it can happen on its own.
  • Severe dehydration. This condition can occur as a complication of severe diarrhea.
  • Complications Specific to Crohns Disease
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