Republic of the Philippines

CENTRAL MINDANAO UNIVERSITY

COLLEGE OF NURSING
University Town, Musuan, Maramag, Bukidnon

E-mail: nursing@cmu.edu.ph

ULCERATIVE COLITIS
In Partial Fulfillment of the Requirements in
NCM 74: CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND
GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION,
AND COORDINATION.
(ACUTE AND CHRONIC)

BSN 3 – B
Mandawe, Myrna Lomerosbren T.
Masongsong, April D.
Reporters

CLINICAL INSTRUCTOR
NEDA JOY L. ESPINA, MAN, LPT, RN

February 2022
Table of Contents

Page
PRELIMINARIES
Table of Contents 2
INTRODUCTION 3
Definition 3
Statistics 3
Types of Hyperthyroidism 4
CONCEPT MAP 5
Etiology of the disease 5
Risk factors 5
Pathophysiology (Disease process) 5
Clinical Manifestations 6
Nursing Diagnoses 6
Nursing Management 6
Surgical/Medical Management 7
Diagnostic Tests 7
Pharmacological Management 8
Prognosis 8
TEST QUESTIONS 9
REFERENCE 10

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Introduction

Ulcerative Colitis

Ulcerative Colitis is an inflammatory bowel disease (IBD) that causes

inflammation and ulcers (sores) in your digestive tract. It affects the
innermost lining of your large intestine (colon) and rectum. Symptoms
usually develop over time, rather than suddenly. It has no known cure,
treatment can greatly reduce signs and symptoms of the disease and bring
about long-term remission.

Statistical Data

Northern Europe and North America has the highest incidence and
prevalence of inflammatory bowel diseases seen worldwide. Inflammatory
bowel illness is strongly linked to a westernized lifestyle and environment.
Ulcerative colitis has an incidence of 9 to 20 cases per 100,000 persons per
year. Its prevalence is 156 to 291 cases per 100,000 persons per year.
Ulcerative colitis has a greater prevalence in adults than Crohn’s disease.
When considering the pediatric population; however, ulcerative colitis is
less prevalent than Crohn’s disease.

Types of Ulcerative Colitis

Proctitis

Ulcerative colitis is limited to rectum. It is an inflammation of the lining of the rectum

(muscular tube connected to the colon). Proctitis can be short-lived or chronic and it can
cause diarrhea, bleeding, rectal pain, and continuous feeling that you need to have a
bowel movement.

Figure 1. Proctitis

Distal or Left Sided Colitis

The last portion of the colon. The Mucosal Inflammation extends from the rectum
proximally up to the splenic flexor. Left-sided colitis causes bloody diarrhea, constipation,
rectal spasm, abdominal cramping and pain on the left side, and urgency to defecate.
Approximately 30 percent of people with ulcerative colitis are diagnosed with left-sided
colitis.

Figure 2. Distal or Left-sided Colitis

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Pancolitis

Pancolitis is an Inflammation that spreads throughout the entire colon. It causes

abdominal cramps and pain, fatigue, weight loss, and an urgent need to empty the
bowels. Pancolitis is common in children with ulcerative colitis, approximately 40 to 60
percent children with ulcerative colitis are diagnosed with pancolitis.

Figure 3. Pancolitis

Concept Map

Figure 4. Concept Map of Ulcerative Colitis

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Etiology

The cause of ulcerative colitis is unknown but there are factors that appear to
trigger ulcerative colitis. Many experts believe that ulcerative colitis resuls from being
abnormal immune response to bacteria in the people who are genetically predisposed to
develop this condition.

Risk factors

Predisposing Factors:

• Age: Between 15 and 30 years of age, or older than 60 years

• Family History of inflammatory bowel disease

• Race/ Ethnicity: (white populations, individuals of Ashkenazi Jewish

descent)

• Genetic Predisposition (e.g., HLA-B2& association)

• Episodes of previous intestinal infection

Precipitating Factors:

• Smoking

• Consumption of polyunsaturated fatty acids

• Sedentary lifestyle

• Environmental factors (air pollution, medications, diet)

Pathophysiology

• Mucinous layer- Protects the innermost mucosal epithelium

• Impaired synthesis of mucinous layer- impairment of the mucinous layer.

• Thinning of mucinous layer- Inability to protect the epithelial cells.

• Increased intestinal permeability.

• Defective regulation of the tight junctions.

• Dysfunctional host immune response Abnormal interaction between the gut

microflora and the body’s immune system.

• Antigens invade Intestinal Cells.

• Inflammation perpetuates, starting from the wall of colon and rectum.

• Ulceration of the wall of colon and rectum.

a) Proctitis: Ulcerative Colitis is limited to Rectum.

b) Distal or Left-sided Colitis: The last portion of the colon. The Mucosal
Inflammation extends from the rectum proximally up to the splenic
flexor.

c) Pancolitis: Inflammation spreads throughout the entire colon.

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Clinical Manisfestations

• Diarrhea with passage of mucos or pus

• Bloody stools

• Weight loss

• Intermittent tenesmus

• Vomiting

• Fever

• Left lower quadrant abdominal pain

Nursing Diagnosis

• Risk for Deficient Fluid Volume Diarrhea

• Hypethermia

• Acute Pain

Nursing Interventions

• Risk for Deficient Fluid Volume Diarrhea

1. Assess skin and oral mucous membranes.

2. Monitor vital signs for changes.

3. Weigh the client and compare with recent weight history.

4. Provide supplemental IV Fluids.

5. Encourage oral intake.

6. Limit caffeine and high-fiber foods; avoid milk and fruits as appropriate.

7. Refer to ND’s.

• Hyperthermia

1. Monitor core temperature by appropriate route.

2. Monitor heart rate and rhythm.

3. Monitor and record all sources of fluid loss.

4. Administer medications; CAUTION with aspirin & anticoagulant therapy.

5. Promote surface cooling.

6. Promote client safety.

• Acute Pain

1. Evaluate pain characteristics and intensity.

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 2. Perform pain assessment each time pain occurs.

3. Monitor skin color, temperature, and vital signs.

4. Administer analgesics as indicated, to maximum dosage as needed;

combinations of medications may be used on prescribed intervals.

5. Provide and promote non-pharmacological pain management.

Surgical/ Medical Management

Barium Enema. Useful for differential diagnosis of right sided type or

segmental type of ulcerative colitis from other inflammatory bowel
diseases.

Colonoscopy with biopsy. To see for ulcerative colitis damage like

swelling, redness, and sores in your intestine and it can show how severe
the disease is.

Removal of the pathological part of the colon. The only cure for
ulcerative colitis is to have sugery which removes the colon and the lining
of the rectum.

Nutritional therapy and Low residue diet. A low-fiber diet can help
reduce your most symptoms of ulcerative colitis such as abdominal pain
and cramping.

Diagnostic Tools

Abdominal X-ray. Useful for adjunct to imaging in causes of ulcerative

colitis of acute onset.

CBC (Complete Blood Count). Commonly used by HCPs when testing for
crohn’s and ulcerative colitis.

BMP (Basic Metabolic Panel). Blood test that measures your glucose
level, electrolyte and fluid balance, and kidney function.

Stool Sample. White blood cells or certain proteins in your stool can
indicate ulcerative colitis. Changes in stool can be directly related to how
ulcerative colitis affects your colon.

Barium Enema. Useful for differential diagnosis of right sided type or

segmental type of ulcerative colitis from other inflammatory bowel
diseases.

Proctitis

Colonoscopy. To see for ulcerative colitis damage like swelling, redness,

and sores in your intestine and it can show how severe the disease is.

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 Stool Sample. White blood cells or certain proteins in your stool can
indicate ulcerative colitis. Changes in stool can be directly related to how
ulcerative colitis affects your colon.

CBC (Complete Blood Test). Commonly used by HCPs when testing for
crohn’s and ulcerative colitis.

Test for sexually transmitted infections. These tests involve obtaining a

sample of discharge from your rectum or from the tube that drains urine
from your bladder (urethra).

Distal or Left-sided Colitis

Endoscopy. It uses lighted cameras to view the inner lining of the colon.

Pancolitis

Physical examination. Ulcerative colitis shows intestinal and extra

intestinal findings on physical examination.

Colonoscopy. To see for ulcerative colitis damage like swelling, redness,

and sores in your intestine and it can show how severe the disease is.

Pharmacological Management

• Antidiarrheal. Use anti-diarrheal medications with great caution and after talking
with your doctor, because they may increase the risk of an enlarged colon (toxic
megacolon).

• Antibiotic. Antibiotics, also known as antibacterials, are medications that destroy

or slow down the growth of bacteria.

• Aminosalicylates. Most people with UC take prescription drugs called

aminosalicylates (or “5-ASAs”) that tame inflammation in the gut.

• Antipyretics. A medication that reduces fever or quells it.

• Analgesics. Analgesics are also called painkillers. It relieve different types of pain
including lower abdominal pain.

Prognosis

If Treated

Reduces a person's risk of developing severe and potentially life-

threatening complications by calming the inflammation, and help the
individual get better and get back to their daily activities.

If Untreated

Symptoms of ulcerative colitis can get worse and may become more
challenging to treat in future.

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References

Faubion, W. (2021). Ulcerative colitis. Mayo Clinic.https://www.mayoclinic.org/diseases-

conditions/ulcerative-colitis/symptoms-causes/syc-20353326

Greengard, S. (2020). Ulcerative Colitis Treatment Options. Healthline.

https://www.healthline.com/health/ulcerative-colitis-take-control/treatment

Kelsen et al. (2019). Ulcerative Colitis in Children. Medscape.

https://emedicine.medscape.com/article/930146-overview#a3

Khati, M. (2020). How Do I Know If I Have Ulcerative Colitis. Mayo Clinic.

https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/do-i-have-ulcerative-colitis

Ordas et al.. Ulcerative colitis. The Lancet. 2012; 380 (9853): p.1606-1619. doi:10.1016/S0140-
6736(12)60150-0

Parmar, S. (2021, October 4). Ulcerative Colitis (Pathophysiology & Complications) | Dr.
ShikhaParmar [Video].YouTube. https://www.youtube.com/watch?v=pwhlR6kUj8M&lis
t=LL&inex1&t=217s&ab_channel=Dr.ShikhaParmarClasses

Ulcerative colitis - knowledge @ amboss. ambossIcon. (n.d.).

https://www.amboss.com/us/knowledge/Ulcerative_colitis/

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