ulcerative colitis.new podwerpoint

8/8/2019 Ulcerative Colitis.new Podwerpoint

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Ulcerative colitisUlcerative colitis

Mary GraceMary Grace MaltoMalto

Jennifer DebitJennifer Debit


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Ulcerative colitisUlcerative colitis

An inflammatory condition that affects theAn inflammatory condition that affects the surface of thesurface of thecolon,ulcerative colitis causes friability and erosions w/colon,ulcerative colitis causes friability and erosions w/

bleeding.The disease usually begins in the rectal areableeding.The disease usually begins in the rectal areaand may extend through the entire bowel, lessand may extend through the entire bowel, lessfrequently,it extends into the splenic flexure,or morefrequently,it extends into the splenic flexure,or moreproximally extends upward into the entire colon.It rarelyproximally extends upward into the entire colon.It rarelyaffects the small intestine,except for the terminalaffects the small intestine,except for the terminalileum.Severity ranges from a mild,localized disorder to aileum.Severity ranges from a mild,localized disorder to a

fulminant disease that may lead to a perforatedfulminant disease that may lead to a perforatedcolon,progressing to peritonitis and toxemia.colon,progressing to peritonitis and toxemia.


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causescauses

Autoimmune response (possibly)Autoimmune response (possibly) Exacerbated or triggered by stress .Exacerbated or triggered by stress .


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Signs and SymptomsSigns and Symptoms

PeritonitisPeritonitis Pyoderma gangrenosum on the legs and anklesPyoderma gangrenosum on the legs and ankles

Sclerosing cholangitisSclerosing cholangitis Strictures,pseudopolyps,stenosis and perforatedStrictures,pseudopolyps,stenosis and perforated

coloncolon

TenesmusTenesmus

Thromboembolic eventsThromboembolic events ToxemiaToxemia UveitisUveitis


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Signs and SymptomsSigns and Symptoms

AnorexiaAnorexia Ankylosing spondylitisAnkylosing spondylitis ArthritisArthritis Bloody diarrheaBloody diarrhea CholangiocarcinomaCholangiocarcinoma

CirrhosisCirrhosis Coagulation defectsCoagulation defects EpiscleritisEpiscleritis Erythema nodosum on the face and armsErythema nodosum on the face and arms Fecal urgencyFecal urgency HypovolemiaHypovolemia

Impaired nutritionImpaired nutrition Intermittent bleeding and mucus productionIntermittent bleeding and mucus production Left lower quadrant pain relieved by defecationLeft lower quadrant pain relieved by defecation Loss of muscle massLoss of muscle mass PericholangitisPericholangitis


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PATHOPYSIOLOGYPATHOPYSIOLOGY

Food or Bacteria such asFood or Bacteria such asEscheriaEscheria colicoli

PREDISPOSING FACTOR/ PECIPITATING FACTPREDISPOSING FACTOR/ PECIPITATING FACTOR/MODIFIABLEOR/MODIFIABLENON MODIFIABLENON MODIFIABLE

AGE AUTOIMMUNE AGE AUTOIMMUNE RESPONSERESPONSE GENDER STREGENDER STRESSSS

INLAMMATION OF MUCOSAL LAYER IN LARGE INTESTINEINLAMMATION OF MUCOSAL LAYER IN LARGE INTESTINE

COLONS MUCOSAL SURFACE BECOME DARK, RED, VELVETYCOLONS MUCOSAL SURFACE BECOME DARK, RED, VELVETY

LEADS TO COALESCELEADS TO COALESCE

ULCERULCER

HEMMORAGE, CONGESTION,EDEMA, EXUDATIVE INFLAMMATIONHEMMORAGE, CONGESTION,EDEMA, EXUDATIVE INFLAMMATION

NECROTICNECROTIC

SLOUTHING CAUSES BLOOBY , MUCUS FILLED STOOLSSLOUTHING CAUSES BLOOBY , MUCUS FILLED STOOLS

SCARRING AND THICKENING IN BOWELS INNER MUSCLE LAYSCARRING AND THICKENING IN BOWELS INNER MUSCLE LAYERER

NARROW , SHORTEN AND LOOSES THE CHARACTERISTIC POUCHES OFNARROW , SHORTEN AND LOOSES THE CHARACTERISTIC POUCHES OF COLONCOLON


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Diagnostic testsDiagnostic tests

SigmoidoscopySigmoidoscopy-- establishes the diagnosis byestablishes the diagnosis bydemonstrating increased mucosaldemonstrating increased mucosalfriability,decreased mucosal detail,edema,andfriability,decreased mucosal detail,edema,and

erosionserosions BiopsyBiopsy--can help confirm the diagnosiscan help confirm the diagnosis ColonoscopyColonoscopy--may be used to determining themay be used to determining the

extent of the disease and to evaluate the areasextent of the disease and to evaluate the areas

of the stricture and pseudopolyps.Colonoscopyof the stricture and pseudopolyps.Colonoscopyshouldnt be performed during an acute episodeshouldnt be performed during an acute episodebecause of the risk of perforationbecause of the risk of perforation

Stool specimen analysisStool specimen analysis--reveals blood,pus,andreveals blood,pus,andmucus but no pathogenic organisms.mucus but no pathogenic organisms.


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TreatmentTreatment

The goals of treatment are to controlThe goals of treatment are to controlinflammation,replace nutritional losses,and bloodinflammation,replace nutritional losses,and bloodvolume,and prevent complications.volume,and prevent complications.

Supportive treatment includes I.V.fluidSupportive treatment includes I.V.fluidreplacement,dietary therapy,bedrest,and medicationsreplacement,dietary therapy,bedrest,and medications Total parenteral nutrition (TPN) rests the intestinalTotal parenteral nutrition (TPN) rests the intestinal

tract,decreases stool volume,and restores positivetract,decreases stool volume,and restores positivenitrogen balancenitrogen balance

The patient with moderate signs and symptoms mayThe patient with moderate signs and symptoms mayreceive.Ensure or another brand of elemental feeding toreceive.Ensure or another brand of elemental feeding toprovide adequate nutrition with minimal bowelprovide adequate nutrition with minimal bowelstimulation.stimulation.

Blood transfusions or iron supplements may beBlood transfusions or iron supplements may benecessary to correct anemia.necessary to correct anemia.


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TreatmentTreatment

Medications to control inflammation include;corticortropin andMedications to control inflammation include;corticortropin andadrenal corticosteroids,such as prednisone,prednisolone,andadrenal corticosteroids,such as prednisone,prednisolone,andhydrocortisone;sulfasalazine,w/c has antihydrocortisone;sulfasalazine,w/c has anti--inflammatory andinflammatory andantimicrobial properties;and mesalamine;given rectally and orally.antimicrobial properties;and mesalamine;given rectally and orally.

Surgery,the treatment of last resort,is recommended for patientsSurgery,the treatment of last resort,is recommended for patientswho have toxic megacolon or who fail to respond to drugs andwho have toxic megacolon or who fail to respond to drugs andsupportive measures.Surgery may include proctocolectomy w/supportive measures.Surgery may include proctocolectomy w/ileostomy;total colectomy and ileorectal anastomosis(requiresileostomy;total colectomy and ileorectal anastomosis(requiresobservations of the remaining rectal stump for any signs of cancerobservations of the remaining rectal stump for any signs of canceror colitis);pouch ileostomy(kock pouch or continent ileostomy),or anor colitis);pouch ileostomy(kock pouch or continent ileostomy),or anileonal reservoir(a twoileonal reservoir(a two--step procedures that preserves the analstep procedures that preserves the anal

sphincter and provides the patient w/ a reservoir made from thesphincter and provides the patient w/ a reservoir made from theileum and attached to the anal opening.ileum and attached to the anal opening.


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Nursing ConsiderationsNursing Considerations

Accurately record intake and output,particularly the frequency and volumeAccurately record intake and output,particularly the frequency and volumeof the stools.of the stools.

Watch for signs and symptoms of dehydration and electrolyteWatch for signs and symptoms of dehydration and electrolytelmbalances,specifically of hypokalemia (muscle weakness,paresthesia)andlmbalances,specifically of hypokalemia (muscle weakness,paresthesia)andhypernatremia(fever,tachycardia,flushed skin,and dry tounqe.)hypernatremia(fever,tachycardia,flushed skin,and dry tounqe.)

Monitor hemoglobin and hematocrit levels,and transfused as ordered.Monitor hemoglobin and hematocrit levels,and transfused as ordered. Provide good mouth care for the patient whos allowed nothing by mouth.Provide good mouth care for the patient whos allowed nothing by mouth. After each bowel movement,thoroughly clean the skin around the rectum.After each bowel movement,thoroughly clean the skin around the rectum. If the patient needs TPN,change dressings asses for inflammation at theIf the patient needs TPN,change dressings asses for inflammation at the

insertion site and check blood glucose every 6 hours.insertion site and check blood glucose every 6 hours. Take precautionary measures if the patient is prone to bleeding.WatchTake precautionary measures if the patient is prone to bleeding.Watch

closely for signs of complications, such as perforated colon andclosely for signs of complications, such as perforated colon andperitonitis,(fever,severe abdominal pain,abdominal rigidity andperitonitis,(fever,severe abdominal pain,abdominal rigidity andtenderness,and cool,clammy skin) and toxic megacolon (abdominaltenderness,and cool,clammy skin) and toxic megacolon (abdominaldistention,decreased bowel sounds).distention,decreased bowel sounds).


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