Ulcerative Colitis | Med-Surg Nursing

In this video, we'll dive into what ulcerative colitis is and everything you need to know about it for your nursing school exams. I'll walk you through the must know pathophysiology, the signs and symptoms, the nursing assessment and the nursing interventions so that you can really easily understand it. Because let's be honest, med surg can be hard in nursing school, right? So let's walk through ulcerative colitis studies step by step so you can pass your nursing school exam. Hello. Hello, my friend. My name is Christina Rafano and I am the creator of the nursing school show, where of course, we walk you through how to pass nursing school step by step. So hit that subscribe button and click the notification bell and let's dive in. So let's get started with the first thing that you need to know about ulcerative colitis. What exactly does that mean? What is ulcerative colitis? And it is, simply put, it's inflammation of the colon. So that's the first thing that you should think of when you think of ulcerative colitis, inflammation of the colon in the GI tract. Now, ulcerative colitis and Crohn's disease, they're often confused together and that can get confusing when you are trying to study for your nursing school exams, right? So don't get me wrong, they are very similar because they are both inflammatory, meaning that they cause a lot of inflammation in the GI tract and they are both chronic conditions. We don't know exactly what causes them. So they do have a lot of similarities. They're very similar. But how are we going to differentiate between the two so that we can make sure we know the biggest differences between them? You can pass your exams, right? To know which one is which, trust me, you will need to know this for your nursing school exams. Now, the difference is that ulcerative colitis only occurs in the colon, whereas Crohn's disease can occur anywhere along the GI tract. That is the major key difference. So now that we know that key difference between the two, let's walk through the pathophysiology of what is happening here in ulcerative colitis. Now, the good news is for you though, is that we don't know a whole lot about it, about ulcerative colitis and why it happens. So the steps are pretty straightforward here. So let's walk through the pathophysiology of ulcerative colitis step by step so that when you get to your nursing school exam, when you get to that exam question, you know exactly how to critically think through it, and you can confidently answer. So the first thing that happens with ulcerative colitis, you see, is the immune system is triggered. Now, typically, your immune cells have checks and balances. So they can't just create inflammation and attack body tissues as they see fit by themselves. They have to actually be responding to something, like attacking an actual pathogen. But in ulcerative colitis, the body's immune system, it's triggered and it keeps going unchecked. It just keeps trying to attack as if there was a pathogen, even though there may not be. Now, that's what makes this a chronic condition. It keeps persisting and it doesn't go away. Now, we don't exactly know why that immune system gets triggered in this way, but there are several theories. Maybe genetics or environmental factors or diet might play a role. Now, once that immune system is triggered, the immune cells start attacking and wearing away the tissue inside the colon. Now, this leads to ulcers along the walls of the colon. That's why it's called ulcerative colitis. There are ulcers all along the colon. Now, the inflammation also causes redness, edema and swelling, irritation as it continues, and then the persisting inflammation. Remember now, the checks and balances that are supposed to hal inflammation when there isn't a real threat, they're not working properly. So the body continues to try to fight off a pathogen that's not really there. So as this inflammation continues, scar tissue forms throughout the colon. Now, think of this scar tissue as a thicker layer of tissue along the inside of the colon. Now, let's take a step back and let's think about what the job of the colon is. What does it do? The job is to absorb nutrients and water and form waste. And what happens if there's a layer of thick scar tissue where the nutrients and the water where they're supposed to be absorbed and taken up by the body? Well, what's going to happen? The scar tissue will decrease the cone's ability to absorb the nutrients in the water. Now, because of all of this inflammation that is going on, as a nurse, we want to make sure that we are thinking ahead to help provide the best care possible for our patients. Of course. So that brings up the last step, which is possible complications with ulcerative colitis. Now, although these complications won't happen in everyone, they're still a possibility. Now, things like toxic megacolon, where the colon becomes dilated, which is a medical emergency, perforation of the colon, and colon cancer perhaps, and then Typically, patients with ulcerative colitis will have periods where it gets better and their symptoms really start to improve, followed by periods where it does get worse. Now, I know that's a lot of pathophysiology to learn and understand, so I want to make sure that you download our free nursing school study checklist that we have for you that has some really, really great study tips to help you learn things faster in nursing school. So I'm going to put the link down below in the description in the description box for you to check that out. You'll definitely want to download that. So now that we fully understand what is happening inside of the body with ulcerative colitis, let's walk through the signs and symptom that you might see in a patient. So remember, when you think ulcerative, think inflammation of the colon. We think ulcerative colitis, think inflammation of the colon, because that's exactly, exactly what's happening here. The body's inflammatory response, it's kicked into high gear and it's attacking the tissue in the colon. There's a result of two primary things now, the inflammation and the ulcers themselves and the scar tissue that forms. So keep that in mind as we walk through these signs and symptoms. So the first sign we'll talk about is loose, watery, bloody or mucousy stools. Since the colon is inflamed and its tissue is damaged, it can't absorb water and the nutrients like it normally does to help form solid stool. So the stool ends up being much more watery and loose simply because the colon can't absorb that water back into the body. The stool also irritates the lining of that large intestine as it passes, and it picks up some of the bloody and infected tissue from the ulcerated areas, from the areas with those ulcers. Now, this is what causes that mucusy and bloody stools. Now, the frequent loss of blood in the stool can lead to anemia. So it will be important to monitor your patient's hematocrit and their hemoglobin levels. Then, of course, abdominal pain, abdominal cramping, these are really common and constant symptoms. The patient may go through flare ups and then remissions, but abdominal cramping is a common symptom throughout. So with all that inflammation, with the swelling, with the ulcers, it's no wonder, of course, that it would cause a lot of pain and a lot of cramping in the belly. It's like having all these open wounds on the inside of your body. Right. So that's certainly not fun, not a good thing to experience. And if the rectum is affected, and if the rectum is inflamed, it can cause an intense urge to have a bowel movement due to the inflammation just itself. And then rectal bleeding is also a big symptom if the lining of the rectum is inflamed and has ulcers, too. Now, the ulcers can lead to a ruptured bowel, which can very quickly lead to sepsis and is a medical emergency. So make sure that you're watching for signs and symptoms of intense abdominal pain and abdominal distension, hypoactive or absent bowel sounds, severe diarrhea and fever. Those will be really key and important to look for. And since the colon can't absorb water and nutrients like it normally does, since all that scar tissue is there, the patient might lose weight and be dehydrated or lack important nutrients since, of course, that colon can't absorb them back into the body. Right. So the signs and symptoms of ulcerative colitis really fall into those two main categories. They really have to do with either the inflammation and the ulcers that are inside of the colon. So those signs of symptoms like bleeding, diarrhea and pain, or they have to do with that scar tissue formation, scar tissues, that that's there. Things like nutritional deficits and dehydration. Now, remember, when you think ulcerative colitis, the first thing you should think of is inflammation of the colon. And then that will help remind you of these signs and symptoms. Now, we want to have a goal when we are going to do your nursing assessment. Right. Your assessment should help do two things. Should see where the patient's symptoms are at in the current moment and then ensure that their signs and their symptoms are getting worse. Worse, and that complications are not occurring. A thorough abdominal assessment is very important with these patients making sure that their belly is not getting more distended, their bowel sounds stay regular in all four quadrants, and that their belly is soft and there's not an increase in tenderness upon palpations when you press on it. And since ulcerative colitis causes ulcers in the colon, it's possible for a bowel perforation to occur and for GI contents to stop spill out into the abdominal space in the bloodstream, causing sepsis. This is not what we want. Any sign of a fever, increase in abdominal pain, or decrease in bowel sounds should be a signal to look more closely and assess for signs of sepsis and if you want a deep dive on sepsis, we do have another video on that, so be sure to check that out if you need to get a better idea of their symptoms, if they're getting better or worse. You will also need to assess their bowel habits, like how frequently do they typically have a bowel movement, how much is typically excreted for them, if they have pain or no pain, or their consistency of their stool, the color of the stool, the smell of their stool, and if they experience any vomiting or nausea or diarrhea. Ask if there are any foods or environments or stressors that can cause a flare up. These are all things that you'll need to monitor closely and make sure that your patient is aware of what they should be looking for and tracking for themselves as well. Now, since ulcerative colitis is chronic condition, the more that your patient can pay attention to what triggers a flare up, the better they're going to be at managing their symptoms or improving their quality of life. And since since the patient may be nauseous and may not be eating as much. Along with that, of course, decreased absorption of the nutrients in their colon, you'll need to assess their daily weights and check their electrolyte and their hematocrit and their hemoglobin levels to assess for malnutrition and anemia. If their colon isn't able to take up as much nutrition, particularly iron, they may develop anemia and have a lowered hematocrit and hemoglobin level. So remember, with ulcerative colitis it means that the colon is inflamed and ulcerated. There's ulcers in there and it can't absorb as many nutrients as it usually could. And our assessment will be focused on monitoring how the patient is coping with that. Now, because ulcerative colitis is a chronic condition, there is only one way to cure it by removing the colon and the rectum. Now, since those are the only parts of the GI tract that are affected, however, it can be managed with diet and medications during flare ups to help reduce the patient's symptoms. Things like steroids can help reduce inflammation, but they should not be used for a prolonged period of time. The doctor may prescribe them only during flare ups since the side effects of long term steroid use may outweigh the benefits of using those steroids. Then, immune suppressors, things like infliximab, methotrexate and azithria prine, those can be used to help suppress the inflammatory response in order to decrease that Inflammation in the colon. So remember, with ulcerative colitis, it is the immune system that here that is overreacting and causing that inflammation to continue. And then antibiotics are also sometimes given to help heal infections that occur because of those ulcers and the lesions in the colon and the rectum. So you might see ciprofloxacin or metronidazole prescribed for that reason. And then acetophenamine might be used as a pain reliever. But NSAIDs, things like ibuprofen or aspirin should be avoided because they are super harsh on the colon and they might increase flare ups and symptoms. So as a nurse, you'll need to do a lot of education with them around how to control flare ups and exasperations of symptoms. Limiting foods that are hard to digest and high in fiber can increase symptoms like nuts, raw fruits and vegetables, grains, beans and oats. And since the colon is already irritated, they may be more susceptible to other foods as well. Things like dairy, gluten, wheat, spicy foods, fish or red meat. Then alcohol and fried foods may also increase their symptoms. This will vary from person to person, but helping them keep a food diary with corresponding symptoms can really help them narrow down foods that trigger their symptoms for them. Now, during a flare up, it's especially important to avoid all trigger foods and eat a diet that is very low in fiber and that's very easy to digest. Then staying hydrated will help the body heal the inflammation and inside the colon as well. Now, some patients may need to be placed on total parenteral nutrition or tpm, or given fluids and electrolytes through an IV in order to give the colon a rest time to heal while still allowing the patient to get the proper nutrition they need. Then surgical treatment can sometimes help too. A J pouch or an S pouch may be an option for some patients, which is where the colon is removed along with most of the rectum. And a small pouch is created to pack cast stool from the ilium to the anus. Now this is in severe cases only when other management has failed. So the biggest thing to remember here is that ulcerative colitis is inflammation and ulcers in the colon. Now the main goal is to reduce that inflammation and the ulcerations as much as we can and help the patient go into remission and reduce the frequency of their flare ups and their symptoms. We also want to make sure that the patient is well nourished and well hydrated. And we want to help educate them on how to control their flare ups in the future. Now there's three ways that I can help you more through nursing school. Number one, like we mentioned, be sure to download that nursing school checklist that I have for you that walks you through how to study in nursing school step by step. Don't miss out on that. Now you'll also want to be sure to check out one of our nursing school boxes that we have available for you. They are packed with resources to help you succeed in nursing school. And of course, if you want me to hold your hand throughout nursing school and come alongside your nursing school journey with you, don't miss out on joining the Nursing SOS Membership community. It is filled with step by step nursing lectures to help you understand everything faster so you will be more prepared for your nursing school exams. Now the links to all of those things are down below in the description box and if you like this video, be sure to hit that like button. Leave a comment below to let me know that you loved it and share it with one of your nursing school friends if they need help with Med Surg as well. And of course hit that subscribe button and click the notification bell so you never miss a video. And click on one of these videos right over here so you can keep rocking nursing school. And as always my friend, go become the nurse that God created only you to be. And I'll catch you next time on the Nursing School show. Take care. Bye bye.