UC 2

Treatments for Ulcerative Colitis

Surgical Treatments

  • Overview of Surgical Options: In severe cases of ulcerative colitis, surgical intervention may be required. There are two main types of surgical procedures:

    • Proctocolectomy:

    • Definition: Surgical removal of the colon and rectum.

    • Consequence: Following this surgery, patients will require a permanent ileostomy.

      • Permanent Ileostomy:

        • Description: A stoma is created that comes through the surface of the abdomen, allowing stool elimination instead of through the rectum.

        • Educational Resource: Reference to a video series on ostomies for NCLEX review.

    • Ilioanal Anastomosis (J-Pouch Surgery):

    • Definition: Removal of the colon and rectum with the creation of a pouch connected to the ileum.

    • Advantage: This procedure allows for stool passage through the anus, negating the need for a permanent ostomy.

Medical Management

  • Medication Overview:

    • Goals of Medication: Control flare-ups and maintain remission.

    • Prescription approach varies based on severity:

    • Mild cases: Typically treated with aminosalicylates.

    • Moderate to severe cases: May involve a combination of stronger medications.

  • Categories of Medications:

    • Anti-Inflammatory Medications:

    • Aminosalicylates:

      • Example: Sulfasalazine

      • Indication: First-line treatment for mild to moderate ulcerative colitis.

      • Contraindication: Not suitable for patients with allergies to sulfa.

      • Alternative: If ineffective, corticosteroids may be prescribed.

    • Corticosteroids:

    • Example: Prednisone

      • Usage: Given for more severe cases but generally short-term due to side effects.

      • Side Effects: High blood sugar, skin thinning, bruising, osteoporosis, increased infection risk.

      • Important Note: Must be tapered off; patients should not abruptly stop.

    • Immunosuppressors / Immunomodulators:

    • Purpose: Last-resort medications for patients with severe ulcerative colitis who have not responded to other treatments.

    • Example: Azathioprine (Imuran)

      • Effects: Suppresses the immune system to reduce inflammation.

      • Risks: Liver and pancreas effects, increased cancer risk, risk of infection.

      • Additional Note: No live vaccinations allowed while on these medications.

    • Immunomodulators:

      • Example: Humira (adalimumab)

      • Classification: TNF blockers that reduce inflammation by blocking tumor necrosis factor.

      • Precaution: Prior tuberculosis screening due to reactivation risk while on medication.

  • Additional Medications:

    • Antibiotics:

    • Rationale: Used for infections associated with ulcers.

    • Example: Ciprofloxacin (Cipro).

    • Antidiarrheals:

    • Indication: Patients frequently experience diarrhea.

    • Example: Loperamide (Imodium)

    • Important Caution: Should be used sparingly to avoid the risk of toxic megacolon.

    • Pain Relief:

    • Recommendation: Use acetaminophen (Tylenol) for pain management. Avoid NSAIDs as they can exacerbate ulcerative colitis symptoms.

Nursing Interventions

  • Vital Sign Monitoring:

    • Rationale: To detect potential complications like peritonitis or toxic megacolon.

    • Specific Indicators to Monitor:

    • Abdominal tenderness or extreme pain.

    • Severe abdominal bloating.

    • Fever, increased heart rate, increased respiration.

    • Changes in bowel sounds: absence or decrease in active bowel sounds indicates potential complications.

  • Bowel Movements Assessment:

    • Key Questions: "How many bowel movements have you had?" and "Is there blood, mucus, or pus present?"

    • Action: Regular assessment to evaluate stool consistency and presence of blood.

  • Gastrointestinal Assessment:

    • Focus: Palpation of the abdomen to assess tenderness.

    • Focus on signs of complications, including severe pain or altered bowel sounds.

  • Diet Management:

    • Importance: Dietary choices have significant implications for ulcerative colitis patients.

    • Foods to Avoid:

    • High fiber foods (e.g., nuts, popcorn, corns, raw fruits, and vegetables with skin).

    • Dairy products, spicy foods, and high-fat foods that may trigger symptoms.

    • Recommended Foods:

    • Low-fiber, low-residue foods that are easy to digest and high in protein (e.g., cooked fruits and vegetables without skin).

    • Importance of hydration emphasized.

  • Colon Cancer Screening:

    • Recommendation: Patients should undergo regular screenings to monitor for cancer risk associated with ulcerative colitis.

  • Ostomy Care:

    • Post-Surgical Considerations: Knowledge of ostomy care if the patient has undergone a proctocolectomy with ileostomy.

    • Key Nursing Roles: Both pre-operative and post-operative training in changing ostomy pouches and care.