4 Best Nursing Care Plans for Ulcerative Colitis

This article discusses Nursing Care Plans for Ulcerative Colitis plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Ulcerative colitis (UC) is an inflammatory bowel disease. It causes irritation, inflammation, and ulcers in the lining of your large intestine/colon.

There’s no cure, and people usually have symptoms off and on for life. But the right treatments can help keep a handle on the disease.

Nursing Care Plans for Ulcerative Colitis – Causes of Ulcerative colitis

Ulcerative colitis happens when the immune system makes a mistake. Normally, it attacks invaders in the body, like the common cold. But when one has UC, the immune system thinks food, good gut bacteria, and the cells that line the colon are the intruders. White blood cells that usually protect the body attack the colon’s lining instead. They cause inflammation and ulcers.

Doctors aren’t sure why people get the condition. Genes may play a role; the disease sometimes runs in families. Other things in the world around may make a difference too.

Nursing Care Plans for Ulcerative Colitis – Risk Factors of Ulcerative colitis

Things that can affect one’s risk of getting ulcerative colitis include:

Age

It’s most likely to get ulcerative colitis if one is between 15 and 30 years old or older than 60.

Ethnicity

The risk is highest in people of Ashkenazi Jewish descent.

Family history

A person’s risk could be up to 30% higher if they have a close relative with the condition.

Food and stress don’t cause it, but they can trigger a flare of symptoms.

Nursing Care Plans for Ulcerative Colitis – Types of Ulcerative Colitis

The type of ulcerative colitis depends on where it is in the body:

Ulcerative Proctitis

Ulcerative Proctitis is usually the mildest form. It’s only in the rectum, the part of the colon closest to the anus. Rectal bleeding may be the only sign of the disease.

Proctosigmoiditis

Proctosigmoiditis happens in the rectum and the lower end of the colon. Bloody diarrhea, belly cramps, and pain are the likely symptoms of this condition. A patient with this condition usually has the urge to poop but can’t be able to.

Left-sided colitis

Left-sided colitis causes cramps on that side of the belly. A patient also has bloody diarrhea and might lose weight without trying. A patient will have inflammation from the rectum up through the left side of the colon.

Pancolitis

Pancolitis often affects the entire colon. It can cause severe bouts of bloody diarrhea, belly cramps, pain, fatigue, and major weight loss.

Acute severe ulcerative colitis

Acute severe ulcerative colitis is rare. It affects the entire colon and causes severe pain, heavy diarrhea, bleeding, and fever.

Nursing Care Plans for Ulcerative Colitis – Symptoms of Ulcerative Colitis

The main symptom of ulcerative colitis is bloody diarrhea. There might be some pus in the stools too.

Other problems include:

• Cramping belly pain
• Sudden urges to poop
• Not feeling hungry
• Weight loss
• Feeling tired
• Fever
• Dehydration
• Joint pain or soreness
• Canker sores
• Eye pain when you look at a bright light
• Too few red blood cells, called anemia
• Skin sores
• Feeling like you haven’t completely emptied your colon after using the bathroom.
• Waking up at night to go
• Not being able to hold stool in
• Pain or bleeding with bowel movements

Nursing Care Plans for Ulcerative Colitis – Diagnosis of Ulcerative Colitis

A doctor will use tests to tell if a patient has UC instead of another gut disease.

Blood tests can show if a patient has anemia or inflammation.

Stool samples can help the doctor rule out an infection or parasite in the colon. They can also show if there’s blood in the stool.

Flexible sigmoidoscopy lets the doctor look at the lower part of the colon. They’ll put a bendable tube into the lower colon through the bottom. The tube has a small light and camera on the end. A doctor might also use a small tool to take a piece of the lining of the lower colon. This is called a biopsy. A doctor in a lab will look at the sample under a microscope.

Colonoscopy is the same process as flexible sigmoidoscopy, only the doctor will look at the whole colon, not just the lower part.

X-rays are less common for diagnosing the disease, but a doctor may want a patient to have one in special cases.

Nursing Care Plans for Ulcerative Colitis – Treatment of Ulcerative Colitis

UC treatment has two main goals. The first is to make a patient feel better and give the colon a chance to heal. The second is to prevent more flare-ups. A patient may need a combination of diet changes, medication, or surgery to reach those goals.

Diet

Some foods can make the symptoms worse. Soft, bland food doesn’t bother as much as spicy or high-fiber dishes. If a patient can’t digest the sugar in milk called lactose, a doctor may tell him or her to stop eating dairy products. A balanced diet with plenty of fiber, lean protein, fruits, and veggies should provide enough vitamins and nutrients.

Medicine

A doctor may prescribe a few different kinds of drugs, including:

• Antibiotics. These fight infections and let your large intestine heal.
• Aminosalicylates. These drugs have something called 5-aminosalicylic acid (5-ASA) that fights inflammation and helps control symptoms.
• Corticosteroids. If aminosalicylates don’t work or the symptoms are severe, a doctor might give these anti-inflammatory drugs for a short time.
• Immunomodulators. These help stop the immune system’s attack on the colon. They can take a while to take effect. A patient might not notice any changes for up to 3 months.
• Biologics. These are made from proteins in living cells instead of chemicals. They’re for people with severe ulcerative colitis.
• Janus kinase inhibitors (JAK inhibitors). These are oral medicines that can work quickly to get and maintain remission in ulcerative colitis.
• Sphingosine 1-phosphate (S1P) receptor modulators. This is an oral medication for patients with moderately to severely active UC.
• Loperamide. This can slow or stop diarrhea.

Surgery. If other treatments don’t work or UC is severe, a patient might need surgery to remove the colon (colectomy) or colon and rectum (proctocolectomy). If a patient has a proctocolectomy, a doctor might make a small pouch out of the small intestine and attach it to the anus. This is called ileal pouch-anal anastomosis (IPAA). It lets the body expel waste normally, so a patient doesn’t need to wear a bag to collect stool.

Nursing Care Plans for Ulcerative Colitis – Complications of Ulcerative Colitis

Complications of ulcerative colitis can include:

Bleeding. This can lead to anemia.

Osteoporosis. Patients’ bones might become weak because of the diet or if they take a lot of corticosteroids.

Dehydration. A patient might need to get fluids through a vein (intravenous or IV) if the large intestine can’t absorb enough.

Inflammation. This can affect the joints, skin, or eyes.

Fulminant colitis. If UC attack is severe, the colon might burst, or infection could spread through the body. The intestines stop moving waste, and the belly swells.

Megacolon. Fulminant colitis can cause the large intestine to swell or burst. This is a dangerous complication, and a patient will probably need surgery.

Liver disease. The bile ducts or liver could become inflamed or could get scar tissue.

Colon cancer. Ulcerative colitis puts a patient at higher risk of getting colon cancer, especially if the whole large intestine is affected or if UC persists for a long time.

Nursing Care Plans for Ulcerative Colitis Based on Diagnosis

Nursing Care Plans for Ulcerative Colitis: Care Plan 1 – Diagnosis: Diarrhea related to inflammation of the bowel

Evidenced by:

• Loose, watery stools, abdominal cramping, and pain
• Increased urgency to defecate
• Tenesmus
• Increased bowel sounds

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Desired Outcome

The patient will be able to return to more normal stool consistency and frequency.

Interventions	Rationales
1. Commence a stool chart. Use a standardized stool assessment tool such as the Bristol stool chart.	To monitor the patient’s bowel pattern.
2. Administer medications for ulcerative colitis as prescribed.	To help decrease the frequency of stools and alleviate diarrhea, the doctor may prescribe: Anti-inflammatory drugs- the first line of treatment for people with ulcerative colitis Immune system suppressors- work by prohibiting inflammatory response through suppressing the immune system Biologics- work by stopping proteins in the body from causing inflammation anti-diarrheal and antispasmodics.
Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Avoid cold drinks. Check if the patient is in any fluid restriction before doing so.	To help ensure that the patient will not have dehydration due to severe diarrhea. Cold drinks can increase intestinal motility.
Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and avoid high fiber, high-fat foods.	To relieve abdominal pain and cramping, alleviate diarrhea, and promote healthy food habits. To avoid flare-ups of ulcerative colitis. High fiber and high-fat foods can irritate the intestines.
Start the patient on a nothing by mouth status and gradually progress to clear liquids, followed by a bland and low residue diet. The patient can then have a low fat/residue, low fiber diet long-term, as recommended by the dietitian.	Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. Gradual progression from NBM up to low fat and low fiber diet can help manage the symptoms of Ulcerative colitis.

Nursing Care Plans for Ulcerative Colitis: Care Plan 2 – Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to altered absorption of nutrients secondary to Ulcerative Colitis

Evidenced by:

• Diarrhea
• Abdominal pain and cramping
• Weight loss
• Nausea and vomiting
• Loss of appetite

Desired Outcome

The patient will be able to achieve weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

Intervention	Rationale
Explore the patient’s daily nutritional intake and food habits (e.g., mealtimes, duration of each meal session, snacking, etc.)	To create a baseline of the patient’s nutritional status and preferences.
Create a daily weight chart and a food and fluid chart. Discuss the short-term and long-term nutrition and weight goals related to Ulcerative colitis with the patient.	To effectively monitor the patient’s daily nutritional intake and progress in weight goals.
Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol, and high fiber, high-fat foods.	To relieve abdominal pain and cramping, alleviate diarrhea, and healthy food habits. Caffeine is a stimulant of gastric acid production, which can worsen the condition.
Refer the patient to the dietitian.	To provide more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed Ulcerative colitis.
Start the patient on a nothing by mouth status and gradually progress to clear liquids, followed by a bland and low residue diet. The patient can then have a low-fat, low-fiber diet on a long-term basis.	Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. Gradual progression from NBM up to low fat and low fiber diet can help manage the symptoms of Ulcerative colitis.

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Nursing Care Plans for Ulcerative Colitis: Care Plan 3 – Diagnosis: Acute Pain

May be related to:

• Hyperperistalsis
• Prolonged diarrhea
• Skin/tissue irritation
• Perirectal excoriation
• Fissures
• Fistulas

Possibly evidenced by:

• Reports of colicky/cramping abdominal pain/referred pain
• Guarding/distraction behaviors, restlessness
• Facial mask of pain; self-focusing

Desired Outcomes

• Report pain is relieved/controlled.
• Appear relaxed and able to sleep/rest appropriately.

Nursing Interventions	Rationale
Encourage the patient to report pain.	May try to tolerate pain rather than request analgesics.
Assess abdominal cramping or pain reports, noting location, duration, and intensity (0–10 scale). Investigate and report changes in pain characteristics	Colicky intermittent pain occurs with Crohn’s disease
Note nonverbal cues (restlessness, reluctance to move, abdominal guarding, withdrawal, and depression). Investigate discrepancies between verbal and nonverbal cues.	Body language or nonverbal cues may be both physiological and psychological and may be used in conjunction with verbal cues to determine the extent and severity of the problem.
Review factors that aggravate or alleviate pain.	May pinpoint precipitating or aggravating factors (such as stressful events, food intolerance) or identify developing complications.
Encourage the patient to assume a position of comfort (knees flexed).	Reduces abdominal tension and promotes a sense of control.
Provide comfort measures (back rub, reposition) and diversional activities.	Promotes relaxation refocuses attention, and may enhance coping abilities.
Cleanse the rectal area with mild soap and water or wipes after each stool and provide skincare (A&D ointment, Sween ointment, karaya gel, Desitin, petroleum jelly).	Protects skin from bowel acids, preventing excoriation.
Provide sitz bath as appropriate.	Enhances cleanliness and comfort in the presence of perianal irritation or fissures.
Observe for ischiorectal and perianal fistulas.	Fistulas may develop from erosion and weakening of the intestinal bowel wall.
Observe and record abdominal distension, increased temperature, decreased BP.	May indicate developing intestinal obstruction from inflammation, edema, and scarring.
Implement prescribed dietary modifications (commence with liquids and increase to solid foods as tolerated).	Complete bowel rest can reduce pain cramping.

Nursing Care Plans for Ulcerative Colitis: Care Plan 4 –Diagnosis: Ineffective Coping

May be related to:

• Multiple stressors, repeated over a period of time; situational crisis
• Unpredictable nature of disease process
• Personal vulnerability; inadequate coping method; lack of support systems
• Severe pain
• Lack of sleep, rest

Possibly evidenced by:

• Verbalization of inability to cope, discouragement, anxiety
• Preoccupation with the physical self, chronic worry, emotional tension, poor self-esteem
• Depression and dependency

Desired Outcomes

• Assess the current situation accurately.
• Identify ineffective coping behaviors and consequences.
• Acknowledge own coping abilities.
• Demonstrate necessary lifestyle changes to limit/prevent recurrent episodes.

Nursing Interventions	Rationale
Assess patient’s and SO’s understanding and previous methods of dealing with the disease process.	Enables the nurse to deal more realistically with current problems. Anxiety and other problems may have interfered with previous health teaching and patient learning.
Determine outside stressors (family, relationships, social or work environment).	Stress can alter the autonomic nervous response, affecting the immune system and contributing to the exacerbation of the disease. Even the goal of independence in the dependent patient can be an added stressor.
Provide an opportunity for the patient to discuss how illness has affected the relationship, including sexual concerns.	Stressors of illness affect all areas of life, and a patient may have difficulty coping with feelings of fatigue and pain in relation to relationship and sexual needs.
Help patient identify individually effective coping skills.	Use of previously successful behaviors can help a patient deal with the current situation and plan for the future.
Provide emotional support: Active-Listen in a nonjudgmental manner; Maintain nonjudgmental body language when caring for the patient; Assign the same staff as much as possible.	Aids in communication and understanding patient’s viewpoint. Adds to patient’s feelings of self-worth. It prevents reinforcing the patient’s feelings of being a burden (frequent need to empty bedpan or commode). Provides a more therapeutic environment and lessens the stress of constant adjustments.
Provide uninterrupted sleep and rest periods.	Exhaustion brought on by the disease tends to magnify problems, interfering with the ability to cope.
Encourage the use of stress management skills (relaxation techniques, visualization, guided imagery, deep-breathing exercises).	Refocuses attention, promotes relaxation, and enhances coping abilities.
Include patient and SO in team conferences to develop an individualized program.	Promotes continuity of care and enables patients and SO to feel a part of the plan, imparting a sense of control and increasing cooperation with the therapeutic regimen.
Administer medications as indicated: antianxiety agents, such as lorazepam (Ativan) Alprazolam (Xanax).	Aids in psychological and physical rest. Conserves energy and may strengthen coping abilities.
Refer to resources as indicated (local support group, social worker, psychiatric clinical nurse specialist, spiritual advisor).	Additional support and counseling can assist patients and SO in dealing with specific stress and problem areas.

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Related FAQs

1. What is the main cause of ulcerative colitis?

Abnormal immune response, genetics, microbiome, and environmental factors all contribute to ulcerative colitis. Research suggests that ulcerative colitis could be triggered by an interaction between a virus or bacterial infection in the colon and the body’s immune response.

2. How serious is ulcerative colitis?

Ulcerative colitis is a lifelong condition that you have to manage, rather than a life-threatening illness. Still, it’s a serious disease that can cause some dangerous complications, especially if you don’t get the right treatment. Ulcerative colitis is one form of inflammatory bowel disease (IBD).

3. Can you live a long life with ulcerative colitis?

If you have ulcerative colitis (UC), your life expectancy is pretty much the same as someone without it. Getting the right medical care is the key to preventing complications, including some that could be life-threatening. Medicine, changes to your diet, and surgery can help you stay well.

4. What were your first symptoms of ulcerative colitis?

Diarrhea and bloody stools are the two most common initial symptoms of ulcerative colitis. People also often experience abdominal or rectal pain, weight loss, and fever.

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