- Acute Pain related to Inflammation of the intestines and Hyperactive bowels
as evidenced by Complaints of abdominal pain and Reports of abdominal cramping - Diarrhoea related to Inflammation of the lining of the colon and frequent bowel movements as evidenced by Loose and watery stools and Bloody stools (bright red, maroon, or black stools), Stool with pus or mucus
- Ineffective Tissue Perfusion related to Intestinal inflammation and Intestinal or rectal bleeding as evidenced by Rectal bleeding and Bloody stools
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: Verbal reports from the patient -Expressions of pain, such as crying -Unpleasant feeling (such as a prick, burn, or ache) Objective data: -Significant changes in vital signs -Changes in appetite or eating patterns -Changes in sleep patterns -Guarding or protective behaviors | Acute Pain related to Inflammation of the intestines and Hyperactive bowels as evidenced by Complaints of abdominal pain and Reports of abdominal cramping | Patient will report relief from abdominal cramping. Patient will report two strategies to relieve abdominal pain. Patient will be able to manifest a calm and well-rested appearance. | 1. Position the patient comfortably. The left side of the abdomen or the rectum often hurts in colitis. Certain positions can worsen ulcerative colitis pain depending on which side of the intestinal tract is inflamed. 2. Instruct on appropriate medications. Administer acetaminophen for mild colitis pain. Antispasmodic medications can relieve abdominal cramps. In contrast, do not give ibuprofen, naproxen, or diclofenac, as they can exacerbate abdominal discomfort. 3. Administer opioids and adjuvants. Severe colitis pain may require opioid narcotics. Antidepressants are recommended adjuvant analgesics. 4. Encourage psychotherapy. Cognitive behavioral therapy can be useful as a complementary treatment when pain is chronic and cannot be completely relieved. CBT can also improve quality of life. 5. Encourage the patient to avoid triggering factors. Stress and improper diet trigger exacerbation of symptoms. Stress management and an appropriate diet can help prevent inflammation, abdominal pain, and cramping due to colitis. 6. Relieve rectal pain. Rectal pain and skin irritation are common with frequent loose stools. Offer a warm sitz bath for comfort and clean the rectal area with soft, cool wipes. | Patient reported relief from abdominal cramping. Patient reported two strategies to relieve abdominal pain. Patient manifested a calm and well-rested appearance. |
| Subjective data: -Abdominal pain Gas, bloating -Urgency and frequency Objective data: -Hyperactive bowel sounds -Three or more loose stools per day -Blood or mucus in the stool | Diarrhoea related to Inflammation of the lining of the colon and frequent bowel movements as evidenced by Loose and watery stools and Bloody stools (bright red, maroon, or black stools), Stool with pus or mucus | Patient will report a decrease in frequency and urgency to less than three stools per day. Patient will be able to demonstrate bowel sounds within normal limits upon auscultation. Patient will be able to pass stool without blood or mucus. | 1. Gradually change the diet as ordered. Maintain NPO status followed by diet changes from clear liquids to a low-fiber diet as prescribed and tolerated during the acute phase of colitis. Not giving anything by mouth at the start of diarrhea will help decrease bowel movements. 2. Assist the patient in creating a meal plan. A low-fiber and high-protein diet supplemented with vitamins and iron supplements is recommended. Avoid foods that cause gas, dairy products, raw fruits and vegetables, whole grains, nuts, pepper, alcohol, and caffeine-containing items. 3. Administer medications as prescribed. This includes a combination of medications such as salicylate compounds, corticosteroids, immunosuppressants, and antidiarrheals. Anti-inflammatory (salicylate compounds) medications are the first line of treatment for ulcerative colitis. Time-limited corticosteroid treatment induces remission. Steroids have anti-inflammatory and immunosuppressive properties. Immunosuppressants block the immunological response causing the body to release substances that cause inflammation. 4. Prepare the patient for surgery. Surgery may be needed if symptoms become worse and more complicated. Surgery includes the removal of the entire colon and rectum, and an internal pouch connected to the anus will enable bowel movements without a bag. A pouch may sometimes be appropriate—instead, creating a stoma in the abdomen. A bag attached to the stoma will collect the stool. 5. Refer to an IBD specialist. Inflammatory bowel disease (IBD) refers to conditions that affect the tissues in your digestive tract and are long-lasting (chronic). Ulcerative colitis is a type of IBD. A specialist role can evaluate and follow patients receiving therapy and offer professional advice and expertise on all aspects of inflammatory bowel disease. 6. Refer the patient to a dietitian or nutritionist. Following the recommended diet will help prevent colitis flare-ups. A dietician can educate about food recommended for colitis and help tailor a specialized diet for the patient. | Patient reported a decrease in frequency and urgency to less than three stools per day. Patient demonstrated bowel sounds within normal limits upon auscultation. Patient passed stool without blood or mucus. |
| Subjective data: -Dizziness -Visual disturbance -Fatigue or weakness Objective data: -Altered mental status -Restlessness -Changes in speech -Difficulty swallowing -Motor weakness -Changes in pupillary reaction -Syncope -Seizure | Ineffective Tissue Perfusion related to Intestinal inflammation and Intestinal or rectal bleeding as evidenced by Rectal bleeding and Bloody stools | Patient will demonstrate haemoglobin, RBC, and iron levels within acceptable limits. Patient will not experience rectal bleeding or bloody stools. | 1. Administer medications as ordered. Aminosalicylates help reduce inflammation in patients with ulcerative colitis, allowing the damaged intestinal tissues to heal and improving perfusion in the intestines. Immunomodulators or biologics may be required to control severe UC. Steroids are necessary to reduce inflammation during an acute flare. 2. Treat and prevent anemia. Vitamin B12, RBC count, and iron levels that are low will need supplementation through oral or IM routes. Intestinal bleeding may require blood transfusions if hemoglobin levels are concerningly low. 3. Administer intravenous fluids and electrolytes. Fluid resuscitation via intravenous therapy is provided as this can help improve hemodynamics and promote GI tissue perfusion, especially if bleeding complications are present. Loss of electrolytes is also common with UC and should be supplemented. 4. Treat rectal bleeding. Anal fissures and hemorrhoids can cause rectal bleeding and are common in UC. Steroid suppositories can reduce inflammation in the rectal area. A warm sitz bath can alleviate discomfort. 5. Educate on when to seek assistance for bleeding. If UC is controlled or in remission, blood should not be observed. Bloody stools or blood on toilet paper is a sign that a change in treatment may be needed. The patient should be instructed to contact their gastroenterologist. | Patient demonstrated haemoglobin, RBC, and iron levels within acceptable limits. Patient experienced rectal bleeding or bloody stools. |