Thursday, May 18, 2017

Ulcerative colitis - Special considerations

Patients with ulcerative colitis need special care and management. Following points are important to remember:.
  • Accurately record intake and output, particularly the frequency and volume of stools.
  • Watch for signs of dehydration and electrolyte imbalances, specifically signs of hypokalemia (muscle weakness, paresthesia) and hypernatremia (fever, tachycardia, flushed skin, dry tongue).
  • Monitor hemoglobin and hematocrit, and transfuse if necessary.
  • Provide good mouth care for the patient who is allowed nothing by mouth.
  • After each bowel movement, thoroughly clean the skin around the rectum.
  • Administer medication. Watch for adverse effects of prolonged corticosteroid therapy (moonface, hirsutism, edema, gastric irritation). Be aware that such therapy may mask infection.
  • If the patient needs total parenteral nutrition, change dressings, assess for inflammation at the insertion site, and check blood glucose every 6 hours.
  • Take precautionary measures if the patient is prone to bleeding. Watch closely for signs of complications, such as a perforated colon and peritonitis (fever, severe abdominal pain, abdominal rigidity and tenderness, and cool, clammy skin), and toxic megacolon (abdominal distention, decreased bowel sounds).
  • Prepare the patient for surgery, and provide teaching related to the care of an ileostomy. Consult the enterostomal therapy nurse for preoperative teaching and stoma marking. Provide a bowel preparation.
  • After surgery, provide education regarding ostomy care as well as psychological support. Arrange for the patient to consult an enterostomal therapy nurse.
  • Keep the nasogastric tube patent. After removal of the tube, provide a clear-liquid diet. Gradually advance to a low-residue diet as tolerated.
  • After a proctocolectomy and ileostomy, provide education regarding ostomy care. Wash the skin around the stoma with soapy water and dry it thoroughly. Apply karaya powder around the base of the stoma to prevent irritation and provide a tight seal. Cut an opening in the ring to fit over the stoma, and secure the pouch to the skin. Empty the pouch when it’s one-third full.
  • After a pouch ileostomy, uncork the catheter every hour to allow contents to drain. After 10 to 14 days, gradually increase the length of time the catheter is left corked until it can be opened every 3 hours. Then remove the catheter and reinsert it every 3 to 4 hours for drainage. Teach the patient how to insert the catheter and how to take care of the stoma.
  • Encourage the patient to have regular physical examinations.

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