Nursing Assessment, Management and Treatment of Autoimmune Diseases
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● Left-sided colitis : Inflammation extends from the rectum through the sigmoid and descending colon. Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and an urgent need to defecate. ● Pancolitis : The entire colon is affected, causing bloody diarrhea that may be severe, abdominal cramping and pain, fatigue, and weight loss. Risk factors There are several risk factors associated with the development of ulcerative colitis. These include the following (Mayo Clinic, 2021d): ● Age : Ulcerative colitis typically begins before the age of 30. However, it can occur at any stage in life. Some patients may not develop the disease until after the age of 60. ● Race or ethnicity : Whites develop the disease most often, although it can occur in any race or ethnicity. The risk is even higher if someone is of Ashkenazi Jewish descent. ● Family history/gemetocs : Risk increases if a parent, sibling, or child has the disease. Complications. Complications that may occur with ulcerative colitis. These in- clude the following (Mayo Clinic, 2021d): ● Hemorrhage. ● Perforated colon. ● Severe dehydration. ● Osteoporosis. ● Skin, joint, and eye inflammation. ● An increase in the risk for colon cancer. ● Toxic megacolon. ● Increased risk of blood clots. Assessment and diagnosis In order to diagnose ulcerative colitis, a complete history and physical is per-
Early in the course of the disease, the mucous membrane is erythematous and finely granular. There is a loss of normal vascular pattern often accompanied by scattered hemorrhagic areas. Severe dis- ease is characterized by large mucosal ulcers with copious purulent exudate. Fis- tulas and abscesses do not occur (Merck Manual, 2020c). A summary of the disease progression is as follows (Rebar et al., 2019): ● The disease typically originates in the rectum. It may progress to involve the entire colon. ● The colon’s mucosa develops diffuse ulceration with hemorrhage, congestion, edema, and exudative inflammation. ● Large mucosal ulcers form and drain purulent pus and become necrotic. ● Sloughing of the mucosa occurs, leading to bloody, mucous-filled stools. Progression of the disease may cause intestinal obstruction, dehydration, and significant fluid and electrolyte imbalanc - es. Malabsorption is common and anemia may develop because of blood loss in the stools (Rebar et al., 2019). Ulcerative colitis is often classified ac - cording to its location. Types of ulcerative colitis include the following (Mayo Clinic, 2021d): ● Ulcerative proctitis: Inflammation is confined to the area that is closest to the anus. Rectal bleeding may be the only sign of the disease. ● Proctosigmoiditis : Inflammation involves the rectum and sigmoid colon. Bloody diarrhea, abdominal cramps and pain, and constipation are signs and symptoms of proctosigmoiditis.
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