253 Nursing Assessment, Management and Treatment of Autoimmune Diseases
formed, family history obtained, symp- toms reviewed, and some diagnostic tests ordered (NIDDK, n.d.). Signs and symptoms Patients are assessed for the following symptoms, which vary depending on the severity of the disease and its location. Signs and symptoms may include the fol- lowing (Mayo Clinic, 2021d): ● Diarrhea, often containing blood or pus. ● Abdominal pain and cramping. ● Rectal pain. ● Rectal bleeding. ● Urgency with defecation. ● Unable to defecate despite urgency feelings. ● Weight loss. ● Malaise. ● Fever. ● In children, failure to grow. Most peopl e with ulcerative colitis have mild to moderate symptoms. Ad- ditionally, the course of the disease may vary from person-to-person, and some patients have long periods of remission (Mayo Clinic, 2021d). Diagnostic tests Stool cultures for enteric pathogens should be done to identify a pathogen- ic cause of the disease. In women who are using oral contraceptives, contra- ception-induced colitis is possible. This type of ulcerative colitis usually resolves spontaneously after hormone therapy is stopped (Merck Manual, 2020c). Additional diagnostic tests include the following (Mayo Clinic, 2021d; Merck Manual, 2020c): ● Flexible sigmoidoscopy : Flexible sigmoidoscopy is used to visually confirm the diagnosis and allows direct sampling of stool or mucous for culture and microscopic evaluation.
If the sigmoid colon is severely inflamed, a flexible sigmoidoscopy may be performed instead of a full colonoscopy. ● Colonoscopy : Colonoscopy allows visualization of the entire colon. Tissue samples are obtained for laboratory analysis, which is necessary to make an accurate diagnosis. ● X-rays : If patients have severe symptoms an X-ray of the abdominal area can help to rule out serious complications, such as a perforated colon. ● CT scan : A CT scan is typically used if complications are suspected. It can also show how much of the colon is inflamed. ● Computerized tomography (CT) enterography and magnetic resonance imagery (MRI) : These non-invasive tests may be performed to exclude inflammation of the small intestine. Treatment Treatment goals are to control inflam - mation, replace lost nutrients and blood, and prevent complications. General sup- portive initiatives include bed rest, IV flu - id replacement, and, if needed, blood transfusions (Rebar et al., 2019). Medications Several classifications of drugs are used in the treatment of ulcerative colitis. Medi - cations prescribed depend on the sever- ity of the disease and need to be indi- vidualized to each patient (Mayo Clinic, 2021d; Rebar et al., 2019). Drugs include the following: ● Corticosteroids : Corticosteroids such as prednisone are used to control inflammation when the patient does not respond to other treatments. They are usually used in patients who have
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