Nursing Assessment, Management and Treatment of Autoimmune Diseases
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Surgery If massive dilation of the colon (toxic megacolon) occurs, surgery may be indi- cated. The most common surgical proce- dure is proctocolectomy with colostomy or ileostomy (Rebar et al., 2019). Nursing interventions In addition to facilitating adherence to treatment regimens, nurses need to help patients modify their lifestyles to help re- duce symptoms and increase quality of life. Diet modifications may be of signif - icant help. Keeping a food diary is rec- ommended. Patients should keep track of what they eat and how they feel after eat- ing. By doing this, patients may be able to identify what foods exacerbate their symptoms and learn to avoid them (Mayo Clinic, 2021d). Rather than eating two or three large meals, eating five or six small meals a day may help to reduce symptoms. Pa- tients should also be encouraged to drink plenty of fluids. Water is the beverage of choice. Alcohol and beverages con- taining caffeine stimulate the intestines, which can exacerbate diarrhea. Carbon- ated drinks may cause flatulence and in - crease cramping (Mayo Clinic, 2021d; Re - bar et al., 2019). Stress reduction is important. Stress can worsen symptoms and trigger disease flare-ups. To help control stress patients may find the following interventions help - ful (Mayo Clinic, 2019d): ● Exercise : Exercise can help to reduce stress, relieve depression, and restore some normalcy to bowel functioning. Patients should consult their healthcare providers before beginning exercise programs. ● Biofeedback : Biofeedback helps to reduce muscle tension and reduce heart rate. The goal of biofeedback
moderate to severe ulcerative colitis. Corticosteroids are not given long- term and must be tapered off, not abruptly discontinued. ● Aminosalicylates : These medications (e.g., mesalamine [Asacol]) are taken to reduce inflammation. ● Anti-diarrheal medications : These are prescribed for patients who have frequent, troublesome diarrhea and whose ulcerative colitis is otherwise under control. ● Immune system suppressors : In addition to reducing inflammation, immune system suppressors suppress the immune response that initiates the inflammation process. ● Iron supplements : Iron supplements are given to correct anemia. ● Biologics : Biologics target proteins manufactured by the immune system. These drugs (e.g., infliximab [Remicade]) help to heal the intestinal lining and, hopefully, to induce remission. ● Antispasmodics : Antispasmodics are given to help reduce cramping. ● Pain relievers : For mild pain, acetaminophen (Tylenol) may be taken. However, ibuprofen (e.g., Advil, Motrin) is contraindicated since it can exacerbate symptoms and increase disease severity. Diet Patients may find that limiting or elim - inating dairy products may help to im- prove issues such as diarrhea. Patients affected by severe disease may need to- tal parenteral nutrition (TPN) and to take nothing by mouth. Patients with moder- ate disease may benefit from supplemen - tal drinks. A low-residue diet may be or- dered for patients who have mild disease (Rebar et al., 2019).
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