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Abstract
The prevalence of inflammatory conditions that affect the gastrointestinal tract is increasing in
adults and children. A greater number of predispositions to such diseases have been identified
that include specific environmental factors, which have been associated with its development.
This paper explores the pathophysiology of inflammatory bowel diseases including ulcerative
colitis and Crohn’s disease. In addition, this piece will provide helpful information regarding the
various techniques utilized to assess, diagnose, and manage these conditions. In discussing the
above mentioned, the objective of this paper is to provide a helpful guide for the reader to better
understand the various etiologies, complications, and approaches to care for inflammatory bowel
diseases such as ulcerative colitis and Crohn’s disease.
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Pathophysiology
Ulcerative colitis is defined as a condition characterized by the inflammation and
ulceration within the lining of the rectum and gradually up the bowel towards the cecum.
Crohn’s disease is best described as when inflammation and ulceration occurs in the lining of
any area of the GI tract. Causes of these conditions currently are unknown but there are many
risk factors observed in clients with ulcerative colitis to take significant note of. Typical risk
factors include infectious agents, autoimmune reactions, allergies, heredity, and foreign objects
(Linton & Matteson, 2020). Recent research shows that this disease occurs as an intestinal
immune response when there is a predisposed genetic host and specific intraluminal microbiota
or other toxic pathogens present (Hindryckx et al., 2016). Although there is no definitive cause
for the disease, research continues to focus on the genetic markers observed in clients that have
been diagnosed with ulcerative colitis in order to gain better understanding and medical
management.
Assessment
When assessing a patient with ulcerative colitis and Crohn’s disease, it is essential to
identify the symptoms for which the patient decided to seek care for. Cardinal symptoms are pain
and diarrhea. If the condition includes portions of the stomach and the duodenum, symptoms
such as vomiting and epigastric pain are to be expected. If the small intestines are involved in the
given condition, then pain, abdominal tenderness, and cramping are expected findings when
conducting an assessment (Linton & Matteson, 2020). Upon gathering the presenting symptoms,
the nurse should then record the onset, location, severity, and duration of the experienced
symptoms. It is important to inquire with the patient what factors may contribute to their
symptoms as well as what relieves them such as diet, stressors, and other activities. Note any
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occurrence of diarrhea, as well as the presence of blood. Lastly the nurse should assess the vitals,
the perianal area for irritation or ulceration, intake and output records, as well as the number of
stools the patient normally has. In collecting these assessment findings, the nurse can better
direct the approach to care they will implement when treating the patient.
Lab & Diagnostic Test
Common tests typically ordered for Crohn’s and colitis include X-rays, blood tests, CT
scan, stool tests, imaging tests, colonoscopy, ultrasonography, or tissue biopsies. Oftentimes, an
abdominal radiography is done to rule out any obstruction. The patient will swallow a capsule
and this will provide a view of the small intestines. Other lab tests following a radiography are
blood tests and stool tests. A CBC will show any signs of infection or anemia. Liver function
tests will show any liver or bile duct problems. Electrolytes will most likely show low potassium
due to diarrhea from IBD. Vitamin B-12 will also be low due to the small intestine not absorbing
nutrients from having Crohn's Disease. (Crohn's & Colitis Foundation. (n.d.). Retrieved
November 1, 2021).
Further testing will be X-rays of the GI tract. X-rays will show any narrowing of the
intestines or intestinal blockage. CT scans are usually done to find complications from the
disease such as fistulas, intestinal blockages, or abscesses. Additional testing to look further into
the abdomen using a small camera would be an endoscopy. Typical endoscopies that could be
performed are colonoscopies and upper GI endoscopies. This can help determine the severity of
the disease, as well as differentiate between the two diseases or any other types of intestinal
conditions. If the doctor decides to obtain a tissue sample of the colon or an area of the GI tract,
they will perform a biopsy. A patient diagnosed with Crohn's disease or colitis will need to have
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routine blood tests to determine the activity of the disease and to see how well medications are
working for them. (Nagaich, 2019).
Medication & Surgical Management
The first line of treatment for ulcerative colitis and Crohn’s disease involves
pharmacological therapy. Based on the severity of the disease, the health as a whole, as well as
other possibly contributing factors, the doctor will recommend which medication to use (Crohn’s
& Colitis Foundation, 2021). A class of medication used to decrease inflammation in the
gastrointestinal tract are aminosalicylates. They contain 5-aminosalicylic, and work particularly
best in the colon. Some examples of aminosalicylates include sulfasalazine, mesalamine,
olsalazine, and balsalazide. Corticosteroids treat moderate to severe ulcerative colitis and
Crohn’s Disease. They suppress the immune system as a whole instead rather certain parts of it.
Some examples include prednisone, prednisolone, methylprednisolone, and budenoside. Another
class of medication used to treat ulcerative colitis and Crohn’s disease are immunodulators. This
class of medication works to suppress the body’s immune response so that inflammation doesn’t
continue. In addition, immunodulators are used if aminosalicylates and corticosteroids are not
effective. Some examples include azathioprine, 6-mercaptopurine, cyclosporine, and tacrolimus
(Crohn’s & Colitis Foundation, 2021).
In patients where treatment with medication is unsuccessful, surgery may be
recommended. Sudden, severe, ulcerative colitis is the main cause of emergency surgery. A
proctocolectomy removes the colon and the rectum. The most common surgery is called a
proctocolectomy with ill pouch-anal anastomosis (IPAA). This surgical option restores bowel
function and lets stool move and exit through the anus. Laparascopic surgical procedures may
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also be performed in some cases, and are considered to be a more minimally invasive procedure
that oftentimes is the surgery of choice (Crohn’s & Colitis Foundation, 2021).
Nursing Care Plan
Nursing Diagnosis: Fluid volume deficit r/t intestinal inflammation AEB diarrhea
Care Plan Priority #1
Assessment
Expected Outcome
Assess for changes in
LOC, restlessness,
dark urine,
hypotension,
pale/moist/clammy
skin, tachycardia
Patient will maintain
therapeutic fluid volume
and electrolyte levels
AEB stable VS, good
skin turgor, moist mucous
membranes, and adequate
urinary output
Interventions
Rationale
Administer IV
fluids per MD
order
To prevent
further
dehydration
Weigh client
daily and monitor
I&O
To monitor
for any lost or
gained fluid
volume
Provide safety
precautions why
hypotensive (side
rails, bed in low
position)
To prevent
injury
Evaluation
Patient
maintains
functional
fluid volume
and electrolyte
balance
Patient free of
injury
Nursing Diagnosis: Acute pain r/t intestinal inflammation AEB abdominal pain and cramping
Care Plan Priority #2
Assessment
Expected Outcome
Interventions
Rationale
Evaluation
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Assess for s/s of
ulcerative colitis such
as: diarrhea,
abdominal pain,
cramping, rectal
bleeding/pain,
inability to defecate,
weight loss, fatigue,
fever
Patient will verbalize
reduced pain.
Assess for elevated v/s
Assess any guarding
or covering of the
abdomen by patient
Administer
IV/analgesics
fluids as ordered
by the provider
To relieve
pain
Allow bed rest
To promote
healing and
rest
Implement
alternative
therapeutic
measures to
relieve pain
(music, TV,
relaxation)
To distract the
patient from
pain
Patient expresses
relief of pain
AEB VSS and
pain level 3/10
or lower
Nursing Diagnosis: Inadequate nutrition r/t diet AEB poor eating patterns and food choices
Care Plan Priority #3
Assessment
Assess for excessive
weight loss
Assess nutritional
history
Assess blood lab
values (albumin,
magnesium,
potassium, and
sodium)
Assess food choices
and eating patterns
Expected Outcome
Interventions
Rationale
Evaluation
Patient will verbalize an
understanding of how to
manage their condition
as well as what their diet
should be like to avoid
further inflammation to
their intestinal tract
Educate patient
on foods/drinks
to avoid when
on a low fat, low
residue, low
fiber diet (whole
grains, raw
vegetables, fruit
skin, seeds,
carbonated
drinks)
Reduce potential
inflammation of
intestinal tract
Patient will
follow diet
plan and
Maintain
nutritional diet,
small frequent
meals
To maintain
adequate nutrition
Patient will
maintain
adequate
nutrition
Weigh patient
daily
To monitor for
excessive weight
loss
Patient’s
weight will
remain
stable
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References
Crohn's & Colitis Foundation. (n.d.). Retrieved November 1, 2021, from
https://www.crohnscolitisfoundation.org/.
Crohn's & Colitis Foundation. Medication options for ulcerative colitis. (n.d.). Retrieved October
31, 2021, from https://www.crohnscolitisfoundation.org/what-is-ulcerativecolitis/medication.
Crohn's & Colitis Foundation. Surgery for ulcerative colitis. (n.d.). Retrieved October 31, 2021,
from https://www.crohnscolitisfoundation.org/what-is-ulcerative-colitis/surgery.
Hindryckx, P., Jairath, V., & D'haens, G. (2016). Acute severe ulcerative colitis: From
pathophysiology to clinical management. Nature Reviews.Gastroenterology &
Hepatology, 13(11), 654-664.
http://kz21jolix.mp02.y.http.dx.doi.org.proxy.lirn.net/10.1038/ nrgastro.2016.116
Linton, A. D. & Matteson, M. A., (2020). Medical-Surgical Nursing. (7th ed.) Elsevier.
Nagaich, N. (2019). Inflammatory bowel disease, ulcerative colitis, Crohn's Disease or
indeterminate colitis? Diagnostic Challenge. Gastroenterology: Medicine & Research,
2(4). https://doi.org/10.31031/gmr.2019.02.000545
Veauthier, B. & Hornecker, J. (2018). Crohn’s disease: diagnosis and management. American
Family Physician. 98(11), 661-669. https://www.aafp.org/afp/2018/1201/p661.html