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INFLAMMATORY BOWEL DISEASE: ULCERATIVE COLITIS, REGIONAL ENTERITIS (CROHN’S DISEASE, ILEOCOLITIS) Inflammatory bowel disease (IBD): Researchers believe that IBD may result from a complex interplay between genetic and environmental factors. Similarities involve (1) chronic inflammation of the alimentary tract and (2) periods of remission interspersed with episodes of acute inflammation. Ulcerative colitis (UC): A chronic condition of unknown cause usually starting in the rectum and distal portions of the colon and possibly spreading upward to involve the sigmoid and descending colon or the entire colon. It is usually intermittent (acute exacerbation with long remissions), but some individuals (30%–40%) have continuous symptoms. Cure is effected only by total removal of colon and rectum/rectal mucosa. Regional enteritis (Crohn’s disease, ileocolitis): May be found in portions of the alimentary tract from the mouth to the anus but is most commonly found in the small intestine (terminal ileum). It is a slowly progressive chronic disease of unknown cause with intermittent acute episodes and no known cure. UC and regional enteritis share common symptoms but differ in the segment and layer of intestine involved and the degree of severity and complications. Therefore, separate databases are provided. CARE SETTING Usually handled at the community level; however, severe exacerbations requiring advanced pain control, nutrition, rehydration may necessitate short stay in acute care medical unit. RELATED CONCERNS Fecal diversions: postoperative care of ileostomy and colostomy Fluid and electrolyte imbalances, see Nursing Care Plan CD-ROM Peritonitis Psychosocial aspects of care Total nutritional support: parenteral/enteral feeding Patient Assessment Database—Ulcerative Colitis ACTIVITY/REST May report: Weakness, fatigue, malaise, exhaustion Insomnia, not sleeping through the night because of diarrhea Feeling restless Restriction of activities/work due to effects of disease process CIRCULATION May exhibit: Tachycardia (response to fever, dehydration, inflammatory process, and pain) Bruising, ecchymotic areas (insufficient vitamin K) BP: Hypotension, including postural changes EGO INTEGRITY May report: Anxiety, apprehension, emotional upsets, e.g., feelings of helplessness/hopelessness Acute/chronic stress factors, e.g., family/job-related, expense of treatment Cultural factor—increased prevalence in Jewish population May exhibit: Withdrawal, narrowed focus, depression ELIMINATION May report: Stool texture varying from soft-formed to mush or watery Unpredictable, intermittent, frequent, uncontrollable episodes of bloody diarrhea (as many as 20–30 stools/day); sense of urgency/cramping (tenesmus); passing blood/ pus/mucus with or without passing feces Rectal bleeding History of renal stones (dehydration) May exhibit: Diminished or hyperactive bowel sounds, absence of peristalsis or presence of visible
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peristaltic waves
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