Assessment

HISTORY. A patient with acute ulcerative colitis typically reports numerous episodes of bloody diarrhea. The number of stools may range from 4 to 5 to 10 to 25 per day during severe episodes,

912 Ulcerative Colitis often causing sleepless nights. In addition, the patient may report abdominal pain and cramping that is relieved with defecation. Other symptoms may include fatigue, diminished appetite with weight loss, low-grade fever, and nausea with vomiting.

PHYSICAL EXAMINATION. Because ulcerative colitis is a chronic disease, which may cause periods of anorexia, diarrhea, and intestinal malabsorption, inspect for the signs of malnutrition and dehydration: dry mucous membranes, poor skin turgor, muscle weakness, and lethargy.

Palpate the patient's abdomen for tenderness and pain. Typically, pain is noted in the left lower quadrant of the abdomen. Auscultate the patient's abdomen; bowel sounds are often hyperactive during the inflammatory process.

Assess the patient for infection. During the acute inflammatory process, monitor the patient's vital signs every 4 hours or more frequently if the patient's condition is unstable. Watch for temperature elevations and rapid heart rate, which often indicate an infectious process.

PSYCHOSOCIAL. The effects of chronic illness and debilitating symptoms often result in psychological problems for the patient with this disease. Note the patient's current psychological status because depression is common for those with ulcerative colitis. Because emotional stress increases bowel activity and plays a critical role in the exacerbation of the disease, it is also important to assess the patient's current life stressors. In addition, determine the need for instruction on stress reduction techniques.

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