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6-mercaptopurine

decrease steroid requirements

Other Drugs: Balsalazide (Colazal), infliximab (Remicade), cyclosporine (Neoral, Sandimmune). Antidiarrheal agents to alleviate symptoms of abdominal cramping and diarrhea in patients with mild symptoms or postresection diarrhea. Metronidazole (Flagyl) is effective in colon disease; it treats infections with fistulae and perianal skin breakdown and is beneficial in patients who have not responded to other agents. Some patients suffering with severe abdominal pain may require narcotic analgesics such as meperidine (Demerol). Also, patients who develop deficiencies because of problems of malabsorption may require vitamin B12 injections monthly or iron replacement therapy. Other nutritional supplements include calcium, magnesium, folate, and other micronutrients.

914 Urinary Tract Infection

Independent

Promote patient physical and emotional comfort. Encourage the patient to assume the position of comfort. Instruct in distraction techniques as needed. Promote mental comfort by encouraging the patient to share thoughts and feelings and provide supportive, empathetic care. Discuss measures to decrease life stressors. Teach the patient about the disease process and the typical treatment regimen. Areas to include in the teaching plan include the signs of disease complications, the importance of rest and stress reduction, and any dietary adjustments.

If the patient requires surgery, several nursing interventions are important in the preopera-tive phase. First, conduct preoperative teaching sessions on deep-breathing techniques and leg exercises. Also, discuss the operative procedure and the typical postoperative course. When appropriate, discuss with the patient information on stoma placement and stoma care. After surgery, ensure a healthy respiratory status for the patient by encouraging the patient to cough and deep-breathe every 1 to 2 hours. Manage patient pain and discomfort with prescribed analgesics and proper positioning techniques. Monitor for adequate wound healing by checking the color and approximation of the wound and noting any wound drainage or odor. Note the stoma size and color during every shift and immediately report any duskiness noted at the stoma site. Note the condition of the skin around the stoma; protect the skin with appropriate barrier products because ileostomy drainage is extremely caustic to skin tissues. Finally, encourage the patient's participation in ostomy care. Assess whether a community resource person from the United Ostomy Association is needed to offer the patient additional support.

• Evidence of stability of vital signs, hydration status, bowel sounds, and electrolytes

• Response to medications, tolerance of foods, and ability to eat and select a well-balanced diet

• Location, intensity, frequency of pain, and factors that relieve pain

• Number of diarrheal episodes and stool characteristics

• Description of discharge and follow-up instructions given to the patient

• Presence of complications: Hemorrhage, bowel strictures, bowel perforation, infection

• Patient participation in care of stoma and periostomal skin

The patient must understand all prescribed medications, including actions, side effects, dosages, and routes. Emphasize ways to prevent future episodes of inflammation (rest, relaxation, stress reduction, well-balanced diet). Review the symptoms of inflammation. Teach the patient to seek medical attention if such symptoms occur. Be certain the patient understands symptoms of complications, such as hemorrhage, bowel strictures and perforation, and infection. The patient must know to seek medical attention if these complications should occur. Ensure that the patient understands the importance of close follow-up because of the high incidence of colon and rectal cancer in patients with ulcerative colitis.

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