SCHOOL OF NURSING SCIENCE AND RESEARCH SHARDA UNIVERSITY

Micro teaching
On
colitis
SUBJECT: - NURSING EDUCATION

SUBMITTED TO: SUBMITTED BY:-

POOJA SAHU

POST BASIC BSC NURSING 1ST YR

SNSR, SHARDA UNIVERSITY

SUBMITTED ON:

Topic : Colitis
Subject : Nursing Education
Group of students : GNM students
Duration : 20 min
Venue : GNM Classroom
Time : 3.30-4.00 pm
Date :
Method of teaching : Lecture cum discussion
Teaching learning material : Power points, charts
Name of presenter : Pooja Sahu
Name of the supervisor :
General objectives: - At the end of the lecture the student will acquire knowledge about Colitis.
Specific objective: - At the end of seminar the student will able to:-

 Introduces to topic
 Define colitis.
 Enlists risk factor of Colitis.
 Enlists the causes of colitis.
 Explain pathophysiology of colitis.
 List the symptom of Colitis.
 Discuss the diagnosis of Colitis.
 Explain the management of Colitis.
 List the complication of Colitis.
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2 min. To introduce INTRODUCTION Students listen
the topic. Ulcerative colitis (UC) to the lecture
is an inflammatory and clears
bowel disease. It causes doubts
irritation, inflammation
, and ulcers in the
lining of your large
intestine (also called
your colon).
There’s no cure, and
people usually have
symptoms off and on
for life. But the right
treatments can help you
keep a handle on the
disease

2 min. The students DEFINITION Teacher defines colitis. Students listen Define
will able to to the lecture colitis?
define colitis. Ulcerative colitis is a chronic inflammatory and clears
disease of the colon, The inflammatory doubts
process involves the mucosa and submucosa
of the colon. Gradually, multiple ulcerations
and abscesses form at the inflamed areas. As
the disease progresses, the colon mucosa
becomes edematous and thickened with scar
tissue formation, which results in altered
absorptive capabilities of the colon. The
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severity of the disease ranges from a mild
form that is localized in specific areas of the
bowel to a critical syndrome with life-
threatening complications.

RISK FACTORS
The students
2 min. will able to Ulcerative colitis happens when Teacher enlists the risk Students listen
enlist the risk your immune system makes a mistake. factor of colitis. to the lecture Enlist the
factor of colitis. Normally, it attacks invaders in your body, and clears risk factor
like the common cold. But when you have doubts of colitis?
UC, your immune system thinks food,
good gut bacteria, and the cells that line
your colon are the intruders. White blood
cells that usually protect you attack the
lining of your colon instead. They cause
the inflammation and ulcers.
Things that can affect your risk of getting
ulcerative colitis include:

 Age. It’s most likely if you’re

between 15 and 30 years old or
older than 60.
 Ethnicity.
 Family history. Your risk could be
up to 30% higher if you have a close
relative with the condition.

Food and stress don’t cause it, but they can

trigger a flare of symptoms.
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Teacher list the causes Students listen
The students of colitis to the lecture List the
5 min. will able to list and clears causes of
CAUSES
the causes of doubts colitis?
Research has not established a specific
colitis.
cause for ulcerative colitis. Several
theories are being pursued, including
infectious agents such as a virus or
bacteria, immune factors, environmental
factors such as geographic location, and
genetic factors. Current thinking holds that
psychosomatic factors such as emotional
stress are a result of the chronic and severe
symptoms of ulcerative colitis rather than
a cause, as was once thought. Risk factors
include smoking, consumption of milk
products, psychological stress, and
family history.

The students
will able to PATHO PHYSIOLOGY
explain the The inflammation of ulcerative colitis is
pathopysiology diffuse and involves the mucosa and
of colitis. submucosa

With alternate periods of exacerbations

and remissions the disease is usually
begun in the rectum and sigmoid colon
and spreads up the colon in a continuous
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pattern Teacher explains the Students listen
pathopysiology of to the lecture
colitis. and clears Explain the
doubts pathopysiol
ogy of
colitis?

The mucosa of the colon is hypermic and

endematous in the affected area.Multiple
abscesses develop in the crypts of the
intestinal gland .

As the disease advances the abscesses

break through the crypts into the
submucosa,leaving ulcerations .These
ulcerations also destroy the mucosal
epithelium ,causing bleeding and diarrhea .

Losses of fluid and electrolyte occur

because of the diseased mucosal surface
area of the absorption .Breakdown of cells
results in protein loss through the stools.
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The students Teacher enlists the Students listen
will able to SYMPTOMS symptoms of colitis. to the lecture
enlist the Colitiscauses a wide range of and clears Enlist the
symptoms of uncomfortable symptoms, including: doubts symptoms
colitis. of colitis?
 Anorexia ,nausea and weight loss PPT

 Weakness and Malaise

 Fever and leukocytosis
 Iron Defiency anemia

 vomiting
 Stool containing
blood,mucus,possibly pus
 diarrhea
 severe abdominal cramps
 loss of fluids
,sodium,calcium,potassium and
The students bicarbonate.
Teacher explains the
will able to diagnosis of colitis.
explain the Students listen
5 min. diagnosis of to the lecture Explain the
colitis. and clears diagnosis
doubts of colitis?

DIAGNOSIS
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 Blood tests can show if you

have anemia or inflammation.
 Stool samples can help your doctor
rule out an infection or parasite in
your colon. They can also show if Chart
there’s blood in your stool that you
can’t see.
 Flexible  sigmoidoscopy  lets your
doctor look at the lower part of your
colon. They’ll put a bendable tube
into your lower colon through your
bottom. The tube has a small light
and camera on the end. Your doctor
might also use a small tool to take a
piece of the lining of your lower
colon. This is called a biopsy. A
doctor in a lab will look at the
sample under a microscope.
 Colonoscopy is the same process as
flexible sigmoidoscopy, only your
doctor will look at your whole
colon, not just the lower part.
 X-rays are less common for
diagnosing the disease, but your
5 min. doctor may want you to have one in PPT
special cases.
 Air or barium enema. An air or
barium enema is basically
enhanced imaging of the colon that
may be done for certain suspected
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causes of obstruction. During the
procedure, the doctor will insert air
or liquid barium into the colon
The students through the rectum. For Students listen
will able to intussusception in children, an air to the lecture
explain the or barium enema can actually fix Teacher explains the and clears Explain the
management of the problem most of the time, and management of colitis. doubts managemen
colitis. no further treatment is needed. t of colitis?

MANAGEMENT
General management

ASSESSMENT
5 min.
HISTORY. A patient with acute
ulcerative colitis typically reports rectal
bleeding with numerous episodes of
bloody diarrhea. The number of stools
may range from 4–5 to 10–25 per day
during severe episodes, often causing
sleepless nights. In addition, the patient
maydescribe abdominal pain and cramping
that is relieved with defecation. Ask the
patient about accompanying symptoms
such as fatigue, abdominal distention,
anorexia, nausea, and weight loss. Some
patients will have a history of low-grade
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fevers. Take a medical history to
determine if other inflammatory conditions
exist, such as pleuritis, uveitis
(inflammation of the uvea of the eye),
ankylosing spondylitis (spinal arthritis),
and other join swelling.

PHYSICAL EXAMINATION. The most

Teacher explains the
common symptoms are abdominal pain management of colitis.
and cramping that is relieved with
defecation. Other symptoms may include
fatigue, diminished appetite with weight
loss, low-grade fever, and nausea with
vomiting. Because ulcerative
UlcerativeColitis 1117
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 PPT
the patient’s abdomen for tenderness and
pain. Typically, pain is noted in the left
lower quadrant of the abdomen.
Auscultatethepatient’s abdomen; bowel
sounds are often hyperactive during the
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inflammatory process.
Assessthepatientforinfection.Duringtheacu
teinflammatoryprocess,monitorthepatient’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.

Teacher explains the

medical management
MEDICAL. Drug therapy is the typical of colitis.
5 min. method used to control the inflammatory
process. Mesalazine and budesonide are
the primary drugs used to achieve
remission. After remission
1118 Ulcerative Colitis
is established, dosages are generally
reduced, and patients continue on this
agent for at least 1 year after an acute
attack. To maintain fluid and electrolyte
balance during acute attacks, IV fluids are
generally prescribed, and electrolytes may
be added to the solutions as needed. Blood
transfusions may also be prescribed if the
patient is anemic because of numerous
bloody diarrheal stools. To achieve bowel
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“rest,” the patient is usually given nothing
by mouth. During this time, nutritional
deficits may be managed through the use
of total parenteral nutrition with vitamin
supplements. Helping patients maintain an
adequate nutritional status, fluid balance,
and electrolyte balance is a priority
nursing measure. Record intake and output
accurately every shift. Note the number of
stools and stool characteristics. Gradually,
as the acute attack subsides and
inflammation clears, the patient is placed
on a low-residue, low-fat, high-calorie,
high-protein, and lactose-free diet.

 Diet. Some foods can make your

symptoms worse. You might find
that soft, bland food doesn’t bother
you as much as spicy or high-fiber
dishes. If you can’t digest
the sugar in milk called lactose
(meaning you’re lactose intolerant),
your doctor may tell you to stop
eating dairy products. A balanced
diet with plenty of fiber,
lean protein, fruits, and veggies
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should provide enough vitamins and Students listen

nutrients. to the lecture
 Medicine. Your doctor may and clears
prescribe a few different kinds of doubts
drugs, including:
o Antibiotics. These fight
infections and let your large
intestine heal.
o Aminosalicylates. These
drugs have something called
5-aminosalicylic acid (5-
ASA) that fights
inflammation and helps
control symptoms. You
might get pills to swallow or
an enema or suppository to
put in your bottom.
o Corticosteroids. If
aminosalicylates don’t work
or your symptoms are
severe, your doctor might
give you these anti-
inflammatory drugs for a
short time.
o Immunomodulators. These
help stop your immune
system’s attack on your
colon. They can take a while
to take effect. You might not
notice any changes for up to
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3 months.
o Biologics. These are made
from proteins in living cells
instead of chemicals.
They’re for people with Students listen
severe ulcerative colitis. Teacher explains the to the lecture
o Loperamide. This can slow surgical management and clears
or stop diarrhea. Talk to of colitis. doubts
your doctor before taking it.

SURGICAL. Surgery may be performed

when patients fail to respond to
conservative treatment, if acute episodes are
frequent, or when a complication such as
bleeding or perforation occurs. The standard
surgical procedure, when performed, is a
total proctocolectomy with ileostomy. This
The student procedure is considered a permanent cure
teacher will to for ulcerative colitis. To prepare the patient
list the for surgery, administer bowel preparations
complication of such as laxatives and enemas. Teacher list the Students listen
Colitis. complication of to the lecture
COMPLICATIONS: Colitis. and clears
doubts

Complications of ulcerative colitis can

include:

 Bleeding. This can lead to anemia.

 Osteoporosis. Your bones might
become weak because of your diet
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or if you take a lot of
corticosteroids.
 Dehydration. You might need to
get fluids through a vein List the
(intravenous, or IV) if your large complicatio
intestine can’t absorb enough. n of
 Inflammation. This can affect Colitis?
your joints, skin, or eyes.
 Fulminant colitis. If your UC
attack is severe, your colon might
burst, or infection could spread
through your body. Your intestines
stop moving waste, and your belly
swells.
 Megacolon. Fulminant colitis can
cause your large intestine to swell
or burst. This is a dangerous
complication, and you’ll probably
need surgery.
 Liver disease. Your bile ducts or
liver could become inflamed, or
you could get scar tissue in your
liver.
 Colon cancer. Ulcerative colitis
puts you at higher risk of getting
colon cancer, especially if your
whole large intestine is affected or
if you’ve had UC for a long time.
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NURSING DIAGNOSIS
1. .Diarrhea related to irritated
bowel ,intestinal hyperactivity .
Intervention
 Monitor frequency and character of
stools.
 Maintain food and fluid restriction
to rest bowel.
 Teach patient to avoid caffeine and
food or fluids that irritate the
bowel.
 Rarely administer anti diarrheal
medications as they may
precipitate colonic dilation.

2. Anxiety related possible social

embrassement unfamiliar
environment ,diagnostic test and
treatment..

Interventions:
 Monitor signs of anxiety .
 Encourage open discussion of
feelings about diagnosis.
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 Explain disease
,treatments,diagnostic test and
medications.

PPT
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2 min.
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CONCLUSION
Ulcerative colitis is a chronic inflammatory disease of the colon, and 20% of the cases occur before the individual reaches age 20.
Approximately 1 million people have ulcerative colitis in the United States. Usually, the disease begins in the rectum and sigmoid
colon and gradually spreads up the colon in a continuous distribution pattern. The inflammatory process involves the mucosa and
submucosa of the colon. Gradually, multiple ulcerations and abscesses form at the inflamed areas. As the disease progresses, the colon
mucosa becomes edematous and thickened with scar tissue formation, which results in altered absorptive capabilities of the colon. The
severity of the disease ranges from a mild form that is localized in specific areas of the bowel to a critical syndrome with life-
threatening complications. The most common complications are nutritional deficiencies; other complications include sepsis, fistulae,
abscesses, and hemorrhage. For unknown reasons, patients with ulcerative colitis also have a high risk for arthritis and cancer, but all
those conditions have immune dysregulation in common.

BIBLIOGRAPHY
 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 12th Edition. Philadelphia: Lippincott Williams and
Wilkins. Page no.-508-504
 Lewis text book of medical surgical nursing 7th edition printed in 2009, published by Elsevier page no.-1617- 1620
 Williams. L. S. & Hopper, P. D. (2011). Understanding Medical- Surgical Nursing. 5th Edition. Philadelphia: F. A. Davis
Company3.
 www.medscape.com
 www.emedicinehealth.com
 www.wikipedia.com.