ASKEP COLITIS

COLON
Gambaran kolitis
 COLITIS ULSERATIF
• Kolitis ulseratif adalah suatu penyakit
inflamasi usus yang menyebabkan peradangan
berkelanjutan dan ulkus (luka terbuka) di
lapisan terdalam dari usus besar (kolon) dan
rektum. Ulkus berdarah, memproduksi nanah
dan lendir, dan peradangan menyebabkan
usus untuk sering mengosongkan,
menyebabkan diare.
Beda penyakit crohn’s dan colitis
 Etiologi
Infeksi bakteri:
• Campylobacter,
• Shigella,
• E. Coli,
• Yersinia, and
• Salmonella.
• Infeksi terjadi karena mengkonsumsi makanan
yang terkontaminasi
 Gejala
• nyeri perut, dan diare berdarah. Gejala-gejala
dapat berkisar dari ringan sampai parah, yang
mungkin muncul sangat tiba-tiba atau secara
bertahap. Gejala lain meliputi : diare
berkepanjangan, perdarahan rektum, feses
seperti darah, penurunan beratbadan,
anemia, demam dan dehidrasi.
 Tes diagnostik
• pemeriksaan darah, tinja; kolonoskopi dan
sigmoidoskopi digunakan untuk mengambil
gambar dari usus besar dan rektum.
• Colitis ini dimulai di rektum dan kolon
sigmoid dan secara bertahap menyebar
sampai usus besar. Proses inflamasi
melibatkan mukosa dan submukosa usus
besar.Secara bertahap, beberapa ulserasi dan
abses terbentuk di daerah radang. Akibat
penyakit berlangsung, mukosa usus menjadi
edema dan menebal dengan pembentukan
jaringan parut, yang menghasilkan
kemampuan perubahan menyerap usus besar.
• Obat obat yang biasa digunakan pada
kolitis meliputi ; aminosalisilat (Sulfasalazine)–
obat anti inflamasi; kortikosteroid (seperti
budesonide, prednisone, and prednisolone) –
obat ini mengurangi keradangan akut, anti diare
(diphenoxylate, loperamide, or psyllium) dan
anti sedatif digunakan untuk mengurangi
peristaltik, mengistirahatkan usus yang
terinflamasi.
• Cairan oral, diet rendah serat, tinggi kalori dan
protein dan terapi suplemen vitamin dan
pengganti besi diberikan untuk memenuhi
kebutuhan nutrisi. Pada kasus kolitis disertai
perdarahan masif, sakit berat, ruptur kolon
atau resiko kanker, dilakukan pengangkatan
kolon atau rektum (kolektomi).
 Pengkajian
• Riwayat keperawatan perlu dikaji antara lain
karakteristik nyeri, adanya diare atau
dorongan buang air besar, mengejan saat
defekasi (tenesmus), mual, muntah,
penurunan berat badan serta riwayat keluarga
tentang penyakit radang usus.
• Diare berhubungan dengan proses keradangan
usus
• Perubahan nutrisi : kurang dari kebutuhan tubuh
berhubungan dengan anoreksia, diare dan
penurunan absorpsi usus halus.
• Defisit volume cairan dan elektrolit berhubungan
dengan anoreksia dan diare
• Nyeri abdomen berhubungan dengan
berhubungan dengan inflamasi usus dan
peningkatan peristaltik.
• . Diarrhea
• Nursing Diagnosis
• Diarrhea
• May be related to
• Inflammation, irritation, or malabsorption of the bowel
• Presence of toxins
• Segmental narrowing of the lumen
• Possibly evidenced by
• Increased bowel sounds/peristalsis
• Hyperactive bowel sounds
• Frequent, and often severe, watery stools (acute phase)
• Changes in stool color
• Abdominal pain; urgency (sudden painful need to defecate), cramping
• Desired Outcomes
• Report reduction in frequency of stools, return to more normal stool consistency.
• Identify/avoid contributing factors.
• Ascertain onset and pattern of diarrhea
• Observe and record stool frequency,
characteristics, amount, and precipitating
factors.
• Observe for presence of associated factors,
such as fever, chills, abdominal pain,cramping,
bloody stools, emotional upset, physical
exertion and so forth.
• Promote bedrest, provide bedside commode.
• Identify and restrict foods and fluids that
precipitate diarrhea (vegetables and fruits,
whole-grain cereals, condiments, carbonated
drinks, milk products).
• Restart oral fluid intake gradually. Offer clear
liquids hourly; avoid cold fluids.
• Observe for fever, tachycardia, lethargy,
leukocytosis, decreased serum protein,
anxiety, and prostration.
• isk for Deficient Fluid Volume
• Nursing Diagnosis
• Risk for Deficient Fluid Volume
• Risk factors may include
• Excessive losses through normal routes (severe frequent diarrhea,
vomiting)
• Hypermetabolic state (inflammation, fever)
• Restricted intake (nausea/anorexia)
• Hemoconcentration; altered serum sodium
• Desired Outcomes
• Maintain adequate fluid volume as evidenced by moist mucous
membranes, good skin turgor, and capillary refill; stable vital signs;
balanced I&O with urine of normal concentration/amount.
• Demonstrate behaviors to monitor and correct deficit, as indicated, when
condition is chronic.
• Imbalanced Nutrition: Less Than Body Requirements
• Nursing Diagnosis
• Nutrition: imbalanced, less than body requirements
• May be related to
• Altered absorption of nutrients
• Hypermetabolic state
• Medically restricted intake; fear that eating may cause diarrhea
• Possibly evidenced by
• Weight loss; decreased subcutaneous fat/muscle mass; poor muscle tone
• Hyperactive bowel sounds; steatorrhea
• Pale conjunctiva and mucous membranes
• Aversion to eating
• Desired Outcomes
• Demonstrate stable weight or progressive gain toward goal with normalization of
laboratory values and absence of signs of malnutrition.
• Nursing Interventions
• Weigh daily.
• Encourage bedrest and limited activity during
acute phase of illness.
• Recommend rest before meals.
• Provide oral hygiene.
• Serve foods in well-ventilated, pleasant
surroundings, with unhurried atmosphere,
congenial company.
• Avoid or limit foods that might cause or
exacerbate abdominal cramping, flatulence
(milk products, foods high in fiber or fat,
alcohol, caffeinated beverages, chocolate,
peppermint, tomatoes, orange juice).
• Promote patient participation in dietary
planning as possible.
• Encourage patient to verbalize feelings
concerning resumption of diet.
• Resume or advance diet as indicated (clear
liquids progressing to bland, low residue; then
high-protein, high-calorie, caffeine-free,
nonspicy, and low-fiber as indicated).
• There are many factors that alter nutrient intake in the
patient with colitis . Nutrition abnormalities may be a
result of malabsorption, decreased food intake, and
intestinal losses. These deficiencies will differ
depending on the location of disease activity and
specific nutrient absorption found at these sites.
Maintaining fluid balance and promoting optimal
nutritional status are priority goals. Oral fluids and a
low-residue, high-protein, high-calorie diet with
supplemental vitamin therapy and iron replacements
are indicated to meet nutritional needs, reduce
inflammation, and control pain and diarrhea.
Helping patients cope
• Coping with chronic illness may be difficult for
your patient. Emotional stress increases
peristalsis, causing abdominal pain and
discomfort to increase. It's important for your
patient to participate in activities that reduce
stress, depression, and anxiety. A reduction in
stress also helps to normalize bowel function.
Encourage your patient to engage in regular
exercise to tolerance, such as walking, riding a
bicycle, yoga, or going to the gym.
Nutritional strategies to prevent or reduce symptoms
• Avoid foods that produce GI discomfort.
• Avoid trigger foods, including high-fiber foods (nuts;
raw, leafy vegetables; whole-grain cereals), high-fat
foods (greasy, fried foods), caffeine, alcohol, spicy
foods, and milk products.
• Ensure adequate intake of fluids, carbohydrates,
protein, fats, fruits, and vegetables.
• Drink 8 to 10 glasses of water daily to prevent
dehydration. If fluid intake doesn't keep up with
diarrhea, kidney function may be affected.
• Avoid carbonated beverages because they can cause gas.
• Eat small meals. Patients who eat 5 to 6 small meals each
day have less GI pain and discomfort than those who eat 2
to 3 large meals.
• Bread and rice are good sources of carbohydrate. Meats,
fish, eggs, and poultry are good sources of protein. Make
sure vegetables are included in the nutrition plan and that
they're steamed, stewed, or baked. Healthy sources of fat
include olive and canola oil.
• Contact the healthcare provider if eating 5 to 6 small meals
a day is causing an increase in symptoms.
 Tugas…
• Baca askep sesuai diagnosa di atas…