CONCEPT OF THEORY AND CONCEPT

OF NURSING CARE “KOLITIS”

COMPILED BY:
1. ANISA CAHAYA WARDANI (P071204230030)
2. MELANIE (P07120423068)
3. M. GIBRAN ADAM (P07120423071)
4. PUTRI SHAFINA AZIZA RUSTAM (P07120423031)

MINISTRY OF HEALTH OF THE REPUBLIC OF INDONESIA

POLTEKKES MINISTRY OF HEALTH, MATARAM
NURSING DEPARTMENT
BACHELOR OF APPLIED NURSING STUDY PROGRAM
MATARAM
2024
 FOREWORD
Praise be to God Almighty for giving the author the opportunity to
complete this paper. It is by His grace and guidance that the author can
complete the paper on time.
This paper is compiled to fulfill the lecturer's assignment in the
undergraduate study of applied nursing, medical surgery course at
Poltekkes Kemenkes Mataram. In addition, the author also hopes that this
paper can add insight to the readers. The author would like to express his
deepest gratitude to Dewi Punramawati, S. Kep.Ns. M.Kep.
This assignment that has been given can increase knowledge and
insight related to the field that the author is engaged in. The author also
thanks all parties who have helped the process of compiling this paper. The
author realizes that this paper is still far from perfect.
Therefore, the author will accept constructive criticism and
suggestions for the perfection of this paper.
 TABLE OF CONTENTS

FOREWORD
LIST OF CONTENTS
CHAPTER I INTRODUCTION
A. Background
B. Formulation of the problem
C. Objective
CHAPTER II LITERATURE REVIEW
A. Understanding
B. Etiology
C. Classification
D. Pathophysiology
E. Pathway
F. Clinical manifestations
G. Supporting investigation
H. Diagnostic examination
I. Complications
CHAPTER III CLOSING
A. Conclusion
B. Suggestion
 CHAPTER
INTRODUCTION
A. Background
Colitis comes from the words colon (large intestine) and itis (inflammation).
Ulcerative colitis is a non-specific inflammatory disease of the colon that
generally lasts a long time with alternating periods of remission and exacerbation.
Abdominal pain, diarrhea and rectal bleeding are important signs and symptoms.
The frequency of the disease is highest between the ages of 20-40 years, and
attacks both sexes equally. The incidence of ulcerative colitis is about 1 per
10,000 white adults per year.
The main function of the colon is to store food waste that must be excreted,
absorption of water, electrolytes and bile acids. Absorption of water and
electrolytes is mainly done in the right colon, namely in the coecum and
ascending colon, and a small part is distributed to other colons. Likewise, several
types of drugs given per rectum can be absorbed, generally in the form of
suppositories. A normal colon for 24 hours can absorb 2.5 liters of water, 403
mEq Na and 462 mEq Cl. Conversely, the colon secretes 45 mEq K and 259 mEq
bicarbonate.
Acute colonic inflammation can be caused by a number of infectious agents,
including viruses, bacteria, or parasites. Clinical manifestations of this infection
include fever, lower abdominal cramps, and diarrhea that may be bloody. In
severe cases, blood may be grossly present in the stool, and the clinical and
sigmoidoscopy picture may resemble acute ulcerative colitis. Acute inflammatory
cells are present in Shigella or Salmonella infections, acute amoebic colitis, or
idiopathic ulcerative colitis; they are absent in viral gastroenteritis or diarrhea
caused by enterotoxins.
B. Formulation of the problem
The formulation of the problem in this paper is about nursing care for
clients with colitis.

C. Objective
The purpose of this paper is to find out about nursing care for clients
with colitis.
 CHAPTER II
LITERATURE REVIEW
A. Understanding
Ulcerative colitis is a chronic condition of unknown cause that usually begins
in the rectum and distal colon and may spread upward to involve the sigmoid and
descending colon or the entire colon. It is usually relapsing (acute exacerbations
with prolonged remissions), but some individuals (30%-40%) have persistent
symptoms (Doenges, 471, 2000).
Colitis can be caused by various factors, including acute or chronic infections
by viruses, bacteria, and amoeba, including food poisoning. Colitis can also be
caused by impaired blood flow to the colon area known as ischemic colitis. The
presence of autoimmune diseases can cause colitis, namely ulcerative colitis and
Cohrn's disease. Lymphocytic colitis and collagenous colitis are caused by several
layers of the colon wall covered by lymphocyte and collagen cells. In addition,
colitis can be caused by chemicals due to radiation with barium enema which
damages the mucosal layer of the colon, known as chemical colitis
Risk factors that influence the occurrence of colitis, based on theory, have not
been divided into four factors, namely: biological factors, environmental factors,
health service factors, and behavioral factors.
a. Biological Factors: Gender: Women are at greater risk than men Age : 15-25
years, and over 50 years. Genetic/familial: Family history of colitis
b. Environmental Factors: Environment with poor sanitation and hygiene. Poor
nutrition.
c. Behavioral Factors: Overweight (obesity). Smoking. Stress/emotions.
Excessive use of laxatives. The habit of eating high-fiber foods, high sugar,
alcohol, caffeine, nuts, popcorn, spicy foods. Lack of awareness to seek
treatment. Early . Delay in seeking treatment. Not doing routine health checks.
d. Health Service Factors: Lack of knowledge of health workers. Lack of
adequate facilities and infrastructure. Delays in diagnosis and therapy. Errors
in diagnosis and therapy. Absence of adequate programs in the early screening
process for diseases.
B. Etiology
Colitis can spread to the back causing proctitis. There are several causes of
colitis, including:
a. Infection: Trichuris vulpis, Ancylostoma sp. Entamoeba histolytica,
Balantidium coli, Giardia spp. Trichomonas spp. Salmonella spp.
Clostridium spp. Campylobacter spp. Yersinia enterolitica, Escherichia
coli, Prototheca, Histoplasma capsulatum, and Phycomycosis
b. Familial/genetic factors
The disease is more common in whites than in blacks and Chinese, and its
incidence is increased (3 to 6-fold) in Jews compared to non-Jews. This
suggests that there is a genetic predisposition to the development of the
disease.
1) Foreign body trauma, abrasive materials.
2) Protein allergy from feed or it could also be bacterial protein.
3) Rectocolonic polyps
4) Ileocolon intussusception
5) Lymphoplasmacytic, coshinophilic, granulopmatous, histiocytic
inflammation
6) Neoplasia: Lymphosarcoma, Adenocarcinoma
7) Irritable Bowel Syndrome

C. Classification
Based on the cause it can be classified as follows:
1. Infectious colitis, for example shigellosis, tuberculous colitis, amebic
colitis, pseudomembranous colitis, colitis due to viruses/bacteria/parasites.
2. Non-infectious colitis, for example ulcerative colitis, Crohn's disease,
radiation colitis, ischemic colitis, microscopic colitis, non-specific colitis
(simple colitis).

D. Pathophysiology
An attack can be sudden and severe, causing severe diarrhea, high
fever, abdominal pain and peritonitis (inflammation of the lining of the
abdomen). During an attack, the person may appear very ill. More often, the
attack begins gradually, with the person having an intense urge to have a
bowel movement, mild cramping in the lower abdomen and bloody, mucousy
stools.
If the disease is confined to the rectum and sigmoid colon, the stool
may be normal or hard and dry. But during or between bowel movements,
mucus containing many red and white blood cells comes out of the rectum.
Common symptoms include fever, which may be mild or absent. If the disease
spreads to the large intestine, the stool is softer and the sufferer has 10-20
bowel movements a day.
Sufferers often experience severe abdominal cramps, spasms in the
rectum that are painful , accompanied by a very strong urge to defecate. At
night, these symptoms do not subside. The stool appears runny and contains
pus, blood and mucus. The most common finding is stool that is almost
entirely filled with blood and pus.
Patients may have fever, decreased appetite and weight loss.
Ulcerative colitis is a recurrent ulcerative and inflammatory disease of the
mucosal lining of the colon and rectum. This disease generally affects
Caucasians, including those of Jewish descent. The peak incidence is at the
age of 30-50 years. Ulcerative colitis is a serious disease, accompanied by
systemic complications and high mortality rates. Finally, 10%-15% of patients
develop colon carcinoma.
Ulcerative colitis affects the superficial mucosa of the colon and is
characterized by multiple ulcerations, diffuse inflammation, and desquamation
or sloughing of the colonic epithelium. Bleeding occurs as a result of the
ulcerations. Lesions progress one after another, one lesion following another.
The disease process begins in the rectum and may eventually involve the
entire colon. Eventually the bowel becomes narrow, shortened, and thickened
due to muscular hypertrophy and fat deposits.
E. Pathway
F. Clinical Manifestations
Most symptoms of Ulcerative Colitis initially consist of more frequent
bowel movements. The most common symptoms of ulcerative colitis are
abdominal pain and bloody diarrhea. Patients may also experience: 1. Anemia
3. Fatigue/ Exhaustion
4. Weight loss
5. Loss of appetite
6. Loss of body fluids and nutrients
 7. Skin and eye lesions
8. Joint pain
9. Growth failure (especially in children)
10. Defecate several times a day (10-20 times a day)
11. There is blood and pus in the feces.
12. Rectal (anal) bleeding.
13. Uncomfortable feeling in the stomach.
14. Suddenly my stomach felt upset.
15. Stomach cramps.
16. Pain in the joints.
17. The pain disappears in the rectum
18. Anorexia
19. Hypocalcemia

G. Supporting investigation
1. Radiological Image
1) Plain abdominal radiograph
2) Barium enema
3) Ultrasonography (USG)
4) CT scan and MRI
2. Endoscopic Examination

H. Diagnostic Examination
1. Stool sample (examination used in early diagnosis and during the course
of the disease): contains mainly mucosa, blood, pus and intestinal
organisms especially Entomoeba histolytica.
2. Protosigmoi doscopy: shows ulcers, edema, hyperemia, and inflammation
(due to secondary mucosal and submucosal infection). Areas of decreased
function and bleeding due to necrosis and ulcers occur in 35% of this
section.
3. Cytology and rectal biopsy differentiate between patients with infection
and carcinoma. Neoplastic changes can be detected, as well as the
character of the inflammatory infiltrate called a subcutaneous abscess.
4. Bartholomew's enema, may be performed after visualization examination
has been performed, although it is rarely performed during the acute,
relapsing stage, as it may create exsorption conditions.
5. Colonoscopy: identifies adhesions, changes in the lumen of the wall,
shows intestinal obstruction.
 6. Serum iron levels: low due to blood loss. Prothrombin time: prolonged in
severe cases due to disturbances of factors VII and X caused by vitamin K
deficiency.
7. ESR: increased due to severity of disease Thrombosis: can occur due to
inflammatory disease processes.
8. Electrolytes: decreased potassium and magnesium are common in severe
disease.

I. Complications
1. Bleeding, a complication that often causes iron deficiency anemia. In 10%
of patients, the first attack is often severe, with severe bleeding,
perforation or spread of infection.
2. Toxic Colitis, damage occurs throughout the thickness of the intestinal
wall. This damage causes ileus, where the movement of the intestinal wall
stops, so that the contents of the intestine are not pushed into the channel.
The stomach appears bloated. The colon loses its muscle tension and
eventually becomes dilated.
3. Colon Cancer (Cancer of the Large Intestine). The risk of colon cancer is
increased in people who have had long-standing and severe ulcerative
colitis.
4. Local or systemic in nature
5. Rectal abscess fistulas and fissures
6. Toxic dilation or megacolon
7. Intestinal perforation
8. Colon carcinoma
 CHAPTER III
NURSING CARE FOR PATIENTS WITH COLITIS

A. ASSESSMENT/DATA COLLECTION
1. Biographical Data: Name, age, gender, address, occupation
2. Client Assessment Basic Data
1) Activity/rest
Symptom:
a. Weakness, fatigue, malaise, tiredness
b. Insomnia, not sleeping properly due to diarrhea
c. Feeling restless and anxious
d. Restrictions on work activities related to the effects of the disease process.
2) Circulation
Sign:
a. Crospons tachycardia to fever, dehydration, inflammatory processes, and
pain
b. Redness of the akimonsis area (vitamin K deficiency)
c. TD: hypotension, including postural
d. Skin/macosal membranes, poor turgor, dry, cracked tongue
(dehydration/malnutrition)

3) Ego integrity
Symptom:
a. Anxiety, fear, emotion, upset, for example feelings of
helplessness/hopelessness
b. Acute/chronic stress factors, for example relationships with family/work,
expensive treatment
c. Cultural factors increase prevalence in the Jewish population
Sign:
Rejection, narrowing of attention, depression

4) Elimination
Symptom:
a. The texture of the stool varies from soft to rocky or watery.
b. Episodes of bloody diarrhea are unpredictable, occur frequently and are
uncontrollable (as many as 20-30 bowel movements/day).
 c. Feeling of urgency/cramps (temosmus), bloody/pus/mucous defecation
with or without hard stool.
d. Rectal bleeding
e. History of kidney stones (dehydration)
Sign:
a. Decreased bowel sounds, absent peristolic sounds or visible peristolic
sounds
b. Hermosoid, anal fissure (25%), perianal fissure
c. Oliguria

5) Food/fluid
Symptom:
a. Anorexia, nausea/vomiting
b. Weight loss
c. Intolerant to diet/sensitive to e.g. fresh fruit/vegetables
d. Dairy products or fatty foods
Sign:
a. Subcutaneous fat/muscle mass reduction
b. Weak muscle tone and poor skin turgor
c. Pale mucous membranes, sores, inflammation of the oral cavity

6) Hygiene
Sign:
a. Inability to maintain self-care
b. Stomatitis indicates a vitamin deficiency
c. Body odor

7) Paincomfort
Symptom:
a. Tenderness in the left lower quadrant (may be relieved by defecation)
b. Migratory tenderness, tenderness (arthritis)
Sign:
a. Eye pain, photophobia (iritis)
b. Abdominal tenderness/distension

8) Security
Symptom:
a. History of lupus erythoma tous, hemolytic anemia, vasculitis ..
 b. Arthritis (worsening symptoms with exacerbation of bowel disease)
c. Temperature increase 39.6-40 °C (acute exacerbation)
d. Allergy to food/dairy products (releases histamine into the intestines and
has an inflammatory effect)
Sign:
a. Skin lesions may be present e.g.: erytoma nodusum (raised), pain,
redness and swelling of the hands, face, ploodeima gangrionosa
(purulent pressure lesions/blisters with purplish borders)
b. Ankylosing spondylitis
c. Uveitis, conjunctivitis/iritis

9) Sexuality
Symptoms: decreased frequency/hydration of sexual activity

10) Social interaction

Symptom:
a. Relationship issues/relationship roles with conditions
b. Inability to be active in social
B. Nursing diagnosis
1. Pain bd intestinal irritation, dure, abdominal cramps, surgical response
2. Risk of body fluid imbalance due to loss of body fluids from vomiting
3. Current high risk of nutritional imbalance less than body requirements due to
inadequate food intake

D. Nursing interventions and planning

1. Pain related to intestinal irritation, diarrhea, abdominal cramps, constipation,
surgical response.
Goal: within 3x24 hours after surgery, pain is reduced or adapted.
Evacuation criteria:
a. Subjectively, the pain is reduced or adapted.
b. Pain scale 0-1 (0-4)
c. TTV within normal limits, patient's face relaxed

intervention rational
Explain and assist patients with Approaches using relaxation and other
nonpharmacological and noninvasive nonpharmacological approaches have
pain relief measures. shown effectiveness in reducing pain.
 The PQRST approach can
Perform nursing pain management, comprehensively explore the patient's
including: pain condition.
Assess pain with the PQRST approach Q: The cause of pain can be due to
diarrhea, abdominal cramps, and
constipation or tissue damage.
postoperative .
Q: The quality of pain is dull, cramping,
and stabbing.
R: Pain area in the lower left abdomen
S: The patient experienced a pain scale
of 3 (0-4).
Q: The pain increases when you can't
have a bowel movement.

Give nasal oxygen if the pain scale is ≥3 Oxygen administration is carried out to
(0-4). meet oxygen needs when patients
experience post-operative pain which
can disrupt hemodynamic conditions.

Rest the patient when pain occurs. Get Rest is needed to reduce intestinal
the patient used to defecating in bed. peristalsis. Physiological rest and
defecating in bed will reduce the oxygen
requirement needed to meet basal
metabolic needs in activities and reduce
post-pain fatigue.

Set the physiological position Semi-Fowler positioning can help relax

the abdominal muscles post-surgery,
thereby reducing pain stimuli from post-
surgery wounds.

Providing a vasodilatory response This

Apply a warm compress to the compress is only performed on patients
abdomen. without surgery.

Increase oxygen intake which will

reduce secondary pain from spinal
Teach deep breathing relaxation ischemia.
techniques when pain occurs.
Distraction can reduce internal stimuli.
Teach distraction techniques during pain Touch management during pain in the
form of psychological support touch can
help reduce pain.
Perform touch management
The knowledge that this will help
reduce pain and can help develop
patient compliance with the treatment
Increase knowledge about: causes of plan.
pain and relating how long pain will therapeutic .
last.
Analgesics are given to help inhibit pain
stimuli to the pain perception center in
the cerebral cortex so that pain can be
Collaboration with the medical team for reduced.
administering: Analgesics via
intravenous route Decreased diarrhea response can reduce
pain stimulus,

Antidiarrheal.

2. High risk of malnutrition less than body requirements related to inadequate

food intake.
Objective: After 3x24 hours in non-surgical patients and after 7x24 hours
post-surgery, nutritional intake can be optimally implemented.
Evaluation criteria:
a. The patient can demonstrate the correct method of swallowing food.
b. Complaints of nausea and vomiting decreased.
c. Subjectively reported increased appetite.
d. Body weight on the 7th day after surgery increased by 0.5 kg.
No intervention rational
1 Assess and provide nutrition according Nutritional administration in
to individual tolerance level. patients with regional enteritis
varies according to clinical
conditions and individual tolerance
levels.
2 Serve food in an attractive way
Helps stimulate appetite. This can
be given if oral tolerance is not a
 problem for the patient.
Facilitate patient access to a low-fat
3 diet. Diet is given to patients with
symptoms of malabsorption due to
loss of mucosal surface absorption
function, especially fat absorption.
Involvement of the terminal ileum
can result in steatorrhea (defecation
with stool mixed with fat)

Facilitate patients to obtain a diet with Fiber supplements are said to be

4 high fiber content. beneficial for patients with colon
disease due to the fact that fiber is
converted into short-chain fatty
acids, which provide fuel for
healing of the colonic mucosa.

A low-fiber diet is usually indicated

Facilitate patient access to a low-fiber for patients with symptoms of
5 diet for obstructive symptoms obstruction.

Total parenteral nutrition (TPN) is

Facilitation for the provision of total used when inflammatory bowel
6 parenteral nutrition disease symptoms worsen. With
TPN, nurses can keep accurate
records of fluid intake and output,
as well as the patient's weight each
day.

Useful in measuring the

Monitor intake and output, recommend effectiveness of nutritional and
7 periodic weighing (once a week). fluid support.

Do oral care This intervention is to reduce the

risk of oral infection.
8
Collaborate with a nutritionist Nutritionists must be involved in
regarding the type of nutrition the determining the composition and
9 patient will use. type of food to be provided
according to individual needs,
 3. Actual/risk for fluid and electrolyte imbalance related to diarrhea,
gastrointestinal fluid loss, impaired large bowel absorption, loss of
electrolytes from vomiting.
Goal: within 1x24 hours there is no fluid and electrolyte imbalance.
Criteria:
a. The patient did not complain of dizziness, vital signs were within normal
limits, and consciousness was optimal.
b. Moist mucous membranes, normal skin turgor, CRT >3 seconds.
c. Laboratory: Normal electrolyte values, normal blood gas analysis.

intervention rational
Assess for signs of fluid volume deficit: As a basic parameter for providing fluid
dry skin and mucous membranes, therapy interventions or fulfilling
decreased skin turgor, oliguria, fatigue, hydration.
decreased temperature, increased
hematocrit, increased urine specific
gravity, and hypotension.
Fluid fulfillment interventions: Parameters in determining emergency
Identification of causative factors, onset, intervention. The presence of a history
age specifications and history of other of poisoning and the age of the child or
diseases. elderly provide the severity of the
condition of fluid and electrolyte
imbalance.

a. Perform IVFD installation Parameters in determining emergency

intervention. The presence of a history
of poisoning and the age of the child or
elderly provide the severity of the
condition of fluid and electrolyte
imbalance.

b. Accurate documentation of fluid As an important evaluation of hydration

intake and output interventions and to prevent
overhydration.
c. Assist the patient when vomiting.
Aspiration of vomitus can occur
especially in the elderly with altered
 consciousness. The nurse brings the
vomiting site closer and provides light
shoulder massage to help reduce the
pain response from vomiting.
Interventions for decreasing electrolyte
levels:
a. Evaluation of serum electrolyte To detect the presence of hyponatremia
levels and hypokalemia secondary to loss of
electrolytes from plasma.

Clinical changes such as acute decrease

b. Document clinical changes and in urine output need to be reported to
report to medical team the medical team to obtain further
intervention and reduce the risk of
metabolic acidosis.

Elderly individuals can rapidly become

c. Special monitoring of electrolyte dehydrated and suffer from low
imbalance in the elderly. potassium levels (hypokalemia) as a
result of diarrhea. Elderly individuals
taking digitalis should be alert to the
rapid dehydration and hypokalemia that
can occur with diarrhea. They should
also be instructed to recognize the signs
of hypokalemia because low potassium
levels can exacerbate the action of
digitalis, which can lead to digitalis
toxicity.
Collaboration with the pharmacological
therapy medical team.
a. Antimicrobial Antimicrobials are given according to
stool examination so that antimicrobial
administration can be rational and
prevent drug resistance.

b. Antidiarrheal/antimotility This agent is used to reduce the

frequency of diarrhea. One commonly
given drug is Loperamide (Imodium).
 CHAPTER III
CLOSING
A. Conclusion
The large intestine or colon is a hollow muscular tube that extends
from the cecum to the anal canal and is divided into the cecum, colon
(ascending, transverse, descending, and sigmoid), and rectum. The ileocecal
valve controls the entry of chyme into the colon, while the external and
internal sphincter muscles control the exit of feces from the anal canal. The
diameter of the colon is approximately 6.3 cm with a length of approximately
1.5 m.
Ulcerative colitis is a chronic condition of unknown cause that usually
begins in the rectum and distal colon and may spread upward to involve the
sigmoid and descending colon or the entire colon. It is usually relapsing (acute
exacerbations with prolonged remissions), but some individuals (30%-40%)
have persistent symptoms (Doenges, 471, 2000),
An attack can be sudden and severe, causing severe diarrhea, high
fever, abdominal pain and peritonitis (inflammation of the abdominal lining).
During an attack, the person may appear very ill. More often, the attack
begins gradually, with the person having a strong urge to have a bowel
movement, mild cramping in the lower abdomen and bloody, mucousy stools.

B. Suggestion
 In making this paper, the author also realizes that in making the paper
there are still many mistakes, shortcomings and oddities both in writing and in
conceptualizing the material. For that, the author really hopes for constructive
criticism and suggestions so that in the future it will be better and the author
hopes for all readers, especially students, to be further improved in making
future papers .