A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 pounds since the exacerbation of his ulcerative colitis. The nurse should anticipate that the physician will order which of the following treatment approaches to help the client meet his nutritional needs?
A. Initiate continuous enteral feedings.
B. Encourage a high protein, high-calorie diet.
C. Implement total parenteral nutrition.
D. Provide six small meals a day.
Correct Answer: C. Implement total parenteral nutrition.
Food will be withheld from the client with severe symptoms of ulcerative colitis to rest the bowel. To maintain the client’s nutritional status, the client will be started on TPN. Dietary measures depend on the patient’s condition (if disease is mild, the patient may do well on a low-residue, low-fat diet high in protein and calories with lactose restriction). In moderate disease, elemental enteral products may be given to provide nutrition without overstimulating the bowel. Patient with toxic colitis is NPO and placed on parenteral nutrition.
Option A: Enteral feedings do not allow the bowel to rest. Recommend rest before meals. This quiets peristalsis and increases available energy for eating. Encourage bed rest and limited activity during the acute phase of illness. Decreasing metabolic needs aids in preventing caloric depletion and conserves energy.
Option B: A high-calorie, high-protein diet will worsen the client’s symptoms. 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). Individual tolerance varies, depending on the stage of disease and area of bowel affected.
Option D: Dividing the diet into 6 small meals does not allow the bowel to rest. Keep patient NPO as indicated. Resting the bowel decreases peristalsis and diarrhea, limiting malabsorption and loss of nutrients.
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