IRRITABLE BOWEL SYNDROME

DESCRIPTION
Inflammatory bowel disease (IBD) is a term used to describe disorders that involve chronic inflammation of the
digestive tract.
The types of IBD include:
1. Ulcerative colitis
❏ Causes long lasting inflammation and ulceration in the innermost lining of the colon and
rectum
2. Crohn’s disease
❏ Inflammation of the lining of the digestive tract which often spreads deep into affected
tissues

FOCUS ASSESSMENT (SIGNS AND SYMPTOMS)

➢ Diarrhea
➢ Fever
➢ Fatigue
➢ Abdominal pain and cramping
➢ Blood in the stool
➢ Reduced appetite
➢ Weight loss

DIAGNOSTIC AND LABORATORY TEST

➢ Blood tests
❏ Suggested to check for anemia and check for signs of infection from bacteria or viruses
➢ Fecal occult blood test
❏ Tests for hidden blood in the stool
➢ Colonoscopy
❏ Allows the doctor to view the entire colon using a thin, flexible and lighted tube with an attached
camera
➢ Flexible sigmoidoscopy
❏ Performed to examine the rectum, sigmoid and last portion of the colon
➢ Upper endoscopy
❏ Performed to examine the esophagus, stomach and the first part of the small intestine.
➢ CT scan
❏ Looks at the entire bowel as well as at tissues outside the bowel

RISK FACTORS
➢ Age
➢ Ashkenazi jewish descent
➢ Family history
➢ Non Steroidal anti- inflammatory medications
➢ People living in northern climate

PATHOPHYSIOLOGY
NURSING DIAGNOSES BY PRIORITY
1. Diarrhea related to inflammation of the bowel as evidenced by increased bowel sounds, frequent and
watery passage of stool and abdominal pain
2. Deficient fluid volume related to diarrhea and vomiting as evidenced by dry skin turgor, weakness and
decreased output
3. Imbalanced nutrition: less than body requirements related to reduced appetite as evidenced by weight loss,
nausea and vomiting
4. Acute pain related to prolonged diarrhea as evidenced by restlessness, facial grimace and reports of
abdominal pain
5. Anxiety related to threat to health status as evidenced by increased stress and restlessness

NURSING CARE PLAN

Assessment Diagnosis Planning Intervention Rationale Evaluation

Increased bowel Diarrhea related After 6 hours of 1. Ascertain 1. To assess After 6 hours of
sounds to inflammation nursing onset and etiology and nursing
intervention, the pattern of provide intervention, the
 of the bowel as patient will have diarrhea appropriate care patient was able
Frequent and evidenced by reduced to have reduced
watery passage increased bowel frequency of 2. Observe and 2. Helps assess frequency of
stool and normal record stool severity of stool and normal
of stool sounds, frequent
stool frequency, episode stool
and watery consistency characteristics consistency
Abdominal pain passage of stool and amount 3. Rest
and abdominal decreases
pain 3. Promote bed intestinal
rest motility

4. Restrict raw 4. Avoiding

fruits and intestinal
vegetables, irritants
whole grain promotes
cereals and dairy intestinal rest
and workload
5. Restore fluid
intake gradually
5. Gradual
resumption may
prevent
cramping and
recurrent of
diarrhea

Assessment Diagnosis Planning Intervention Rationale Evaluation

Dry skin turgor Deficient fluid After 24 hours 1. Monitor and 1. Decrease in After 24 hours
volume related of nursing document vital circulating of nursing
Diarrhea to diarrhea and interventions, signs especially blood volume interventions,
vomiting as the patient will RR and HR can cause the patient was
Vomiting evidenced by maintain tachycardia and able to maintain
dry skin turgor, normovolemic 2. Assess skin increased RR normovolemic
Tachycardia weakness and as evidenced by turgor and oral as evidenced by
decreased output absence of mucous 2. Signs of urine output
Weakness diarrhea and membranes for dehydration are greater than 30
vomiting, signs of detectable mL per hour,
Decreased normal skin dehydration through the skin normal skin
output turgor and turgor and
normal pulse 3. Assess color 3. Concentrated absence of
rate and amount of urine denotes tachycardia
urine fluid deficit

4. Monitor and 4. Febrile states

document decrease body
temperature fluids by
perspiration and
5. Auscultate increased
heart sounds, respiration
rate and rhythm
5. Cardiac
6. Monitor alterations may
 active fluid loss reflect
from diarrhea hypovolemia

7. Maintain IV 6. Fluid loss

flow rate from diarrhea
causes
8. Provide decreased fluid
measure to volume and can
prevent lead to
excessive fluid dehydration
loss as indicated
7. Parenteral
fluid
replacement is
indicated to
prevent or treat
hypovolemic
complications

8. Fluid losses
from diarrhea
should be
treated with
antidiarrheal
medications;
antipyretics can
decrease fever

Assessment Diagnosis Planning Intervention Rationale Evaluation

Weight loss Imbalanced After 4 hours of 1. Note exact 1. Used as basis After 4 hours of
nutrition: less nursing weight for caloric and nursing
Nausea and than body intervention, the nutrient intervention, the
vomiting caregiver will 2. Take a requirements caregiver was
requirements
verbalize and nutritional able to verbalize
Loss of appetite related to demonstrate history from the 2. Family and demonstrate
reduced appetite selection of family members members will selection of
as evidenced by foods or meals provide more foods or meals
weight loss, that will 3. Note the accurate details that will
nausea and accomplish a patient’s on the patients accomplish a
vomiting termination of perspective and eating habits termination of
weight loss and feelings toward weight loss and
the patient will eating and food 3. Determines the patient was
take adequate the type, amount able to take
amount of 4. Set and habits of adequate amount
calories appropriate eating of calories
short and long
term goals with 4. Concern in
patient and addressing this
family dilemma may be
lost without
5. Consider six realistic short-
small nutrient term goals
 dense meals
instead of three 5. Eating small,
large meals frequent meals
daily lessens nausea
and decreases
6. Offer high the stimulus to
protein vomit
supplements
based on 6. Such
individual needs supplements can
be used to
increase calories
and protein

NURSING MANAGEMENT
➢ Limit dairy products to prevent diarrhea, abdominal pain and gas
➢ Provide low fat foods to prevent diarrhea
➢ Avoid giving raw fruits and vegetables.
➢ Advise the patient to stop eating spicy foods and avoid alcohol and caffeine
➢ Provide frequent small meals
➢ Encourage the patient to increase fluid intake
➢ Encourage the patient to perform mild exercises to reduce stress and normalize bowel movement

MEDICAL/ SURGICAL MANAGEMENT

➢ Anti- inflammatory drugs
❏ First step in treatment which include corticosteroids and aminosalicylates
➢ Immune system suppressors
❏ Suppresses the immune response that releases inflammation- inducing chemicals in the intestinal
lining
➢ Surgery for ulcerative colitis
❏ Includes proctocolectomy which is the removal of the entire colon and rectum of ileal pouch anal
anastomosis where a pouch is constructed from the end of the small intestine and attached directly
to the anus

DRUG ANALYSIS
Drug Indication Action Side effects contraindications Nursing consideration

Hydrochloride Management of Increases excretion Dizziness, Hypersensitivity Monitor blood pressure, intake,
mild to moderate of sodium and weakness, (cross-sensitivity output and daily weight
hypertension. water by inhibiting lethargy, with other thiazides
Treatment of edema sodium anorexia, or sulfonamides Assess feet, legs and sacral area
associated with: reabsorption in the nausea, may exist); Some for edema daily
HF, Renal distal tubule. vomiting, products contain
dysfunction, Promotes excretion hypokalemia tartrazine and Assess patient for anorexia,
Cirrhosis, of chloride, should be avoided nausea, vomiting and muscle
Glucocorticoid potassium, in patients with cramps
therapy, Estrogen hydrogen, known intolerance;
therapy magnesium, Anuria Monitor electrolyte levels
phosphate, calcium
and bicarbonate. Advise patient to use sunscreen
 May produce to prevent photosensitivity
arteriolar dilation reactions

Loperamide Adjunctive therapy Inhibits peristalsis Drowsiness, Hypersensitivity; Assess frequency and
of acute diarrhea. and prolongs transit constipation, Patients in whom consistency of stools and bowel
Chronic diarrhea time by a direct abdominal constipation must sounds prior to and during
associated with effect on nerves in pain and be avoided; therapy
inflammatory the intestinal distention, Abdominal pain of
bowel disease. muscle wall. nausea, unknown cause, Assess fluid and electrolyte
Decreases the Reduces fecal vomiting especially if balance
volume of volume, increases associated with
ileostomy drainage fecal viscosity and fever; Alcohol Assess for signs of dehydration
bulk while intolerance
diminishing loss of Provide oral hygiene
fluid and
electrolytes