Nursing Care Plan (NCP) Inflammatory Bowel Disease (IBS)

Nursing diagnosis: Diarrhea related to Inflammation, irritation, or malabsorption of the bowel, Presence of toxins, Segmental narrowing of the lumen

Possibly evidenced by

Increased bowel sounds, peristalsis

Frequent, and often severe, watery stools (acute phase)

Changes in stool color

Abdominal pain; urgency, cramping

Desired Outcomes/Evaluation Criteria—Client Will

Bowel Elimination

Report reduction in frequency of stools and return to more normal stool consistency.

Identify and avoid contributing factors.

Nursing intervention with rationale:

1. Observe and record stool frequency, characteristics, amount, and precipitating factors.

Rationale: Helps differentiate individual disease and assesses severity of episode.

2. Promote bedrest and provide bedside commode.

Rationale: Rest decreases intestinal motility and reduces the metabolic rate when infection or hemorrhage is a complication. Urge to defecate may occur without warning and be uncontrollable, thus increasing risk of incontinence and falls if facilities are not close at hand.

3. Remove stool promptly. Provide room deodorizers.

Rationale: Reduces noxious odors to avoid undue client embarrassment.

4. Identify foods and fluids that precipitate diarrhea, such as raw vegetables and fruits, whole-grain cereals, condiments, carbonated drinks, and milk products.

Rationale: Avoiding intestinal irritants promotes intestinal rest.

5. Restart oral fluid intake gradually. Offer clear liquids hourly and avoid cold fluids.

Rationale: Provides colon rest by omitting or decreasing the stimulus of foods and fluids. Gradual resumption of liquids may prevent cramping and recurrence of diarrhea; however, cold fluids can increase intestinal motility.

6. Provide opportunity to vent frustrations related to disease process.

Rationale: Presence of disease with unknown cause that is difficult to cure and that may require surgical intervention can lead to stress reactions that may aggravate condition.

7. Observe for fever, tachycardia, lethargy, leukocytosis, decreased serum protein, anxiety, and prostration.

Rationale: May signify that toxic megacolon or perforation and peritonitis are imminent or have occurred, necessitating immediate medical intervention.

8. Administer medications, as indicated: Antidiarrheals, such as diphenoxylate (Lomotil), loperamide (Imodium), and anodyne suppositories

Rationale: Decreases GI motility or propulsion (peristalsis) and diminishes digestive secretions to relieve cramping and diarrhea. Note: Use with caution in UC because they may precipitate

toxic megacolon.

9. Anti-inflammatories, such as mesalamine (Pentasa, Asacol); mesalamine-containing drugs, for example, sulfasalazine (Azulfidine); and aminosalicylates, drugs that contain 5- aminosalicyclic acid (5-ASA), such as olsalazine (Dipentum) and balsalazide (Calazal)

Rationale: Most people with mild or moderate ulcerative colitis are treated first with the group of drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs. Clients who do not benefit from it or who cannot tolerate it may receive 5-ASA agents, which are given orally, through an enema, or in a suppository, depending on the location of the inflammation in the colon. This class of drugs is also used

in cases of relapse.

10. Steroids, such as adrenocorticotropic hormone (ACTH), hydrocortisone (Cortenema, Cortifoam), prednisolone (Delta-Cortef), and prednisone (Deltasone)

Rationale: Decreases acute inflammatory process. Steroid enemas (Cortenema) may be given in mild to moderate disease to aid absorption of the drug—possibly with atropine sulfate or belladonna suppository. Current research suggests an 8-week course of time-release steroids may effect remission in Crohn’s disease; however, steroids are contraindicated if intra-abdominal abscesses are suspected.