Irritable Bowel Syndrome IBS

Irritable Bowel Syndrome IBS Nursing Diagnosis Interventions and Care Plans

Irritable Bowel Syndrome IBS NCLEX Review Care Plans

Nursing Study Guide for Irritable Bowel Syndrome

The gastrointestinal tract is comprised of organs responsible for the ingestion and digestion of food and water, absorption of nutrients and elimination of the by-products of these processes.

In irritable bowel syndrome (IBS), the body readily expels consumed food, thereby manifesting diarrhea to patients.

In some cases, an alternation of diarrhea and constipation is experienced by the patient, oftentimes accompanied by mild to severe abdominal pain.

IBS is a functional disorder of the GI system, presenting with abnormal bowel habits and the absence of a specific etiology.

It is chronic, and would usually require long-term pharmacologic intervention, as well as diet and lifestyle modifications.

IBS does not alter the normal gastrointestinal tissue or increase the risk of colorectal cancer.

Signs and Symptoms of IBS

The classic signs and symptoms true to IBS are:

  1. Abdominal pain – the most common site is the lower abdomen, specifically the left lower quadrant; usually diffuse in nature; sometimes relieved by defecation
  2. Changes in bowel habit – presence of either constipation or diarrhea; can be both and alternating
  3. Abdominal distention – feeling bloated and full due to increase in gastric acidity and presence of gas.
  4. Post prandial urgency – Urge to defecate after eating

Other signs and symptoms may include:

  • Dyspepsia, heartburn
  • Nausea and vomiting
  • Sexual dysfunction
  • Non-inflammatory mucorrhea – clear or white mucus
  • Presence of urinary frequency and urgency on some cases
  • Worsening of symptoms during menses
  • Stress-associated symptoms (e.g. co-morbid fibromyalgia)

Causes and Risk Factors of IBS

            The cause of IBS is unknown; however, the following notions are believed to affect the development of IBS:

  1. Muscle contractions in the intestine. Hyperactive intestinal contractions may contribute to diarrhea, while weak contractions may lead to constipation.
  2. Nervous system discrepancies. Problems in the nervous system due to poor neurologic signals can cause the body to overreact and thus manifest as abdominal pain, diarrhea or constipation.
  3. Severe infection. Developing gastroenteritis will result in the activation of the inflammatory response and in turn contribute to IBS.
  4. Changes in microbiologic flora in the gut. Research indicates that transient gut flora of people with IDS might differ from healthy patients

The following risk factors may increase the chances of developing IBS:

  1. Food – certain types of food may trigger bouts of IBS and they include dairy products, citrus fruits, cabbage, beans, and carbonated drinks.
  2. Stress – it has been observed that most people experience more frequent symptoms of IBS when under or during increased periods of stress
  3. Patients below the age of 50
  4. The female gender
  5. Familial history of IBS
  6. Mental health issues – anxiety, depression

Complications of IBS

The complications of IBS are not necessarily fatal but can hinder so much of an individual’s health goals and quality of life.

  1. Poor quality of life. Experiencing and living with uncontrolled IBS can alter the patient’s quality of life. Because of IBS, people with moderate to severe forms are more likely to miss days of work. 
  2. Mood disorders. Unmanaged or mismanaged IBS may lead to mood disorders. Experiencing episodes of abdominal pain and unnecessary irregular bowel patterns may lead to depression and anxiety. Persistence of these episodes with the patient already having mood problems can make it worse.

Diagnosis of IBS

  1. Rome IV criteria – the patient should have had recurrent abdominal pain that averages at least once a day per week during the past 3 months plus 2 or more of the following:
  2. Problems with defecation (maybe increased or unchanged by bowel movement)
  3. Changes in stool frequency
  4. Changes in stool appearance or form

Four bowel patterns were identified with IBS and they are:

  1. IBS-D (diarrhea predominant)
  2. IBS-C (constipation predominant)
  3. IBS-M (mixed diarrhea and constipation)
  4. IBS-U (unclassified; symptoms cannot be categorized to the 3 abovementioned)

Employing these four bowel categories is debatable because there are patients that may change subtypes after one year.

A thorough history, physical examination and laboratory and radiographic work-up are still the gold standard in establishing an IBS diagnosis.

Patients younger than 50 do not necessarily need laboratory or radiographic work up, unless presenting with these alarming features:

  1. Weight loss
  2. Iron deficiency anemia
  3. Familial history of certain GI disorders (Celiac disease, Inflammatory bowel disease, colorectal cancer)

Other tests will be performed to rule out other underlying causes and they include:

Complete blood count – to screen for anemia, infection, inflammation

Comprehensive metabolic panel – to rule out malabsorption and/metabolic disorders

Stool examinations – to rule out for parasitic ova, C. difficile, parasites, Giardia antigen

Breath test  – to rule out excessive growth of intestinal flora

Lactose intolerance test

Tissue transglutamase antibody testing – necessary for Celiac disease screening

Serum calcium testing – to screen for hyparathyroidism

Erythrocyte sedimentation rate and C-reactive protein – nonspecific tests for inflammation

Colonoscopy – for direct visualization of the GI tract

Abdominal X-ray or CT-scan

Upper endoscopy – involves scope guidance and tissue sampling if suspected for Celiac disease

Treatment for IBS

The management of IBS primarily involves providing psychosocial support and recommending dietary changes.

Pharmacological treatment is given adjunctively to address the clinical manifestations of IBS.

Diet and lifestyle changes. For mild symptoms the following are recommended:

Avoiding food triggers – high gas foods, gluten, certain carbohydrates (those with lactose, fructose, etc.)

Eating high fiber diet

Increase fluid intake

Exercising regularly

Adequate rest and sleep

Management of stressors

In addition to these, for moderate to severe IBS the following are recommended:

Fiber supplements

Laxatives

Anti-diarrheal medications

Anticholinergic medications – antispasmodics; to help relieve symptoms of GI spasms SSRI and Tricyclic antidepressants – use is off-label; have visceral analgesic properties

Other medications. The following medications may also be prescribed for IBS patients:

Fibromyalgia agents and anticonvulsants – to address neuropathic pain often associated with IBS

5-HT3 receptor antagonists and Mu-opioid receptor agonists – to decrease bowel hyperactivity

Antibiotics – to combat bacteria overgrowth

Guanylate cyclase-c agonists and chloride channel activators – to increase the amount of fluid in the intestines, thereby making defecation easier

Nursing Care Plans for IBS

Nursing Care Plan 1

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to altered absorption of nutrients secondary to Irritable Bowel Syndrome, as evidenced by diarrhea, abdominal pain and cramping, weight loss, nausea and vomiting, and loss of appetite

Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

InterventionRationale
Explore the patient’s daily nutritional intake and food habits (e.g. mealtimes, duration of each meal session, snacking, etc.)To create a baseline of the patient’s nutritional status and preferences.
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term nutrition and weight goals related to Irritable Bowel Syndrome.To effectively monitory the patient’s daily nutritional intake and progress in weight goals.
Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and high fiber, high fat foods.To relieve abdominal pain and cramping, alleviate diarrhea, and healthy food habits. Caffeine is a stimulant of gastric acid production, which can worsen the condition.  
Refer the patient to the dietitian.To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed Irritable Bowel Syndrome.  
For an IBS patient with severe diarrhea, place the patient on a nothing by mouth status, and gradually progress to clear liquids, followed by bland diet, and the low residue diet. The patient can then have a low fat, low fiber diet on a long-term basis. Foods that may cause indigestion, such as dried fruit and beans, should be avoided.Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. To reduce diarrhea, a low fat and low fiber diet is ideal. Foods that may cause indigestion will likely make an IBS patient bloated or trigger abdominal cramping.

Nursing Care Plan 2

Nursing Diagnosis: Acute Pain related to abdominal muscle spasms secondary to Irritable Bowel Syndrome as evidenced by pain score of 10 out of 10, verbalization of abdominal pain and cramping, guarding sign on the abdomen

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

InterventionsRationale
Administer prescribed medications that alleviate the symptoms of stomach pain.Anti-inflammatory drugs, including corticosteroids and oral 5-aminosalicylates – initially used to reduce the inflammation.
Immunosuppressant and biologic drugs – decrease inflammation by targeting the immune system.
Antibiotics – used to fight off harmful bacteria found in the intestines and to decrease pus formation and drainage from fistula and abscess.
Anti-diarrhea medications.
Analgesics
Vitamins and supplements  
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.  To monitor effectiveness of medical treatment for the relief of heartburn and stomach pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.  
Teach the patient on how to perform non-pharmacological pain relief methods such as deep breathing, massage, acupressure, biofeedback, distraction, music therapy, and guided imagery.To reduce stress levels, thereby relieving the symptoms of Irritable Bowel Syndrome, especially stomach pain and heartburn.
Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and high fiber, high fat foods.To relieve abdominal pain and cramping, alleviate diarrhea, and healthy food habits.

Other Nursing Diagnoses:

  • Diarrhea
  • Ineffective Coping
  • Risk for Deficient Fluid Volume
  • Powerlessness

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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