Inflammatory Bowel Disease

Inflammatory Bowel Disease IBD Nursing Care Plans Diagnosis and Interventions

Inflammatory bowel disease IBD NCLEX Review Care Plans

Nursing Study Guide on Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is an umbrella term to describe two inflammatory disorders of the digestive tract: ulcerative colitis and Crohn’s disease. IBD is a long-term condition characterized by diarrhea, rectal bleeding, abdominal pain, fatigue, and weight loss.

Types of Inflammatory Bowel Disease

  1. Ulcerative colitis – refers to a condition that involves inflammation and/or ulceration of the superficial lining of the large intestine and rectum. The areas involved are continuous and not patchy.
  2.  Crohn’s disease – refers to an inflammatory condition affecting the deeper layer of the intestinal lining from the mouth to the anus. The involved areas appear patchy.

Inflammatory bowel disease can occur at any age. However, it is more commonly diagnosed in people between the age of 15 to 40 years. This condition can be mild to severe that can cause serious complications.

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Signs and Symptoms of Inflammatory Bowel Disease

The signs and symptoms of IBD vary depending on the location and severity of the inflammation or ulceration. They can range from mild to severe with periods of remission.

  • Persistent diarrhea
  • Abdominal pain or abdominal cramps
  • Rectal bleeding
  • Bloody stool
  • Weight loss
  • Extreme tiredness or fatigue
  • Reduced appetite

Causes of Inflammatory Bowel Disease

Inflammatory bowel disease is idiopathic which means it has no known cause. It was suspected before that diet and stress are the causes behind this condition.

However, studies now suggest that they are only aggravating factors. It is believed that IBD is caused by a defective immune response and genetic predisposition.

Although the exact cause of IBD is unknown, there are known risk factors that predispose an individual to this condition.

  • Age – Most IBD cases are diagnosed in people before they turn 30 years old. However, some cases can still develop after the age of 50-60 years.
  • Race and ethnicity – people of Hispanic and non-Hispanic White descent are at higher risk.
  • Family history – having a close relative with IBD is a risk for developing the disease.
  • Cigarette smoking – cigarette smoking is known to prevent ulcerative colitis. However, its known benefit far outweighs the harm that it can cause the person’s overall health.
  • Use of non-steroidal anti-inflammatory medications (NSAIDs) – the use of NSAIDs is known to increase the risk of IBD and worsen the symptoms of those who already have the disease.

Complications of Inflammatory Bowel Disease

  1. Complications From Any Type of IBD
    • Colon cancer. IBD increases the risk of developing colon cancer. Screening for this type of cancer typically begins between 8-10 years of having IBD.
    • Inflammation of the skin, eyes, and joints. Conditions such as arthritis, skin lesions, and uveitis are often associated with IBD flare-ups.
    • Side-effects from IBD medications. Some of the drugs used to treat IBD are related to the development of cancer. Also, medications like corticosteroids can cause high blood pressure, high blood sugar levels, and an increased risk for osteoporosis.
    • Primary sclerosing cholangitis. IBD is also associated with the development of primary sclerosing cholangitis where there is inflammation that causes scarring of the bile ducts resulting to further complications such as liver damage.
    • Blood clots. IBD also increases the risk of clots forming and blocking veins and arteries.
    • Anal fissure. This refers to a small tear in the tissue surrounding the anus. It can get infected and cause further problems like pain during defecation and perianal fistula formation.
    • Toxic megacolon. This refers to the overdistention and dilation of the colon accompanied by bloating, fever, pain, and sometimes, shock.
    • Perforation of the colon. This can occur secondary to toxic megacolon. However, it can happen on its own.
    • Severe dehydration. This condition can occur as a complication of severe diarrhea.
  1. Complications Specific to Crohn’s Disease
    • Bowel obstruction. Crohn’s disease can cause thickening of the bowel wall causing obstruction. If significant, surgery may be required.
    • Malnutrition. The symptoms associated with Crohn’s disease such as diarrhea, reduced appetite, and abdominal cramps can all affect food intake and nutrition. A deficiency in iron and vitamin B12 is common in people with IBD.
    • Fistulas. A fistula refers to the abnormal connection between two organs. The damage caused by Crohn’s disease to the intestinal wall can result in these abnormal connections causing infection and abscess formation.

Diagnosis of Inflammatory Bowel Disease

The diagnosis of IBD comes after studying the results of imaging studies and endoscopic procedures. Also, physicians may perform stool sampling to rule out other possible causes like infections.

  • Endoscopic Procedures
    • Colonoscopy – This is a procedure to examine the entire colon. It involves the insertion of a thin, flexible camera through the anus into the colon. It can also be used to obtain tissue samples for biopsy. It is the study of choice for the diagnosis of ulcerative colitis.
    • Flexible sigmoidoscopy – this procedure is similar to colonoscopy. However, instead of studying the entire colon, only the sigmoid, or the last part of the colon, is assessed. This may be favored over full colonoscopy in cases where the colon is severely inflamed.
    • Upper endoscopy – This test also uses a thin, flexible camera that is inserted in the mouth to assess the esophagus, stomach, and first part of the intestines called duodenum.
    • Capsule endoscopy – this test is mostly used to diagnose Crohn’s disease. IT involves swallowing a small capsule containing a camera. Images are then transmitted to a recorder that can be worn on the belt.
    • Balloon-assisted enteroscopy – this procedure is performed when the results of capsule endoscopy come back inconclusive. It is similar to a simple endoscopy; however, this procedure uses additional equipment called overtube. This piece of equipment allows doctors to reach further down the intestines.
  • Imaging Studies – these may include X-ray, CT scan, and MRI to diagnose IBD. These studies provide images that may suggest inflammation, perforation, and other anatomical abnormalities suggestive of IBD.

Treatment of Inflammatory Bowel Disease

The treatment goal for IBD is to reduce inflammation and control the symptoms. Treatment includes medication use and surgery.

  1. Medications. There are several groups of medications used to manage IBD, such as:
  2. Anti-inflammatory drugs – anti-inflammatory drugs such as steroids and aminosalicylates are the first choice of treatment for IBD.
  3.  Immune system suppressors – drugs that suppress the immune system are also used to treat IBD.
  4. Biologics – These are newer drugs used for the treatment of IBD. They act to neutralize the protein that causes inflammation.
  5. Antibiotics – antibiotics are useful when infection is suspected in cases of perianal Crohn’s disease.
  6. Supplements – people with IBD may also be prescribed supplements to support nutrition. Malnutrition is common in IBD since the intestine is mostly responsible for nutrient absorption.
  7. Surgery. Surgical procedures are usually the last resort of treatment for IBD. The surgical procedure varies depending on the areas affected by the disease. Surgery doesn’t cure the condition, but it can greatly relieve the symptoms. Surgery often involves the removal of the diseased portion of the intestines and establishing a connection between the healthy intestinal regions. It may also include the closure of fistula and/or drainage of abscess.

Nursing Care Plans for Inflammatory Bowel Disease

Nursing Care Plan 1

 Nursing Diagnosis: Diarrhea related to inflammation of bowel as evidenced by loose, watery stools, abdominal cramping and pain, increased urgency to defecate, tenesmus, and increased bowel sounds

Desired Outcome: The patient will be able to return to a more normal stool consistency and frequency.

InterventionsRationales
Commence a stool chart. Use a standardized stool assessment tool such as Bristol stool chart.To monitor the patient’s bowel pattern.
Administer medications for inflammatory bowel disease as prescribed.To help decrease the frequency of stools and alleviate diarrhea, the doctor may prescribe:
-Anti-inflammatory drugs- first line of treatment for people with inflammatory bowel disease.

-Immune system suppressors- work by prohibiting inflammatory response through suppressing the immune system.

-Biologics- work by stopping proteins in the body from causing inflammation.

-Anti-diarrheals and antispasmodics  
Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Avoid cold drinks. Check if the patient is in any fluid restriction before doing so.To help ensure that the patient will not have dehydration due to severe diarrhea. Cold drinks can increase intestinal motility.
Help the patient to select appropriate dietary choices to reduce the intake of milk products, caffeinated drinks, alcohol and avoid high fiber, high fat foods.To relieve abdominal pain and cramping, alleviate diarrhea, and to promote healthy food habits. To avoid flare ups of inflammatory bowel disease. High fiber and high fat foods can cause irritation in the intestines.
Start 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/residue, low fiber diet on a long-term basis, as recommended by the dietitian.Nothing by mouth (NPO) status can help rest the bowel by decreasing peristalsis. Gradual progression from NPO up to a low fat and low fiber diet can help manage the symptoms of Inflammatory bowel disease.  

Nursing Care Plan 2

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to altered absorption of nutrients secondary to Inflammatory bowel disease, 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. meal times, 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 Inflammatory bowel disease.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 Inflammatory bowel disease.  
Start 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.Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. Gradual progression from NBM up to a low fat and low fiber diet can help manage the symptoms of Inflammatory bowel disease.  

Nursing Care Plan 3

Nursing Diagnosis: Acute Pain related to abdominal muscle spasms secondary to Inflammatory bowel disease as evidenced by a 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 inflammationImmunosuppressant and biologic drugs – decrease inflammation by targeting the immune systemAntibiotics – used to fight off harmful bacteria found in the intestines and to decrease pus formation and drainage from fistula and abscessAnti-diarrhea medicationsAnalgesicsVitamins 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 Inflammatory bowel disease, 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 possible nursing diagnoses:

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

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