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 Irritable Bowel Syndrome
The classic signs and symptoms true to IBS are:
- Abdominal pain – the most common site is the lower abdomen, specifically the left lower quadrant; usually diffuse in nature; sometimes relieved by defecation
- Changes in bowel habit – presence of either constipation or diarrhea; can be both and alternating
- Abdominal distention – feeling bloated and full due to increase in gastric acidity and presence of gas.
- 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 Irritable Bowel Syndrome
The cause of IBS is unknown; however, the following notions are believed to affect the development of IBS:
- Muscle contractions in the intestine. Hyperactive intestinal contractions may contribute to diarrhea, while weak contractions may lead to constipation.
- 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.
- Severe infection. Developing gastroenteritis will result in the activation of the inflammatory response and in turn contribute to IBS.
- 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:
- Food – certain types of food may trigger bouts of IBS and they include dairy products, citrus fruits, cabbage, beans, and carbonated drinks.
- Stress – it has been observed that most people experience more frequent symptoms of IBS when under or during increased periods of stress
- Patients below the age of 50
- The female gender
- Familial history of IBS
- Mental health issues – anxiety, depression
Complications of Irritable Bowel Syndrome
The complications of IBS are not necessarily fatal but can hinder so much of an individual’s health goals and quality of life.
- 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.
- 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 Irritable Bowel Syndrome
- 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:
- Problems with defecation (maybe increased or unchanged by bowel movement)
- Changes in stool frequency
- Changes in stool appearance or form
Four bowel patterns were identified with IBS and they are:
- IBS-D (diarrhea predominant)
- IBS-C (constipation predominant)
- IBS-M (mixed diarrhea and constipation)
- 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:
- Weight loss
- Iron deficiency anemia
- 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 Irritable Bowel Syndrome
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
- 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 Diagnosis for Irritable Bowel Syndrome
Irritable Bowel Syndrome 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.
|Irritable Bowel Syndrome Nursing Interventions||Rationale|
|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.|
Irritable Bowel Syndrome 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.
|Irritable Bowel Syndrome Nursing Interventions||Rationale|
|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.
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.|
Irritable Bowel Syndrome Nursing Care Plan 3
Nursing Diagnosis: Diarrhea related to segmental narrowing of lumen secondary to irritable bowel syndrome (IBS) as evidenced by increased peristalsis and hyperactive bowel sound, and watery stools that are frequently severe (acute phase)
- The patient will recognize and avoid the risk factors related to diarrhea.
- The patient will report a decrease in bowel movements and a return to more typical bowel movements.
|Irritable Bowel Syndrome Nursing Interventions||Rationale|
|Examine for the presence of any accompanying symptoms, such as fever, chills, cramping in the abdomen, bloody feces, mental distress, and physical exertion.||To evaluate the etiology and contributing factors to the disease. Constipation, diarrhea, and/or combined constipation and disturbed bowel habits are common symptoms of Irritable Bowel Syndrome (IBS). Bloating, distension, symptoms brought on by eating, a change in pain location and stool pattern with time, and other IBS-related complaints in patients include these.|
|Recognize and avoid meals and liquids that cause diarrhea like vegetables and fruits, whole-grain cereals, carbonated drinks, and milk products.||Intestinal rest and reduced workload are promoted by avoiding intestinal irritants. FODMAPs are short-chain, poorly absorbed, highly fermentable carbohydrates that can be found in foods including some dairy products, wheat products, onions, fruits, and vegetables. Increased gastrointestinal symptoms in IBS patients have been linked to FODMAPs.|
|Gradually continue oral fluid intake. Hourly, offer clear liquids; steer clear of cold liquids.||Allows the colon to rest by reducing or eliminating the stimulation that food and liquids provide. Drinking more water could affect GI function, which might help with IBS symptoms. Constipated IBS-C sufferers may benefit from increasing their water intake. A popular recommendation for IBS-D sufferers is to drink water to avoid dehydration brought on by diarrhea. However, cold liquids can promote intestinal motility. Gradually resuming liquids may minimize cramping and recurrence of diarrhea.|
|Give individuals the opportunity to express their concerns about the disease process.||Stress reactions can worsen conditions when there is a disease present that has no known origin, is difficult to treat, and may need surgical intervention. Patients with IBS frequently worry about their bowel movements, feel “unclean,” and experience difficulties with relationships, intimacy, and sexuality. IBS patients’ experiences with their condition tend to be influenced by three main themes: (1) feeling frustrated from a lack of control; (2) feeling lonely; and (3) dissatisfaction with the therapies that are accessible, the information that is received, and the healthcare system as a whole.|
|Fever, tachycardia, lethargy, leukocytosis, reduced serum protein, anxiety, and prostration should all be looked out for.||It could indicate the presence of a toxic megacolon, a perforation, or peritonitis, all of which call for rapid medical attention. IBS symptoms, such as discomfort, irregular bowel movements, and mucous passing without blood or pus, can occur in IBD patients. IBD patients frequently have systemic symptoms such as weight loss, sweating, lethargy, and arthralgias. A low-grade fever may manifest first as a sign of IBS flare-up.|
|Encourage bed rest and give a toilet by the bed.||When infection or bleeding are complications, rest lowers metabolic rate and inhibits intestinal motility. If facilities are not nearby, an uncontrollable urge to urinate that comes on suddenly can increase the risk of incontinence or falls.|
|Immediately remove the stool. Offer deodorizers for the rooms.||Reduces offensive smells to prevent unnecessary patient humiliation. It will also give the patient comfort and relaxation.|
|Determine the beginning and pattern of diarrhea.||To determine the cause. persistent diarrhea (caused by irritable bowel syndrome, infectious diseases affecting the colon such as IBD). Typically, diarrhea only occurs a few times a year and resolves on its own in 1 to 3 days. However, loose or frequent feces can persist for months or even years in persons with IBS whose predominant symptom is diarrhea (also known as IBS-D).|
|Monitor the frequency, composition, volume, and causes of stools by making observations and notes.||Aids in identifying certain diseases and evaluates the intensity of an incident. According to a previous study of 200 individuals, those with diarrhea-predominant IBS had an average of 12 bowel movements per week, which is more than twice as often as those without IBS ( 8 ). A sudden, strong urge to urinate might also be brought on by IBS’s accelerated intestinal transit.|
Irritable Bowel Syndrome Nursing Care Plan 4
Risk for Deficient Fluid Volume
Nursing Diagnosis: Risk for Deficient Fluid Volume related to excessive losses like severe and frequent diarrhea and vomiting secondary to irritable bowel syndrome (IBS)
- The patient will maintain an appropriate fluid volume as indicated by moist mucous membranes, excellent skin turgor, and capillary refill; stable vitals; balanced I&O with the urine of a normal concentration/amount.
- The patient will demonstrate the necessary behaviors to monitor and repair any deficits in the instance that the condition is persistent,
|Irritable Bowel Syndrome Nursing Interventions||Rationale|
|Observe I&O, taking note of the quantity, type, and number of stools, and calculating insensible fluid losses (diaphoresis). Check for oliguria and measure the specific gravity of the patient’s urine.||Presents recommendations for fluid replacement and information on general fluid balance, renal function, and gastrointestinal disease management.|
|Take note of any circumstances or actions that could result in deficiencies, such as fluid loss, restricted dietary intake, fluid shifts, or environmental factors.||To evaluate the causes and contributing elements. Vomiting or diarrhea may have a side effect of fluid loss. Bloating and abdominal distension, which are signs of external swelling, are common in people with irritable bowel syndrome (IBS). IBS may be triggered by several environmental variables, including bacterial infection, air pollution, radiation, and even stress.|
|Monitor for obvious bleeding and check the patient’s stool every day for blood.||Vitamin K deficiencies and coagulation problems can be caused by an inadequate diet and poor absorption, which increases the risk of hemorrhage. Rectal bleeding is a common symptom of IBS-C, the form of the condition that causes constipation. Small rips in the anus brought on by fecal impaction are frequently the cause. The increasing volume of excrement in the rectum causes pressure on the lining, which can eventually result in damage.|
|Transfusions of blood and parenteral fluids should be administered as needed.||Alternative fluid replacement is necessary for bowel rest maintenance to address anemia and loss correction. Restrictions may apply to sodium-containing fluids if local enteritis is present.|
|Check laboratory tests for ABGs, potassium, magnesium, and other electrolytes (acid-base balance).||Evaluates the efficacy of the therapy and the need for replenishment. IBS sufferers experience “low-grade intestinal inflammation,” increased intestinal permeability, and modifications to their gut flora. An imbalance in electrolytes may result from this.|
|Pay attention to signs of severe skin and mucous membrane dryness, decreased skin turgor, and sluggish capillary refill.||Dehydration as a result of substantial fluid loss is indicated. People who have IBS-D may become dehydrated from frequent diarrheal episodes and may need to drink more fluids and electrolytes to stay hydrated. Water and electrolytes can be rapidly lost in large amounts due to diarrhea.|
|Take note of any widespread muscle weakness or irregular heartbeat.||A lack of electrolytes, such as potassium, which is essential for healthy skeletal and heart muscle function, may result from excessive intestinal loss. Significant or even life-threatening symptoms can be caused by slight changes in serum levels.|
|Keep track of the patient’s weight daily||Indicator of total nutritional and fluid health. A change in diet made to lessen symptoms may contribute to weight gain. Since many fruits and vegetables include indigestible components that ferment in the large intestine, they frequently serve as IBS triggers. The patient might be tempted, as a result of recurrent flare-ups, to swap out fruit and vegetables for carbohydrate sources like potatoes or rice (which often contain more calories and have a poorer nutritional value), which can lead to weight gain. IBS with diarrheal predominance may cause weight loss.|
|Keep an eye on lab tests for electrolytes (particularly potassium and magnesium) and ABGs (acid-base balance).||Evaluates the efficacy of the therapy and the need for replenishment.|
Irritable Bowel Syndrome Nursing Care Plan 5
Nursing Diagnosis: Ineffective Coping related to poor coping mechanisms, lack of support networks, extreme pain, and lack of rest and sleep secondary to irritable bowel syndrome (IBS) as evidenced by expression of difficulty coping with despair, anxiety, and concern with one’s physical appearance.
- The patient will accurately evaluate the current circumstances.
- The patient will determine the effects of inadequate coping strategies.
- The patient will recognize their coping skills.
- The patient will showcase the essential lifestyle modifications to reduce or stop repeated occurrences.
|Irritable Bowel Syndrome Nursing Interventions||Rationale|
|Evaluate the patient’s and significant other’s knowledge of the disease process and any prior coping mechanisms.||Enables the nurse to approach contemporary issues more realistically. It’s possible that past patient education and health, teaching were hampered by anxiety and other issues. Effective coping techniques have been demonstrated to be crucial in reducing symptoms of anxiety, depression, and somatic issues.|
|Identify external stressors (family, relationships, social or work environment).||Stress can change the autonomic nerve response, which can impact the immune system and cause disease to worsen. Even the dependent patient’s desire for freedom might add to their stress.|
|Give the patient the chance to talk about how their sickness has affected their relationships, especially their sexual concerns.||The stressors of sickness affect every aspect of life, and the patient may find it difficult to manage their feelings of pain and weariness in connection to their sexual requirements.|
|When offering emotional support, be active and listen without passing judgment; keep a calm mood while tending to the patient; and assign the same staff members whenever possible.||Helps with communication and comprehending the patient’s perspective. increases the patient’s sense of worth, and prevents the sufferer from feeling like a burden (frequent need to empty bedpan or commode). reduces the tension caused by continual changes and offers a more restorative environment.|
|Promote the adoption of stress management strategies (relaxation techniques, visualization, guided imagery, deep-breathing exercises).||Increasing coping skills improve relaxation and refocuses attention. Since IBS is a stress-sensitive disorder, managing stress and the reactions that stress triggers should be the main focus of treatment. Try stress-reduction techniques like hypnotherapy or cognitive behavioral therapy to lessen psychological tension. Although there is no simple cure for irritable bowel syndrome, relaxation techniques may assist to heal the digestive tract. Gut-directed hypnosis has been proven to be quite successful at lowering stress levels and easing IBS symptoms, according to gastrointestinal psychologists. A skilled therapist uses this method to help a patient enter a focused level of awareness and deep relaxation. The goal of gut-related hypnosis is to relax the digestive system and divert focus from any physical discomfort.|
|Include the patient and SO in team meetings to create a customized program.||Increasing participation with the therapeutic regimen fosters continuity of care and makes the patient and SO feel that they are a part of the plan.|
|Use the resources listed (local support group, social worker, psychiatric clinical nurse specialist, spiritual advisor).||The patient and significant other may benefit from additional support and therapy to deal with certain stressors and problems.|
|Administer anti-anxiety drugs as directed.||Assists with both mental and physical rest. conserves energy and could improve coping skills. Focusing on significant chemical messengers in the brain allows anxiolytics to work. This is said to help lessen abnormal excitability. Among the medications used to treat anxiety are benzodiazepines. By enhancing the effects of the brain chemical gamma-aminobutyric acid, benzodiazepines lessen the symptoms of anxiety (GABA). Certain neurons are inhibited by GABA, which slows down the propagation of nerve impulses.|
|Give the patient uninterrupted time to rest and sleep.||Exhaustion due to the disease often makes problems worse and makes it harder to deal with them. The effects of disturbed sleep go beyond the intestine, causing worse mood and increased somatic discomfort in IBS patients. Sleep disruptions are more common in IBS, and they connect with IBS-related pain, distress, and poorer IBS-related QOL.|
|Assist the patient in identifying their coping mechanisms.||Utilizing strategies that have worked before can help patients deal with their current circumstances and make plans for the future. People may be able to lessen the symptoms of IBS by combining various dietary modifications, exercise, stress management, medications, and psychological therapy.|
More Nursing Diagnosis for Irritable Bowel Syndrome
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. (2022). 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. (2020). 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
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