Irritable bowel syndrome

Diagnostic Test Results-Imaging

Abdominal computed tomography scanning or ultrasonography rules out other disorders. Small-bowel series rules out Crohn's disease. Barium enema reveals colon spasm and a tubular appearance of the descending colon and rules out certain other disorders, such as diverticula, tumors, and polyps.

Nursing Considerations-Nursing Diagnoses

Acute pain Constipation Diarrhea Disturbed body image Imbalanced nutrition: Less than body requirements Ineffective coping

Overview-Other possible triggers

Allergy to certain foods or drugs Hormones Lactose intolerance Laxative abuse Possible link with depression and anxiety

Diagnostic Test Results-General

Assessment involves studies to rule out other disorders.

Treatment-Diet

Based on the patient's symptoms Initially, elimination diet Avoidance of sorbitol, nonabsorbable carbohydrates, and foods that contain lactose or that are high-gas forming Gradual increase in fiber to prevent increased intestinal gas production Increased fluids Avoidance of large meals, fatty foods, and caffeine, which can exacerbate symptoms Regular mealtimes

Nursing Considerations-Nursing Interventions

Because the patient with irritable bowel syndrome isn't hospitalized, nursing interventions almost always focus on patient teaching. Encourage the patient to identify possible triggers, such as anxiety or stress. Evaluate bowel elimination patterns; note onset, frequency, and character of stools. Develop a therapeutic relationship with the patient. Allow the patient to verbalize feelings and concerns; assist the patient in using appropriate coping strategies.

Overview-Pathophysiology

Change occurs in bowel motility, reflecting an abnormality in the neuromuscular control of intestinal smooth muscle. Diminished serotonin receptor activity in the GI tract results in abnormal levels in the GI tract and subsequent problems with bowel movement, motility, and sensation. Autonomic nervous system and its innervation with the colon may be overly responsive to even slight stress or conflict. Visceral perception and pain are enhanced. Stimulus may be luminal or environmental.

Assessment-History

Chronic constipation, diarrhea, or both Lower abdominal pain (typically in the left lower quadrant) usually relieved by defecation or passage of gas Small stools with visible mucus or pasty, pencil-like stools instead of diarrhea Dyspepsia Abdominal cramps, pain, and bloating Heartburn Faintness and weakness Contributing psychological factors, such as a recent stressful life change, that may have triggered or aggravated symptoms Anxiety and fatigue Bowel urgency

Overview

Common condition marked by chronic or periodic diarrhea alternating with constipation Four bowel patterns: constipation predominant; diarrhea predominant; mixed diarrhea and constipation; alternating diarrhea and constipation Accompanied by straining abdominal cramps, bloating, and flatulence Initial episodes early in life, usually in the late 20s Prognosis good Also known as IBS, spastic colon , and irritable colon

Nursing Considerations-Associated Nursing Procedures

Depression or hostility monitoring and precautions Fecal occult blood tests Hydrotherapy Nutritional screening Oral drug administration Pain management Relaxation and stress management techniques Venipuncture

Overview-Complications

Diverticulitis Recurrence

Treatment-If diarrhea is prominent

Fiber Loperamide or diphenoxylate-atropine Antispasmodics, such as dicyclomine hydrochloride, chlordiazepoxide-clindinium, hyoscyamine, or phenobarbital-scopolamine-hyoscyamine-atropine Antidepressants, such as tricyclic antidepressants (amitriptyline hydrochloride, imipramine hydrochloride, desipramine hydrochloride) or selective serotonin reuptake inhibitors (paroxetine hydrochloride, fluoxetine hydrochloride, sertraline hydrochloride) Antiflatulents, such as simethicone, in conjunction with fiber Anticholinergic, antispasmodic drugs such as dicyclomine Serotonin 5-hydroxytryptamine type 3 (serotonin 5-HT3) receptor antagonist (alosetron hydrochloride)

Treatment-If constipation is prominent

Fiber Polyethylene glycol (Glycolax)

Treatment-Medications

Fiber supplements such as psyllium for patients with alternating diarrhea and constipation Lactase for lactose intolerance Probiotics Peppermint oil

Diagnostic Test Results-Diagnostic Procedures

Flexible sigmoidoscopy or colonoscopy is normal and rules out inflammatory bowel disease.

Overview-Incidence

Irritable bowel syndrome (IBS) occurs most commonly in women, with symptom onset before age 35.

Assessment-Physical Findings

Normal bowel sounds Tympany over a gas-filled bowel Left lower quadrant tenderness

Patient Teaching-Discharge Planning

Refer the patient for counseling if depression is a problem. Refer the patient to a local community support group as appropriate.

Treatment-Activity

Regular exercise

Diagnostic Test Results-Laboratory

Stool examination is negative for occult blood, parasites, and pathogenic bacteria. Complete blood count, serologic tests, serum albumin, and erythrocyte sedimentation rate are normal.

Treatment-General

Stress management, hypnosis, biofeedback Lifestyle modifications Therapeutic relationship

Overview-Causes

Unknown Anxiety and stress Dietary factors, such as fiber, raw fruits, coffee, alcohol, carbonated beverages, foods that contain sorbitol, and foods that are cold, highly seasoned, or laxative in nature Combination of altered GI motility, visceral hyperalgesia, and psychopathology

Nursing Considerations-Monitoring

Weight Diet Bowel elimination pattern and frequency of stool

Patient Teaching-General

disorder, diagnosis, and treatment, including proper use, desired effects, and possible adverse reactions of prescribed medications recommended dietary plan and ways to integrate the plan into lifestyle, including eating smaller meals more often or eating smaller portions and eating meals that are low in fat and high in carbohydrates importance of drinking 8 to 10 glasses of water or other compatible fluids daily importance of implementing lifestyle changes that reduce stress and suggested stress-reduction techniques positive coping strategies smoking cessation, if applicable importance of regular physical examinations (for patients older than age 50, emphasize the need for colorectal cancer screening, including annual proctosigmoidoscopy and rectal examinations).

Nursing Considerations-Expected Outcomes

express feelings of increased comfort have stool that's soft and passes easily have normal bowel function express positive feelings about body demonstrate adaptive coping behaviors.