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.