Nursing Care Plans LOWER GI TRACT

Nursing Care PlansLOWER GI TRACT

Inflammatory Bowel Disease (IBD) Nursing Care Plans

The two major types of inflammatory bowel

disease are ulcerative colitis (UC) and Crohn

disease (CD).

Clinical manifestation/Sign and symptoms of Ulcerative Colitis

Regional enteritis (Crohn’s disease, ileocolitis)

Inflammatory bowel disease can have different symptom in different people.

Flare-ups might take days or weeks. Remission might last for months or even years. You may go from a mild flare-ups to a severe one and back again.

DiarrheaRisk for Deficient Fluid Volume

AnxietyAcute Pain

Ineffective CopingImbalanced Nutrition: Less Than Body Requirements

Deficient Knowledge

Here are seven (7) nursing care plans (NCP) and nursing diagnosis for patients with inflammatory bowel diseases: ulcerative colitis, and

Crohn’s disease:

Nursing Care Plans

What happens if IBD is left untreated?

■ One risk of not treating IBD is a higher frequency of flare ups (of inflammation and symptoms) and progression of the inflammation to irreversible bowel damage. Left untreated, complications of IBD can include: Intestinal strictures causing bowel obstruction. Intestinal perforation causing fistulas and abscesses.

Can IBD be cured?

There is currently no cure for IBD. The goal of treatment will be to reduce the symptoms, achieve and maintain remission, and prevent complications. The most common treatments for IBD are medications and surgery

1.Talk to people you trust about what you're going

through. ... 2.Go to your doctor. ...

3.Take time off work. ... 4.Cut stress from your life.

... 5.Surround yourself with things that make you feel

better. ... 6.Make sure you're taking

care of yourself. ... 7.Join online support

groups.

IRRITABLE BOWEL SYNDROME(IBS) NURSING CARE

IRRITABLE BOWEL SYNDROME(IBS) WITH NURSING MANAGEMENT

■ IBS is a common disorder that affects the large intestine(colon).

■ IBS is a disorder characterized by cramping, abdominal pain, bloating, constipation and diarrhea. Young women(˂ 40 years) are commonly affected.

■ Symptoms may range from mild to severe. IBS can start at any age.

History taking is important to establish the symptom profile and should include:

■ » How long symptoms have lasted;

■ » Recent foreign travel;

■ » Medical, surgical and obstetric history;

■ » Medications taken (both prescribed and over the counter);

■ » Diet and fluid intake (using a food and fluid diary);

■ » Stool type (using the Bristol Stool Form Scale and diary);

■ » The most bothersome symptoms.

Laboratory and diagnostic study findings:

■ Barium enema and colonoscopy reveal spasms, distention, or mucus accumulation in the intestines.

■ Complete blood count shows normal findings

■ Stool analysis shows normal findings

Nursing diagnosis NCP Nursing Care Plan for Irritable Bowel Syndrome

■ Acute pain

■ Constipation

■ Deficient knowledge (diagnosis and treatment)

■ Diarrhea

■ Disturbed body image

■ Ineffective coping

Nursing Management

■ Teach the client measures to reduce symptoms by:

■ Eating a well balanced, high-fiber diet; avoiding gas-forming foods; and avoiding fluid intake with meals because it causes abdominal distention.

■ Adhering to a schedule of regular work and rest periods.

■ Participating in regular exercise, which reduces anxiety and increases intestinal motility.

■ Avoiding or minimizing stress-producing situations.

■ Drinking six to eight glasses of water daily (not at meals) to prevent constipation

■ Adhering to a regular eating schedule and chewing food slowly and thoroughly.

■ Promote client and family coping.

■ Provide the client with reassurance and emotional support to help decrease anxiety and increase his sense of control over the situation and its management.

■ Administer medications, which may include anticholinergics, antispasmodics, antidiarrheal, and bulk laxatives.

HemorrhoidNURSING CARE

Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids).

■ Here are three (3) nursing care plans (NCP) and nursing diagnosis for patients with hemorrhoids:

■ Impaired Tissue Integrity

■ Constipation: May be related toLow residue dietLack of dietary bulkHemorrhoidal painMedications

■ Acute Pain

Nursing Interventions Rationale

Instruct patient and/or family in dietary management.

The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily.Increasing bulk, fiber, fluids, and eating fruits and vegetables can help by maintaining soft stools to avoid straining at bowel movements.Eat high-fiber foodsDrink plenty of fluids. If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, the supplements can cause or worsen constipation.

Nursing Interventions Rationale

Instruct patient and/or family regarding causes of

hemorrhoids, methods of avoiding hemorrhoids, and

treatments that can be performed.

Hemorrhoids are caused by straining, heavy lifting, obesity, pregnancy, and any activity that distends rectal veins and causes them to prolapse.Don't strain.Go as soon as you feel the urge.Exercise.Avoid long periods of sitting.

Nursing Interventions Rationale

Instruct patient and/or family in comfort measures to use with the

presence of hemorrhoids.

Use of rubber donuts remove pressure directly placed on the hemorrhoid. Warm sitz baths or suppositories containing anesthetic agents can help to alleviate pain temporarily.

Sitz bath or hip bath is a bath in which a patient sits in water up to the hips to relieve discomfort and pain in the lower part of the body. Sitz bath works by keeping the affected area clean and increasing the flow of blood.

For any type of sitz bath:1.Sit in the water for 10 to 20 minutes.2.Add more warm water as needed to keep the water comfortable.3.Get up slowly from the tub or toilet. ... 4.Gently pat your anal area, perineum, and genitals dry with a clean towel. ... 5.Wash your hands.

Provide “donut cushion” for the patient to sit on if needed.

Colonoscopy is a diagnostic procedure that utilizes a flexible fiberoptic colonoscope inserted into the rectum to allow visual examination of the large intestine (colon) lining. It is indicated for patients with a history of constipation, or diarrhea, persistent rectal bleeding, and lower abdominal pain when the results of proctosigmoidoscopy and a barium enema test are negative or inconclusive.

■ Screen for colon and rectal cancer

■ Detect and evaluate inflammatory and ulcerative bowel disease

■ Locate the source of lower GI bleeding and perform hemostasis by coagulation

■ Determine the cause of lower GI disorders, especially when barium and proctosigmoidoscopy results are inconclusive

■ Assist diagnose colonic strictures and benign or malignant lesions

■ Evaluate the colon postoperatively for recurrence of polyps and malignant lesions

■ Investigate iron-deficiency anemia of unknown origin

■ Remove colon polyps

■ Remove foreign objects and sclerosing strictures by laser

Before the procedure

The following are the nursing interventions prior to colonoscopy:

■ Secure an informed consent.

■ Obtain a medical history of the patient. Check for allergies, bleeding histories, medications, and information relevant to the current complaint.

■ Provide information about the procedure.

■ Ensure that the patient has complied with the bowel preparation. Explain that the large intestine must be thoroughly cleaned to be clearly visible. To do so, tell the patient that he must maintain a clear-liquid diet for 24 to 48 hours before the test, take nothing by mouth after midnight the before, and take a laxative, as ordered, or 1 gallon of GoLYTELY solution in the evening (drinking the chilled solutions at 8 oz[236.6 ml] every 10 minutes until the entire gallon is consumed).

■ Establish an IV line.

■ Provide reassurance.

■ Explain to the patient that air may be introduced through the colonoscope. This is done to distend the intestinal wall and to facilitate viewing the lining and advancing the instrument. Tell him that flatus normally escapes around the instrument because of air insufflation and that he shouldn’t attempt to control it.

■ Instruct the patient to empty bladder prior to the procedure.

■ Instruct the patient to cooperate and follow directions. Instruct patient to remain still during the procedure because movement creates unreliable results.

During the procedure

The following are the nursing interventions during colonoscopy:

■ Assist with patient positioning as necessary. Place the patient on the examination table in a left lateral decubitus position with a sheet draped over the body.

■ Administer medications as ordered. Pain medication and sedative will be given to reduce discomfort and to promote relaxation.

■ Instruct the patient to bear down. Bearing down as if having a bowel movement is advised as the fiberoptic tube is inserted through the rectum.

■ Change the position of the patient. When the scope is advanced through the sigmoid. The patient’s position is changed to supine to allow passage into the transverse colon. Air is insufflated through the tube during the passage to help in visualization.

■ Encourage the patient to take slow, deep breaths. Instruct the patient to take deep breaths to aid in the movement of the scope down through the ascending colon to the cecum and into the terminal portion of the ileum.

After the procedureThe nurse should note of the following nursing interventions post-colonoscopy:

■ Observe the patient closely for signs of bowel perforation. Signs of bowel perforations such as severe abdominal pain, nausea, vomiting, fever, and chills must be reported immediately.

■ Obtain and record the patient’s vital signs. Monitor vital signs and neurological status every 15 minutes for 1 hour, then every 2 hours for 4 hours, or as ordered. Assess temperature every 4 hours for 24 hours.

■ Instruct patient to resume a normal diet, fluids, and activity as advised by the health care provider. After the patient has recovered from sedation, allow him to resume his usual diet and activity unless the practitioner orders otherwise.

■ Provide privacy while the patient rest after the procedure. Inform that the patient may pass large amounts of flatus after insufflation.

■ Monitor for any rectal bleeding. If a polyp has been removed, minimal rectal bleeding is expected for 2 days but an increasing amount of bleeding should be reported immediately.

■ Encourage increased fluid intake. Fluids must be given to replace fluid lost during the preparation of the procedure

What should I do after barium enema?

■ You may notice gray or white stool for several days after a barium enema. That is the remaining barium leaving your body. To prevent constipation and help remove the remaining barium, drink plenty of fluids for the next several days. Your health care team may also recommend taking a laxative.