MANAGEMENT OF PATIENTS WITH INTESTINAL AND RECTAL DISORDERS
IRRITABLE BOWEL SYNDROME (IBS)
Definition: A chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea, constipation, or both.
Prevalence:
Approximately 12% of adults in the United States report symptoms of IBS.
More common in women than men.
Triggers:
Chronic stress.
Sleep deprivation.
Surgery.
Infections.
Diverticulitis.
Specific foods.
CLINICAL MANIFESTATIONS OF IBS
Alteration in bowel patterns
Pain: May vary in intensity and duration.
Bloating: Feeling of fullness and swelling in the abdomen.
Abdominal distention: Visible swelling or increase in girth of the abdomen.
ASSESSMENT AND DIAGNOSTIC FINDINGS OF IBS
Stool studies: Laboratory analysis of stool samples to identify infections or other abnormalities.
Contrast radiography studies: Imaging techniques using contrast material to visualize intestinal structures.
Proctoscopy: An examination of the rectum and lower colon using a flexible scope.
Barium enema: A radiologic exam to visualize the colon and rectum using barium contrast.
Colonoscopy: A diagnostic procedure to examine the interior of the colon using a long, flexible tube.
Manometry: Measures the pressure within the intestines to evaluate motility.
Electromyography: Evaluates the electrical activity of muscles, useful for assessing pelvic floor disorders.
PATIENT LEARNING NEEDS FOR IBS
Medication management: Educate on prescribed medications to manage symptoms.
Complementary medicine: Explore additional therapies such as acupuncture or herbal supplements.
Dietary changes: Emphasize the importance of recognizing triggers (such as certain foods).
Food diary: Encourage keeping a diary of food intake and bowel movements.
Adequate fluid intake: Promote hydration to help manage symptoms.
Avoid alcohol and smoking: Highlight their negative effects on bowel function.
Relaxation techniques: Teach methods to reduce stress that can exacerbate symptoms.
INFLAMMATORY BOWEL DISEASE (IBD)
Consists primarily of two conditions:
Crohn's disease (regional enteritis): Chronic inflammation of the gastrointestinal tract.
Ulcerative colitis: Inflammation primarily in the colon.
ASSESSMENT OF THE PATIENT WITH IBD
Health history: Evaluate onset, duration, and characteristics of symptoms, including:
Pain
Diarrhea
Urgency
Tenesmus (painful urge to defecate)
Nausea
Anorexia
Weight loss
Bleeding
Family history of IBD.
Dietary patterns: Discuss the patient's consumption of alcohol, caffeine, and nicotine.
Bowel elimination patterns: Monitor frequency and consistency of stools.
Abdominal assessment: Physical examination of the abdomen.
COLLABORATIVE PROBLEMS AND POTENTIAL COMPLICATIONS OF IBD
Electrolyte imbalance: Possible due to diarrhea and malabsorption.
Cardiac dysrhythmias: May occur with electrolyte disturbances.
GI bleeding with fluid loss: Can lead to severe anemia and shock.
Perforation of the bowel: Serious complication requiring emergency intervention.
PLANNING AND GOALS FOR THE PATIENT WITH IBD
Major goals may include:
Attainment of normal bowel elimination patterns.
Relief of abdominal pain and cramping.
Prevention of fluid deficit.
Maintenance of optimal nutrition and weight.
Avoidance of fatigue.
Reduction of anxiety.
Promotion of effective coping strategies.
Absence of skin breakdown.
Increased knowledge of the disease process and therapeutic regimen.