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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.
    • Avoidance of complications.
NURSING INTERVENTIONS FOR THE PATIENT WITH IBD