Inflammatory bowel disease (IBD) results froma complex interplay between genetic and environmental factors. Similarities involve (1) chronic inflammation of the alimentary tract and (2) periods of remission interspersed with episodes of acute inflammation.
Ulcerative colitis (UC): A chronic condition of unknown cause usually starting in the rectum and distal portions of the colon and possibly spreading upward to involve the sigmoid and descending colon or the entire colon. It is usually intermittent (acute exacerbation with long remissions), but some individuals (30%–40%) have continuous symptoms. Cure is effected only by total removal of colon and rectum/rectal mucosa.
Regional enteritis (Crohn’s disease, ileocolitis): May be found in portions of the alimentary tract from the mouth to the anus but is most commonly found in the small intestine (terminal ileum). It is a slowly progressive chronic disease of unknown cause with intermittent acute episodes and no known cure. UC and regional enteritis share common symptoms but differ in the segment and layer of intestine involved and the degree of severity and complications. Therefore, separate databases are provided.
Here are 7 Nursing Care Plan (NCP) for inflammatory bowel disease
- 1 7 Inflammatory Bowel Disease Nursing Care Plan (NCP)
- 2 Other Possible Nursing Care Plan (NCP) for Inflammatory Bowel Disease
- 3 Nursing Priorities - Inflammatory Bowel Disease Nursing Care Plan (NCP)
- 4 Discharge Goals - Inflammatory Bowel Disease Nursing Care Plan (NCP)
- 5 Diagnostic Studies for Inflammatory Bowel Disease
- Diarrhea — Inflammatory Bowel Disease Nursing Care Plan (NCP)
- Risk for Deficient Fluid Volume — Inflammatory Bowel Disease Nursing Care Plan (NCP)
- Anxiety — Inflammatory Bowel Disease Nursing Care Plan (NCP)
- Acute Pain — Inflammatory Bowel Disease Nursing Care Plan (NCP)
- Ineffective Coping — Inflammatory Bowel Disease Nursing Care Plan (NCP)
- Imbalanced Nutrition — Inflammatory Bowel Disease Nursing Care Plan (NCP)
- Knowledge Deficit — Inflammatory Bowel Disease Nursing Care Plan (NCP)
Other Possible Nursing Care Plan (NCP) for Inflammatory Bowel Disease
- Pain, acute—hyperperistalsis, prolonged diarrhea, skin/tissue irritation, perirectal excoriation, fissures, fistulas.
- Coping, ineffective—multiple stressors, repeated over period of time; unpredictable nature of disease process; personal vulnerability; severe pain; situational crisis.
- Infection, risk for—traumatized tissue, change in pH of secretions, altered peristalsis, suppressed inflammatory response, chronic disease, malnutrition.
- Therapeutic Regimen: ineffective management—complexity of therapeutic regimen, perceived benefit, powerlessness.
Nursing Priorities - Inflammatory Bowel Disease Nursing Care Plan (NCP)
- Control diarrhea/promote optimal bowel function.
- Minimize/prevent complications.
- Promote optimal nutrition.
- Minimize mental/emotional stress.
- Provide information about disease process, treatment needs, and long-term aspects/potential complications of recurrent disease.
Discharge Goals - Inflammatory Bowel Disease Nursing Care Plan (NCP)
- Bowel function stabilized.
- Complications prevented/controlled.
- Dealing positively with condition.
- Disease process/prognosis, therapeutic regimen, and potential complications are understood.
- Plan in place to meet needs after discharge.
Diagnostic Studies for Inflammatory Bowel Disease
- Stool specimens (examinations are used in initial diagnosis and in following disease progression): Mainly composed of mucus, blood, pus, and intestinal organisms, especiallyEntamoeba histolytica (active stage). Fecal leukocytes and RBCs indicate inflammation of GI tract. Stool positive for bacterial pathogens, ova and parasites or clostridium indicates infections. Stool positive for fat indicates malabsorption.
- Proctosigmoidoscopy: Visualizes ulcerations, edema, hyperemia, and inflammation (result of secondary infection of the mucosa and submucosa). Friability and hemorrhagic areas caused by necrosis and ulceration occur in 85% of these patients.
- Cytology and rectal biopsy: Differentiates between infectious process and carcinoma (occurs 10–20 times more often than in general population). Neoplastic changes can be detected, as well as characteristic inflammatory infiltrates called crypt abscesses.
- Barium enema: May be performed after visual examination has been done, although rarely done during acute, relapsing stage, because it can exacerbate condition.
- Endoscopic examinations, e.g., sigmoidoscopy, esophagogastroduodenoscopy, or colonoscopy: Identifies adhesions, changes in luminal wall (narrowing/irregularity); rules out bowel obstruction and allowed biopsy for features of Crohn’s disease or ulcerative colitis.
- Abdominal magnetic resonance imaging (MRI)/computed tomography (CT) scan, ultrasound: Detects abscesses, masses, strictures, or fistulas.
- CBC: May show hyperchromic anemia (active disease generally present because of blood loss and iron deficiency); leukocytosis may occur, especially in fulminating or complicated cases and in patients on steroid therapy.
- Erythrocyte sedimentation rate (ESR): Elevated in acute inflammation according to severity of disease.
- Serum iron levels: Lowered because of blood loss or poor dietary intake.
- PT: Prolonged in severe cases from altered factors VII and X caused by vitamin K deficiency.
- Thrombocytosis: May occur as a result of inflammatory disease process.
- Electrolytes: Decreased potassium, magnesium, and zinc are common in severe disease.
- Prealbumin/albumin level: Decreased because of loss of plasma proteins/disturbed liver function, decreased dietary intake.
- Alkaline phosphatase: Increased, along with serum cholesterol and hypoproteinemia, indicating disturbed liver function (e.g., cholangitis, cirrhosis).
- Disease-specific antibodies, ANCA (antineutrophil cyctoplasmic antibodies): Positive result increases suspicion of UC, but negative result does not rule out diagnosis.
- Bone marrow: A generalized depression is common in fulminating types/after a long inflammatory process.