7 Inflammatory Bowel Disease (IBD) Nursing Care Plans

July 15, 2013

Inflammatory bowel disease (IBD) is an idiopathic disease caused by a dysregulated immune response to host intestinal microflora. It results from a 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. There is a genetic predisposition for IBD, and patients with this condition are more prone to the development of malignancy.

The two major types of inflammatory bowel disease are ulcerative colitis (UC) and Crohn disease (CD).

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.

Nursing Care Plans

Nursing care management of patients with inflammatory bowel diseases (IBD) includes control of diarrhea and promoting optimal bowel function; minimize or prevent complications; promote optimal nutrition, and provide information about the disease process and treatment needs.

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

Diarrhea

Diarrhea: Passage of loose, unformed stools.

May be related to

Inflammation, irritation, or malabsorption of the bowel
Presence of toxins
Segmental narrowing of the lumen

Possibly evidenced by

Increased bowel sounds/peristalsis
Hyperactive bowel sounds
Frequent, and often severe, watery stools (acute phase)
Changes in stool color
Abdominal pain; urgency (sudden painful need to defecate), cramping

Desired Outcomes

Report reduction in frequency of stools, return to more normal stool consistency.
Identify/avoid contributing factors.

Nursing Interventions	Rationale
Ascertain onset and pattern of diarrhea	To assess etiology. Chronic diarrhea (caused by irritable bowel syndrome, infectious diseases affecting colon such as IBD).
Observe and record stool frequency, characteristics, amount, and precipitating factors.	Helps differentiate individual disease and assesses severity of episode.
Observe for presence of associated factors, such as fever, chills, abdominal pain,cramping, bloody stools, emotional upset, physical exertion and so forth.	To assess causative factors and etiology.
Promote bedrest, provide bedside commode.	Rest decreases intestinal motility and reduces the metabolic rate when infection or hemorrhage is a complication. Urge to defecate may occur without warning and be uncontrollable, increasing risk of incontinence or falls if facilities are not close at hand.
Remove stool promptly. Provide room deodorizers.	Reduces noxious odors to avoid undue patient embarrassment.
Identify and restrict foods and fluids that precipitate diarrhea (vegetables and fruits, whole-grain cereals, condiments, carbonated drinks, milk products).	Avoiding intestinal irritants promote intestinal rest and reduce intestinal workload.
Restart oral fluid intake gradually. Offer clear liquids hourly; avoid cold fluids.	Provides colon rest by omitting or decreasing the stimulus of foods and fluids. Gradual resumption of liquids may prevent cramping and recurrence of diarrhea; however, cold fluids can increase intestinal motility.
Provide opportunity to vent frustrations related to disease process.	Presence of disease with unknown cause that is difficult to cure and that may require surgical intervention can lead to stress reactions that may aggravate condition.
Observe for fever, tachycardia, lethargy, leukocytosis, decreased serum protein, anxiety, and prostration.	May signify that toxic megacolon or perforation and peritonitis are imminent or have occurred, necessitating immediate medical intervention.