7 Inflammatory Bowel Disease (IBD) Nursing Care Plans

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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.

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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.

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

  1. Diarrhea
  2. Risk for Deficient Fluid Volume
  3. Anxiety
  4. Acute Pain
  5. Ineffective Coping
  6. Imbalanced Nutrition: Less Than Body Requirements
  7. Deficient Knowledge
  8. Other Possible Nursing Care Plans
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Risk for Deficient Fluid Volume

Nursing Diagnosis

Risk factors may include

  • Excessive losses through normal routes (severe frequent diarrhea, vomiting)
  • Hypermetabolic state (inflammation, fever)
  • Restricted intake (nausea/anorexia)
  • Hemoconcentration; altered serum sodium

Desired Outcomes

  • Maintain adequate fluid volume as evidenced by moist mucous membranes, good skin turgor, and capillary refill; stable vital signs; balanced I&O with urine of normal concentration/amount.
  • Demonstrate behaviors to monitor and correct deficit, as indicated, when condition is chronic.
Nursing InterventionsRationale
Note possible conditions or processes that may lead to deficits such as fluid loss, limited intake, fluid shifts, environmental factor.To assess causative and precipitating factors. Fluid loss may be an effect of diarrhea or vomiting).
Monitor I&O. Note number, character, and amount of stools; estimate insensible fluid losses (diaphoresis). Measure urine specific gravity; observe for oliguria.Provides information about overall fluid balance, renal function, and bowel disease control, as well as guidelines for fluid replacement.
Assess vital signs (BP, pulse, temperature).Hypotension (including postural), tachycardia, fever can indicate response of fluid loss.
Observe for excessively dry skin and mucous membranes, decreased skin turgor, slowed capillary refill.Indicates excessive fluid loss or resultant dehydration.
Weigh daily.Indicator of overall fluid and nutritional status.
Maintain oral restrictions, bedrest; avoid exertion.Colon is placed at rest for healing and to decrease intestinal fluid losses.
Observe for overt bleeding and test stool daily for occult blood.Inadequate diet and decreased absorption may lead to vitamin K deficiency and defects in coagulation, potentiating risk of hemorrhage.
Note generalized muscle weakness or cardiac dysrhythmias.Excessive intestinal loss may lead to electrolyte imbalance, e.g., potassium, which is necessary for proper skeletal and cardiac muscle function. Minor alterations in serum levels can result in profound or life-threatening symptoms.
Administer parenteral fluids, blood transfusions as indicated.Maintenance of bowel rest requires alternative fluid replacement to correct losses and anemia. Note: Fluids containing sodium may be restricted in presence of regional enteritis.
Monitor laboratory studies such as electrolytes (especially potassium, magnesium) and ABGs (acid-base balance).Determines replacement needs and effectiveness of therapy.
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Recommended Resources

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See also

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Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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