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.

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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Imbalanced Nutrition: Less Than Body Requirements

Nursing Diagnosis

  • Imbalanced Nutrition: Less Than Body Requirements

May be related to

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  • Altered absorption of nutrients
  • Hypermetabolic state
  • Medically restricted intake; fear that eating may cause diarrhea

Possibly evidenced by

  • Weight loss; decreased subcutaneous fat/muscle mass; poor muscle tone
  • Hyperactive bowel sounds; steatorrhea
  • Pale conjunctiva and mucous membranes
  • Aversion to eating

Desired Outcomes

  • Demonstrate stable weight or progressive gain toward goal with normalization of laboratory values and absence of signs of malnutrition.
Nursing InterventionsRationale
Weigh daily.Provides information about dietary needs and effectiveness of therapy.
Encourage bedrest and limited activity during acute phase of illness.Decreasing metabolic needs aids in preventing caloric depletion and conserves energy.
Recommend rest before meals.Quiets peristalsis and increases available energy for eating.
Provide oral hygiene.A clean mouth can enhance the taste of food.
Serve foods in well-ventilated, pleasant surroundings, with unhurried atmosphere, congenial company.Pleasant environment aids in reducing stress and is more conducive to eating.
Avoid or limit foods that might cause or exacerbate abdominal cramping, flatulence (milk products, foods high in fiber or fat, alcohol, caffeinated beverages, chocolate, peppermint, tomatoes, orange juice).Individual tolerance varies, depending on stage of disease and area of bowel affected.
Record intake and changes in symptomatology.Useful in identifying specific deficiencies and determining GI response to foods.
Promote patient participation in dietary planning as possible.Provides sense of control for patient and opportunity to select foods desired, which may increase intake.
Encourage patient to verbalize feelings concerning resumption of diet.Hesitation to eat may be result of fear that food will cause exacerbation of symptoms.
Keep patient NPO as indicated.Resting the bowel decreases peristalsis and diarrhea, limiting malabsorption and loss of nutrients.
Resume or advance diet as indicated (clear liquids progressing to bland, low residue; then high-protein, high-calorie, caffeine-free, nonspicy, and low-fiber as indicated).Allows the intestinal tract to readjust to the digestive process. Protein is necessary for tissue healing integrity. Low bulk decreases peristaltic response to meal. Note: Dietary measures depend on patient’s condition (if disease is mild, patient may do well on low-residue, low-fat diet high in protein and calories with lactose restriction). In moderate disease, elemental enteral products may be given to provide nutrition without overstimulating the bowel. Patient with toxic colitis is NPO and placed on parenteral nutrition.
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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

More nursing care plans related to gastrointestinal disorders:

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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