Irritable Bowel Syndrome Assignment
Introduction (patient & problem)
Our patient is Isa Bella Sandra. She is a 25-year-old female who was diagnosed with the chronic condition of irritable bowel syndrome one month ago. Her family does have a history of IBS and there are potential risk factors with this individual because it happens more in women and she is still young. Her major signs and symptoms include abdominal pain at least 1 day a week, cramping, and changes in bowel movement according to how often it happens and the appearance of it. Additionally, she has had severe weight loss, diarrhea at night, and has persistent pain which is not relieved by passing gas or bowel movement (Anastasi, J. K., Capili, B., & Chang, M, July 2013). At the moment, she is not taking any treatment, but she is watching what she eats when it comes to fiber since this can make her situation worse.
We decided to do our assignment on irritable bowel syndrome because as women, we wanted to learn more about health conditions that affect more women than men. We want to educate ourselves on the reasons why Irritable bowel syndrome affects women more and the treatments that are advised so that we are able to help others who may go through this condition. Additionally, we would have the knowledge of how this may affect their everyday life and possibly be there for the patient to comfort them and let them know that they are not alone, but that others go through hard seasons in their life and there is a way to manage it.
Pathophysiology
- Explain the disease
- How is the disease initiated?
- Why does the disease present those major signs/symptoms?
- What would be the potential complications/sequela of the disease?
Irritable bowel syndrome (IBS) is a bowel disorder that is characterized by chronic or recurring abdominal pain that is usually associated with relief or exacerbation by defecation or change in bowel habit (Holtman et al. 2016). Although the etiologic factors and pathogenesis of IBS are obscure, most evidence shows that IBS is a bowel motility disorder and that studies have demonstrated that myoelectric activity of the colon is altered (Banasik, 2019). When diagnosing IBS, there is no definitive investigation since there is no biomarker specifically for IBS and is diagnosed clinically (Card et al. 2014).
IBS can be categorized in three different ways according to their symptoms. The manifestations of IBS vary between patients, but usually include diarrhea; categorized by IBS-D, constipation; categorized by IBS-C, or a combination of both; categorized by IBS-M (Banasik, 2019). Although the cause for IBS is unknown, some factors that play a role in IBS include stronger muscle contractions in the intestine, cause poorly coordinated signals between the brain and the intestines, a severe bout of gastroenteritis, early life stress, or changes in gut microbes such as bacteria or viruses (Mayo Foundation).
Certain triggers could cause symptoms in IBS patients, such as food and stress. Food allergies or intolerance can make symptoms of IBS worsen, such as when eating or drinking certain foods or beverages that include items such as wheat or dairy products (Mayo Foundation). Although stress may aggravate symptoms of IBS, it does not cause IBS (Mayo Foundation).
History
- Explain what health problems the patient has (Has she/he been diagnosed with other diseases? How do those situations contribute to the current condition?)
- Any other S/S? Any changes on S/S changes from the previous condition?
- Detail any and all previous treatments (Has she/he had any prior surgeries or is he/she on medication?)
- Other family history associated with this disease
- Nursing Physical Assessment
- Chief Complaint: Abdominal pain and cramps. Irregular bowel movement. Diarrhea-predominant stool pattern
- Airway: Patent
- Breathing: Unlabored
- Circulation: Palpable pulse 3+
- Neuro: Alert, clear, oriented
- Temperature: 98.6 °F.
- Respiratory Rate: 18 breaths per minute.
- Heart Rate: 63 beats per minute resting.
- Blood Pressure: 120.5/78.5 mmHg
- Oxygen Saturation: 97 (SpO2) %
- Pain: scale 7-8. Abdominal pain, cramp, pain comes and goes, pain for at least once a week for the past 3 months
- Intervention: Ibuprofen
- Weight: 190 lb.
- Height: 5’4
- Blood sugar level (BSL): 75 mg/dL
- Allergies: None
- Skin: Normal. No rash.
- Extremity: Normal
- Pulses: Regular
- Bowel sounds: Hyperactive
- Incontinence: Bowel
- Genitals: Normal
- Ambulation: Normal
- Abdominal examination: Mild tenderness of the lower left abdominal quadrant upon palpation. Feel no mass.
- Stool: Frequent, more than a quarter of stool are watery, stool softer than usual, whitish mucus in the stool, no bloody stool
- History: Family history of IBS. Family history is negative for IBD and colon cancer. She has always had stomach sensitivity with stomach bloating after eating. Her abdominal pain occurs after meals. She has been diagnosed with depression and anxiety.
Related Treatments
- Explain what MEDICAL treatments the patient is receiving because of his/her medical diagnosis (current and previous)
According to our patients signs and symptoms, she has IBS-diarrhea predominant. She has not been receiving any treatment besides altering her diet which is one of the MAIN things to do with IBS. Besides changing her diet, the doctor might also suggest Immodium A-D over the counter to help with the diarrhea. The doctor can also prescribe anticholinergic medication like Bentyl and that helps relieve painful bowel spasms. (Mayo Foundation) If you have diarrhea and abdominal pain without depression, your doctor may suggest a lower than normal dose of imipramine (Tofranil), desipramine (Norpramin) or nortriptyline (Pamelor). (Mayo Foundation) Our patient has depression so she will also be prescribed an SSRI antidepressant like Prozac or Paxil. There are other medications specifically for IBS, but they have to be prescribed by a doctor enrolled in a special program and these medications are for people who have severe cases and where they have tried everything else and it did not work. Irritable Bowel Syndrome Assignment
Nursing Diagnosis & Patient Goal
- Explain what your nursing diagnosis is (What is the main problem for this patient? What the physical situation, not the disease itself, needs to be addressed?)
- Explain what your goal is for helping the patient recover (What do you want to change for the patient mentally and physically?)
Reference cites: https://nurse.org/resources/nursing-diagnosis-guide/
Nursing diagnosis is where the nurse focuses on the overall care of the patient. For our patient Isa Bella Sandra the main issue for this patient is the symptoms of IBS, such as severe diarrhea, abdominal pain, cramping and change of bowel movements, being overweight and having depression. The first thing we need to do is ask about her health history alongside her family’s and we find out her family has a history of IBS. Then we take her vitals and all those are within the normal range. Then we address her pain level and the diarrhea to manage them so she can at least start to feel a little better. So, we can start an IV to compensate for all the fluids lost. Once those things are addressed, we need to move on and address the other symptoms. Then we can move on and talk to her about health awareness and health management to try and figure out a good healthy diet for her that will not cause inflammation for her IBS, but also give her the proper information that she needs. We need to make sure she understands how important it is to know exactly what she is ingesting and how her body is digesting that item and the absorption process alongside explaining to her how important hydration is for her. My main goal for this patient is to help her to try to live a normal life and not have IBS consume her. I want her to mentally accept her situation so that she can come up with next steps to manage it. Once we can figure out the right diet and treatment plan for her then she should be able to live a good life without lots of discomfort.
Nursing Interventions
There is currently no cure for irritable bowel syndrome. However, nursing interventions are treatments and actions performed by a nurse to help the patient reach their goals. Isa Bella Sandra has IBS-D diarrhea predominated stool pattern. First, there needs to be an observation and record of stool frequency, consistency, and characteristics to make sure there are no other underlying diseases or bacterial infections. The patient’s temperature, emotion, and other stressors need to be observed as well to pinpoint etiology. Isa Bella Sandra has frequent watery bowel movements that will decrease the body fluid volume. To make sure she does not go into hypovolemia there needs to be an oral restriction to minimize the fluid loss. Bed rest should highly be promoted. Bed rest will decrease intestinal motility and metabolic rate; therefore, decreasing intestinal fluid losses (Vera, 2020). To prevent further hypovolemia parenteral fluids such as normal saline should be administered. The treatment a nurse can administer is to give the patient an antimotility agent or antidiarrheal agent (Anastasi, 2013), Loperamide (Anastasi et al., 2013). Loperamide is an opioid receptor agonist. It helps reduce peristalsis, increase intestinal transit time, and diminishes loss of fluid and electrolytes (Lacy, 2016). Loperamide (Imodium) of 2 to 4 mg up to four times a day should be given as needed (Medline Plus, 2018). Loperamide will greatly help with stool frequency and consistency that Isa Bella Sandra is struggling with. It will help relieve the symptoms of diarrhea. However, it will not help with the other symptoms such as bloating and abdominal pain. Another antimotility agent option is Eluxadoline, this can be used for patients on which Loperamide has no effects ((Lacy, 2016). To help with abdomen pain antispasmodics can be given (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). Antispasmodics such as Dicyclomine are used to treat IBS (Medline Plus, 2017). The dosage is 10 to 20 mg up to four times a day as needed (Medline Plus, 2017). This drug helps relieve muscle spasms in the gastrointestinal tract (Medline Plus, 2017). It relieves muscle spasms; therefore, it helps with abdominal pain and cramps. Isa Bella Sandra’s history also notes that she is suffering from depression. She has comorbid IBS and depression disorder. The gut is closely connected with the central nervous system through the gut-brain axis (Gwak and Chang, 2021). Making sure Isa Bella Sandra is taking her antidepressants is important. Antidepressants will help the activity of serotonin in the GI tract and reduce the symptoms of IBS (Lacy, 2016). The symptom also includes abdominal pain. Once Isa Bella Sandra’s diarrhea is more stable, she can start having oral fluid and then solids. Dietary modification needs to be made to a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet. A low FODMAP diet is a restriction or limit put on food such as Oligosaccharides: wheat, rye, legumes, garlic, onions, Disaccharides: lactose, milk, yogurt, cheese, Monosaccharides: Fructose, figs, mangoes, honey, sweetener, and Polyols: blackberries and lychee. Studies have shown that patients with low FODMAP intervention have shown a lower symptoms severity score (March et al., 2016). A low FODMAP diet helps lower abdominal pain and bloating. Before discharge there needs to be a discussion with Isa Bella Sandra about her feelings and concerns regarding the diagnosis. Make sure she understands IBS and provides insight on the syndrome. Provide patient teaching on lifestyle changes such as diet and exercise that can help manage IBS. Schedule her for a consultant with a nutritionist that can provide her with the correct diet plan to minimize her symptoms.
Evaluation
- Explain how effective the nursing intervention was (What happened after your nursing intervention? Did the patient get better?)
- Recommendations
For the patient to improve her condition, the nurse can advise some exercise programs that meet the patient’s needs, help the patients identify life stressors, and they can also refer patients to a dietitian. This can certainly be manageable if she also drinks plenty of water, gets enough sleep, avoids foods with high fiber like wheat, and exercises regularly. Additionally, she can take medication such as alosetron prescribed by the doctor since it relaxes the colon and slows the movement of waste through the lower bowel (Mayo Foundation for Medical Education and Research, October 2015).
References
Anastasi, J. K., Capili, B., & Chang, M. (2013, July). Managing irritable bowel syndrome. The American journal of nursing. Retrieved September 29, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654469/.
Banasik, J. L., & Copstead, L.-E. C. (2019). Pathophysiology. Elsevier.
Canavan, C., Card, T., & West, J. (2014). The epidemiology of irritable bowel syndrome. Clinical Epidemiology, 71.
Gwak, M. G., & Chang, S. Y. (2021). Gut-Brain Connection: Microbiome, Gut Barrier, and Environmental Sensors. Immune network, 21(3), e20. https://doi.org/10.4110/in.2021.21.e20
Holtmann, G. J., Ford, A. C., & Talley, N. J. (2016). Pathophysiology of irritable bowel syndrome. The Lancet Gastroenterology & Hepatology, 1(2), 133–146.
Lacy, B. E. (2016). Diagnosis and treatment of diarrhea-predominant irritable bowel syndrome. International journal of general medicine, 9, 7–17. https://doi.org/10.2147/IJGM.S93698
Marsh, A., Eslick, E. M., & Eslick, G. D. (2016). Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. European journal of nutrition, 55(3), 897–906. https://doi.org/10.1007/s00394-015-0922-1
Mayo Foundation for Medical Education and Research. (2020, October 15). Irritable bowel syndrome. Mayo Clinic. Retrieved September 29, 2021, from