Irritable Bowel Syndrome (IBS) PDF

# Irritable Bowel Syndrome Maria G. Nelson Batch 17 - PCN ## What is IBS? * Also known as spastic colon, spastic colitis, mucous colitis and irritable colon * Most common functional disorder of the GIT * Causes increased motility of the small or large intestine * Affects the intestine’s structu...

# Irritable Bowel Syndrome Maria G. Nelson Batch 17 - PCN ## What is IBS? * Also known as spastic colon, spastic colitis, mucous colitis and irritable colon * Most common functional disorder of the GIT * Causes increased motility of the small or large intestine * Affects the intestine’s structure, but cause is unknown * Does not lead to or cause ulcerative colitis or cancer ## Signs and Symptoms * Causes alternately tense and flaccid bowel segments * Symptoms vary in intensity and pattern * Aggravated by foods, alcohol ingestion, stress and fatigue * Resulting symptoms include: * Nausea * Abdominal pain * Cramps * Flatulence (gas) * Altered bowel function (constipation or diarrhea) * Hypersecretion of colonic mucus ## Diagnosis * Upper GI series * Barium enema * Colonoscopy appropriate for older adults * Tests that eliminate other pathologies with similar symptoms * Nursing Alert! * Rectal Bleeding and fever are not associated symptoms of IBS. The person with these symptoms should report to a physician for evaluation. **Endoscopic Procedure** A diagram showing the endoscope inserted into the rectum, depicting various internal organs of the digestive system. ## Treatment * Lifestyle changes * Counseling * Biofeedback and relaxation training * High-fiber diet and agents that add bulk like Metamucil and Effersyllium * Adequate oral fluids and regular meal patterns * Limitation of dairy products if lactose intolerant * Medications for symptomatic relief ## Types of Medications * Sedatives or tranquilizers such as alprazolam (Xanax) * Help quiet the bowel’s activity * Provide relaxation * Antispasmodic agents like dicylclomine hydrochloride (Bentyl) and hyoscyamine (Donnatal) * Relieve pain and cramping symptoms * Common side effects: * Dry mouth * Blurred vision * Dizziness * Antidiarrheal agents like loperamide (Imodium) to maintain normal activity ## Nursing Considerations * Consistency * Follow prescribed treatment plan. * Keep a log or diary to track progress or identify changes. # Constipation Maria G. Nelson Batch 17 ## What is Constipation? * Infrequent, hard bowel movements accompanied by mucus * May be acute or chronic * Fecal impaction * Loose, watery stool and mucus traveling around the constipated stool * Prolonged constipation * Sign of serious difficulty – intestinal obstruction or paralytic ileus * Immediate action needed! ## Causes * Dehydration * Cancer * Chemical dependency * Mechanical obstruction * Psychosomatic disorder An image shows two diagrams depicting the inside of the rectum and colon for individuals with normal bowel function and chronic constipation. ## Treatment * Enemas for removal of feces and flatus * Diagnostic test or surgery * To alleviate symptoms of constipation or distension * To administer specific medications or fluids * Digital removal of fecal impaction for severely constipated or paralyzed clients * Done only when stool softeners and enemas fail * Fecal impaction as a possible complication of barium enema or barium swallow ## Nursing Considerations * Warn client not to strain while defecating. * Client should quit worrying – compounds the problem * Lots of fluids – drink prune juice * Increase dietary bulk * Exercise * Regular schedule for defecation * Postponing urge to defecate desensitizes the bowel to the presence of feces ## Constipation in Older Adults * Multiple medications may decrease peristalsis, cause water loss and interfere with intestinal absorption. * Limited mobility or exercise * Low intake of dietary fiber * Difficulty with chewing, swallowing or ingesting * Daily stool softeners suggested but regular laxatives should be avoided. * Caution: Loose watery stools may not be diarrhea – could be severe constipation with leakage of H2O around blockage. * Assess for fecal impaction. # Diarrhea Maria G. Nelson Batch 17 ## What is Diarrhea? * Liquid or semi-liquid stools, often light colored * May be foul smelling, contain mucus, pus, blood or fats * Often accompanied by flatus and severe, painful abdominal cramps or spasms (tenesmus) that defecation relieves * Complications of severe or chronic diarrhea include: * Dehydration * Electrolyte disturbances * Cardiac dysrhythmias * Hypovolemic shock ## Signs and Symptoms * Bacterial invasion by S. dysenteriae or Salmonella * Clostridium botulinum * Anaerobic bacterium often the cause of nosocomial diarrhea * Infection that occurs in acutely ill patients who have received countless courses of antibiotics * Inflammatory bowel disease (IBD) * Often cause of diarrhea * Medications * Can cause diarrhea that stops when treatment stops ## Diagnosis * Evaluation of possible causes before client self-medicates * If it awakens the client from normal sleep – indicates intestinal pathology; bacterial infection, IBS or IBD should be ruled out. * Stool tests including cultures, occult blood tests, and O & P smears are performed. * Hematology studies indicate infection of inflammatory processes. * Lower GI barium exams to rule out pathologic causes ## Treatment An image depicts two diagrams illustrating the normal and diarrhea-stricken digestive system, highlighting the differences in the absorption rate of water. * Elimination of the cause * IV fluids and electrolytes * Medications ## Medications for Diarrhea * All contraindicated in poisoning unless poison is removed from GIT * Motility reduction: loperamide (Imodium), diphenoxylate (Lomotil) * Potential for drug dependence; may cause dizziness, constipation and drying of mucous membranes * Lomotil cannot be used when pregnant * Bile salt-binding agent: cholestyramine (Questran) * May cause constipation, nausea, bloating, abdominal pain, rash * Cannot be mixed with other medications because it blocks their absorption * Antibiotics: to treat bacterial/microbial diarrhea ## Nursing Considerations * Assess client's fluid I&O and weight. * Monitor for s/s of electrolyte disturbances and electrolyte levels – can disrupt electrolyte balance * Record exact time, amount and character (TAC) of each stool. * Restrict client’s diet to clear liquids. * Reintroduce food and fluids slowly to observe for improvement or worsening. * Client teaching that includes prevention of food contamination with S. aureus and Salmonella, often sources of diarrhea.