Nursing Care Plan for Inflammatory Bowel Disease (Ulcerative Colitis / Crohn’s Disease)

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Pathophysiology

Inflammatory Bowel Disease is a term that describes two conditions that are characterized by chronic inflammation of the digestive tract. These conditions experience periods of remission and acute phases and include Ulcerative Colitis and Crohn’s disease. Ulcerative Colitis (UC) causes long-lasting inflammation and ulcers in the digestive tract, usually affecting the innermost lining of the colon. Crohn’s disease is a type of inflammatory bowel disease in which the inflammation spreads deep into the layers of the affected bowel tissue anywhere in the GI tract.

Etiology

Cause is not completely known, but it is believed to be related to an immune system dysfunction and heredity. Patients are at increased risk for developing IBD if they have close family members with the condition or have long term use of NSAIDS. Complications may include colon cancer, sclerosing cholangitis and blood clots. Additional complications of Crohn’s disease may be a bowel obstruction, malnutrition, ulcers, fistulas and anal fissures. Ulcerative colitis may lead to toxic megacolon, perforated colon and severe dehydration.

Desired Outcome

Normal stools, free from pain and infection, longer periods of remission

Inflammatory Bowel Disease (Ulcerative Colitis / Crohn’s Disease) Nursing Care Plan

Subjective Data:

  • Severe diarrhea
  • Abdominal pain and cramping
  • Rectal pain
  • Fatigue
  • Reduced appetite
  • Urgency to defecate
  • Inability to defecate despite urgency

Objective Data:

  • Blood or pus in stool
  • Weight loss
  • WBC in stool
  • Multiple stools daily

Nursing Interventions and Rationales

  • Monitor vital signs

 

Watch for signs / symptoms of hypovolemia including:

  • Hypotension
  • Tachycardia
  • Fever

 

  • Perform perineal care

 

Severe diarrhea may lead to incontinence of bowels, especially in patients with limited mobility. Provide perineal care every 2-4 hours or as needed to prevent breakdown of skin and infections. Make sure to clean from front to back, and between skin folds of the buttocks and scrotum. Apply barrier cream as appropriate to protect skin.

 

  • Collect and monitor labs
    • Stool sample- used to determine if there is blood or WBCs in the stool
    • Blood sample – check for anemia and signs of infection, evaluate electrolytes

 

  • Rule out bacterial, viral or parasitic infection
  • Determine if supplementation is necessary
    • Potassium
    • Magnesium
    • Sodium
    • Acid-base balance

 

  • Promote bedrest

 

Rest decreases intestinal motility when diarrhea is a problem. If patient has frequent urge to defecate, provide bedside commode to prevent incontinence and reduce risk of falls

 

  • Monitor I & O

 

Note number, character, and amount of stools to determine renal function, bowel disease control and need for fluid replacement; daily weights may be necessary

 

  • Prep patient / assist with colonoscopy, sigmoidoscopy or upper endoscopy

 

  • Patients must be fasting, no food or drink for 4-8 hours prior to the procedure
  • Administer conscious sedation
  • Monitor vitals while patient is sedated per facility policy
  • Assist with ambulation immediately following procedure until sedation is fully worn off
  • NPO until gag reflex returns

 

  • Provide oral care at least every 12 hours until

 

Dry mouth from an NPO status can cause a build up of bacteria and fungus in the mouth resulting in ulcerations, thrush and cavities.

  • Assess oral mucosa and inspect for dried secretions in the roof of the mouth that may impair breathing.
  • Swab mouth every 2-4 hours for hydration and comfort
  • Use wet toothbrush without toothpaste to clean teeth, gums and tongue to prevent aspiration
  • Suction secretions as necessary

 

  • Administer Medications per order or facility protocol

 

  • Anti-inflammatories– corticosteroids such as prednisone or hydrocortisone
  • Immunosuppressants– azathioprine, cyclosporine
  • Antibiotics– metronidazole, ciprofloxacin
  • Anti-diarrheal– loperamide
  • Pain reliever– acetaminophen (NSAIDS are contraindicated)
  • Iron supplements– as needed for iron-deficiency anemia due to intestinal bleeding

 

  • Perform and educate patient to perform stoma care if ileostomy is necessary

 

  • Change ostomy system as needed per facility protocol, usually every 2-4 days
  • Empty the ostomy pouch when ⅓ full
  • Clean stoma with each bag change, using soap and warm water, avoiding alcohol based cleaners.
  • Assess the skin around the stoma for bruising or ulceration
  • The stoma should be pink or red

 

  • Encourage patient to make healthy lifestyle choices

 

  • Limit or avoid alcohol which may increase diarrhea
  • Exercise- healthy diet and exercise help to normalize bowel function
  • Stop smoking- smoking increases the risk of Crohn’s and the frequency of recurrences
  • Reduce stress- many patients report symptom flares during periods of high stress

 

  • Provide nutrition education

 

  • Limit dairy products due to correlation with lactose intolerance
  • Increase low-fat foods- with Crohn’s disease, fat passes through the intestine instead of being absorbed making diarrhea worse
  • Limit fiber- includes raw fruits, vegetables and whole grains
  • Limit other problem foods- spicy foods, alcohol, caffeine
  • Eat small frequent meals
  • Drink plenty of fluids- water is best

 


References

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