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Nursing 172 > Week 12: Chp 58: Irritable Bowel Syndrome > Flashcards

Week 12: Chp 58: Irritable Bowel Syndrome Flashcards

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1
Q

What is IBS?

A

complex and misunderstood functional disorder characterized by abdominal pain and altered bowel habits for which no other pathophysiological cause can be found

  • characterized by areas of bowel spasm and dilation
  • unknown etiology with no known cure
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2
Q

4 Subtypes of IBS

A
  1. IBS-C (constipation dominant)
  2. IBS-D (diarrhea dominant)
  3. IBS-M (mixed, or alternating from diarrhea to constipation)
  4. IBS unclassified (meets IBS diagnostic criteria but cannot be accurately categorized with the other 3)
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3
Q

Many theories regarding the pathophysiology

A
  • gastrointestinal motility
  • visceral hypersensitivity
  • intestinal inflammation
  • post-infection
  • bacterial overgrowth
  • food sensitivity
  • carbohydrate malabsorption
  • gluten sensitivity
  • genetics
  • psychosocial dysfunction
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4
Q

Clinical Manifestations

A

diarrhea, constipation, flatus, and abdominal pain that may vary based on classification

  • often report LLQ pain accompanied by abdominal distension and alternating bouts of diarrhea and constipation
  • the pain increases after eating and is relieved with bowel movements
  • due to the pain and abdominal cramping, the patient may become anorexic with noticeable weight loss
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5
Q

Treatment for IBS

A

is symptom based

  • no one treatment is effective for all patients; highly individualized
  • may be a lifelong struggle
  • patients are encouraged to keep a dietary diet, episodes of stress, and triggers associated with the onset of symptoms
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6
Q

How to Diagnose IBS

A

no test shows a definitive diagnosis of IBS
-number of tests may be performed to rule out other pathophysiological causes for concern:
>flexible sigmoidoscopy, colonoscopy, CT scans, lactose intolerance tests, stool cultures, and blood tests
-after organic causes have been ruled out, the Rome IV or Manning Criteria are used to make diagnosis of IBS

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7
Q

Rome IV Diagnostic Criteria for Functional Gastrointestinal Disorders

A

common diagnostic instruments
-patient must have had recurrent abdominal pain or discomfort at least 1 day per week in the last 3 months associated with two or more of the following:
>improvement (of pain) with defecation
>onset associated with a change in frequency of stool
>onset associated with a change in form (appearance) of stool

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8
Q

Manning Criteria

A 
tool used in the diagnosis of IBS
>the more clinical manifestations the patient has the greater the likelihood of being diagnosed with IBS:
-pain relieved with defecation
-more frequent stools at the onset of pain
-looser stools at the onset of pain
-visible abdominal distension
-passage of mucus
-sensation of incomplete evacuation
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9
Q

Treatment includes

A
  • medications
  • dietary modification
  • complementary and alternative therapies
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10
Q

Medications used for treatment of IBS

A
  • antispasmodic agents
  • antidiarrheal
  • guanylate cyclase agonists
  • serotonergic agents
  • selective type 2 chloride channel (CIC-2) activator
  • antidepressants
  • selective serotonin reuptake inhibitors (SSRI)
  • tricyclic antidepressants (TCAs)
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11
Q

Medications: antispasmodic agents

A

anticholinergic and antimuscarinic components that block acetylcholine, relaxing smooth muscle spasm and GI motility; inhibit gastric secretion
>Dicyclomine (Bentyl, Antispas)

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12
Q

Medications: Anti-diarrheals

A
  • slow bowel transit, enhance water absorption, and strengthen anal sphincter tone, resulting in fewer stools but does not relieve pain; Loperamide (Imodium)
  • decreases motility, propulsion, and secretions; Diphenoxylate hydrochloride (Lomotil)
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13
Q

Medications: Guanylate cyclase agonists

A

stimulates intestinal fluid secretion and transit

>Linaclotide (Linzess) for IBS-C despite treatment with osmotic laxative

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14
Q

Medications: Serotonergic agents

A
  • agonist activity causes release of other neurotransmitters and results in increased peristalsis, increased intestinal secretion, and decreased visceral sensitivity; Tegaserod (Zelnorm) for IBS-C in females
  • limits gastrocolic reflexes, which can slow transit time and improve muscle tone; Alosetron (Lotronex) for refractory IBS-D in female patients
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15
Q

Medications: Selective type-2 chloride channel (CIC-2) activator

A

increases fluid secretion in the small intestine and is believed to enhance colonic motility by increasing intraluminal volume
>Lubiprostone for IBS-C in women

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16
Q

Medications: Anti-depressants

A

low doses of antidepressants have been shown to decrease pain

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17
Q

Medications: SSRIs

A

inhibit serotonin uptake and may increase pain threshold while decreasing transit time
>Paroxetine (Paxil); fluoxetine (Prozac); sertraline (Zoloft)

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18
Q

Medications: Tricyclic Antidepressants (TCAs)

A

block norepinephrine reuptake and are believed to slow transit time and improve pain tolerance
>Amitriptyline (Elavil); imipramine (Tofranil); nortriptyline (Pamelor); desipramine (Norpramin)

19
Q

Focus on Medical Management

A

controlling spasm, minimizing diarrhea, releasing neurotransmitters to promote peristalsis, and addressing depression

20
Q

Dietary Modifications

A

-diet high in fiber
-diet low in fermentable oligo-, di-, and mono-saccharides and polyols (FODMAPs) are noted to improve symptoms for IBS
-avoid fructose, apples, pears, mangoes, cherries, and wheat
-avoid gas-producing food
-benefit from avoiding lactose
>patient eliminate FODMAPs from their diet for 6 to 8 weeks, after resolution of symptoms, they are gradually re-introduced to determine tolerance for specific foods

21
Q

Complementary and Alternative Therapies

A

relaxation techniques, acupuncture, hypnosis, and hypnotherapy

  • probiotics
  • regular exercise, yoga, massage, or meditation to relieve stress and anxiety
  • herbs (peppermint and fennel, herbal teas, and ginger) demonstrated some relief of IBS but be used with caution under advice of healthcare provider
22
Q

Complications

A

involve psychosocial concerns such as social isolation and diarrhea

  • if certain food groups are avoided because of onset of symptoms, patients may not be receiving all the nutrients they need
  • fluid volume deficit and hypokalemia when the patient has bouts of frequent diarrhea
23
Q

Nursing Management: Assessment and Analysis

A

patients can often associate foods that may trigger symptoms and keeping a diary can assist in identifying these trigger foods

  • patients associate a stressful situation with the onset of symptoms, and the diary helps to identify these sources of stress and find better ways with dealing with them
  • may also complain of anxiety, sleep disturbances, and difficulty concentrating
24
Q

Clinical Manifestations for IBS

A

intermittent abdominal pain and altered bowel habits

  • most frequent complaint of abdominal pain is in the LLQ with relief after defecation
  • abdominal distention and bloating
  • anorexia
  • excessive flatulence
  • dyspepsia (heartburn)
  • eructation (belching)
  • a continual urge to defecate
  • a sense of incomplete evacuation
  • nausea and increased pain may be associated with meals
  • in IBS-D there may be mucus in the stool but not blood
  • IBS-D nocturnal diarrhea is uncommon and is usually indicative of an organic disease
25
Q

Nursing Diagnoses

A
  • chronic pain r/t spasms and increased motility
  • ineffective coping r/t the psychosocial effects of IBS
  • ineffective health maintenance r/t living with a chronic disease
26
Q

Nursing Assessments

A
  • Vital Signs
  • Intake and Output
  • Serum Electrolytes
  • Pain
  • Bowel Pattern
  • Weight
  • Psychosocial Assessment
27
Q

Assessments: Vital Signs

A

elevated heart rate and blood pressure may develop secondary to severe pain
-fever may develop secondary to dehydration, inflammation, or infection

28
Q

Assessment: Intake and Output

A

with frequent bouts of diarrhea, the patient is at increased risk of fluid volume deficit

29
Q

Assessment: Serum Electrolytes

A

the patient is at risk for hypokalemia during bouts of diarrhea
-serum sodium and blood urea nitrogen may be elevated secondary to dehydration

30
Q

Assessment: Pain

A

the most frequent complaint of abdominal pain is in the LLQ with relief after defecation and is most likely due to the intestinal spasm and dilation

31
Q

Assessment: Bowel Pattern

A

patients with IBS may have constipation, diarrhea, or a combination of both

32
Q

Assessment: Weight

A

the patient is at risk of weight loss, particularly during exacerbations of IBS

33
Q

Assessment: Psychosocial assessment

A

because onset of symptoms is often associated with stress, a thorough psychosocial assessment can reveal triggers

34
Q

Nursing Actions

A
  • administer ordered IV solutions
  • establish a trusting relationship
  • avoid foods that exacerbate clinical manifestations
  • establish a regular bowel routine
  • implement complementary and alternative medicines that may relieve symptoms
  • make appropriate referrals
35
Q

Nursing Actions: Administer ordered IV solutions

A

based on the degree of fluid volume deficit that results from diarrhea, IV replacement fluids are ordered
>0.45 NS with potassium supplementation

36
Q

Nursing Actions: Establish a trusting relationship

A

IBS is often thought of as a psychological illness rather than a physical illness
-a therapeutic, trusting relationship is necessary for the patient to have an open relationship with the caregiver, providing empathy and support

37
Q

Nursing Actions: Avoid Foods that exacerbate clinical manifestations of IBS

A

caffeine and alcohol increase GI motility and irritate the GI mucosa
-indigestible carbohydrates such as beans produce increased gas, leading to abdominal discomfort

38
Q

Nursing Actions: Establish a regular bowel routine

A

drinking six to eight glasses of water per day helps to regulate stool frequency
-increase physical activity to promote GI motility

39
Q

Nursing Actions: Implement complementary and alternative medicines that may relieve symptoms

A

often help relieve symptoms and should be used only under the advice of the provider
>Peppermint (Mentha piperita) and fennel (Foeniculum) are natural antispasmodics and have anti-inflammatory properties; they relax smooth muscle in the intestines and help expel gas
>Herbal teas such as chamomile have gentle antispasmodic properties
>ginger helps control nausea and expel gas

40
Q

Nursing Actions: Make appropriate referrals

A 
to:
-dieticians
-psychological counseling
-support groups
>irritable bowel syndrome is a complex disease of unknown etiology that requires an interprofessional approach including a dietitian, case manager, and psychiatric approaches
41
Q

Teachings

A
  • avoid trigger foods that exacerbate clinical manifestations
  • keep a diary
  • consume regular meals and drink 8 to 10 cups of liquid per day (enhances promotion of regular bowel habits)
  • encourage regular exercise and 7 to 8 hours of sleep each night (important for regular bowel habits and managing stress and anxiety)
  • smoking cessation techniques (nicotine increases GI motility leading to increased pain and/or diarrhea)
42
Q

Common Trigger foods for abdominal discomfort

A

caffeine, alcohol, eggs, wheat products, and beverages containing sorbitol or fructose
-these foods may increased GI motility, leading to increased abdominal pain and/or diarrhea

43
Q

Expected outcomes

A

stable vital signs and weight, decrease in clinical manifestations, and patients understanding and adherence to nutritional and activity recommendation to manage this chronic disease
-establish a trusting relationship

44
Q

The nurse recognizes which findings as diagnostic for IBS?

A

Rome IV and/or Manning Criteria

Nursing 172 (120 decks)

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