Question

C.W., a 36-year-old woman, was admitted several days ago with a diagnosis of recurrent inflammatory bowel disease (IBD) and possible small bowel obstruction (SBO). C.W. is married, and her husband and 11-year-old son are supportive, but she has no extended family in-state. She has had IBD for 15 years and has been taking mesalamine (Asacol) for 15 years and prednisone 40 mg/day for the past 5 years. She is very thin; at 5 feet 2 inches she weighs 86 pounds and has lost 40 pounds over the past 10 years. She has an average of 5 to 10 loose stools per day. C.W.'s life has gradually become dominated by her disease (anorexia; lactase deficiency; profound fatigue; frequent nausea and diarrhea; frequent hospitalizations for dehydration; and recurring, crippling abdominal pain that often strikes unexpectedly). The pain is incapacitating and relieved only by a small dose of diazepam (Valium), oral electrolyte solution (Pedialyte), and total bed rest. She confides in you that sexual activity is difficult: “It always causes diarrhea, nausea, and lots of pain. It's difficult for both of us.” She is so weak she cannot stand without help. You indicate complete bed rest on the nursing care plan.

Discuss the pathophysiology of this client, plan of care and have 3 management goals

Answer 1

#. Pathophysiology of the disease :-

Involves an immune reaction to a person's own intestinal tract

Some agent or combination of agents triggers an overactive, inappropriate, sustained immune response

Results in widespread inflammation and tissue destruction

#. Plan of care :-

Ascertain onset and pattern of diarrhea To assess etiology. Chronic diarrhea (caused by irritable bowel syndrome, infectious diseases affecting colon such as IBD).

Observe and record stool frequency, characteristics, amount, and precipitating factors. Helps differentiate individual disease and assesses severity of episode.

Observe for presence of associated factors, such as fever, chills, abdominal pain,cramping, bloody stools, emotional upset, physical exertion and so forth.To assess causative factors and etiology.

Promote bedrest, provide bedside commode Rest decreases intestinal motility and reduces the metabolic rate when infection or hemorrhage is a complication. Urge to defecate may occur without warning and be uncontrollable, increasing risk of incontinence or falls if facilities are not close at hand.

Remove stool promptly. Provide room deodorizers. Reduces noxious odors to avoid undue patient embarrassment.

Identify and restrict foods and fluids that precipitate diarrhea (vegetables and fruits, whole-grain cereals, condiments, carbonated drinks, milk products).Avoiding intestinal irritants promote intestinal rest and reduce intestinal workload.

Restart oral fluid intake gradually. Offer clear liquids hourly; avoid cold fluids.Provides colon rest by omitting or decreasing the stimulus of foods and fluids. Gradual resumption of liquids may prevent cramping and recurrence of diarrhea; however, cold fluids can increase intestinal motility.

#.3 Management goals :-

- Reduce pain

- Manage diarrhoea

- Improve nutrition status