Nursing Care Plan (NCP) 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

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

A Nursing Care Plan (NCP) for Inflammatory Bowel Disease (Ulcerative Colitis / Crohn’s Disease) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

In this nursing care plan, we will explore inflammatory bowel disease, including both ulcerative colitis and Crohn’s disease. So in this nursing care plan for inflammatory bowel disease, we’re going to look at the outcome, the subjective and objective data and the nursing interventions along with the rationales for each. 

 

Our medical diagnosis for a patient is inflammatory bowel disease and we’re going to explore both ulcerative colitis and Crohn’s disease. Inflammatory bowel disease is a term that describes two conditions that are both characterized by inflammation in the GI tract. Ulcerative colitis causes long lasting inflammation and ulcers in the digestive track on the innermost lining. Crohn’s disease causes the inflammation deep within those layers and is throughout the entire GI tract. The causes are not completely understood, but it’s believed to be an immune system dysfunction and also hereditary. The desired outcome is to have normal stools be free from pain and infection and to have periods of remission. 

 

Now, let’s take a look at our care plan. So the subjective data that you might see in your patient is that they might be experiencing severe diarrhea, abdominal cramping and pain, rectal pain, fatigue, reduced appetite, urgency or the inability to defecate. All of these symptoms are all because of the inflammation and irritation in the bowels. 

 

For the patient’s objective data, we’re going to probably see some blood or even pus in the stool. The patient might experience weight loss. If they’ve been having a lot of diarrhea or are unable to eat, they might experience some white blood cells in the stool and like I said previously, they might be having multiple stools daily. 

 

Now let’s take a look at our nursing interventions and the rationales for each. So our first nursing intervention is to monitor their vital signs. You’re going to be watching for hypovolemia like low blood pressure, high heart rate, or fevers. You’re also going to be performing perineal care in your patient. Remember, this is going to cause some diarrhea in your patient, which can even lead to incontinence. So, we want to keep them clean, provide the peri care every two to four hours to prevent skin breakdown, and we don’t want to get any infections. You will want to collect and monitor labs and collect a stool sample to look for blood and white blood cells. You will have them draw blood to look for anemia, signs of infection, and electrolyte imbalances.  You’re going to rule out any bacterial, viral or parasitic infections in the patient. 

 

For your patient with inflammatory bowel disease, you want to try to promote bed rest, because rest decreases intestinal motility to try to help slow things down and decrease that diarrhea. If your patient has really frequent urges to defecate, or maybe they’re having some problem with some incontinence, just provide a commode at the bedside and maybe that will help them and also reduce the risk of falls.

 

So, the next nursing intervention is to monitor the intake and output of your patient. Now, I want you to note the number, character and amount of stools to determine hydration and control of the disease. Your patient might have to have a colonoscopy, sigmoidoscopy or an upper endoscopy, depending on what the doctor chooses. So, you’ll prep the patient according to your policy and prepare them for the procedure. You might have to provide bowel prep the night before to clean their bowels out so that they can see with the camera. The patient’s going to be NPO at least four to eight hours before the procedure as well. So, the patient has to be monitored during the procedure, including their vital signs, while they’re sedated per facility policy. Immediately after, help them with their ambulation until that sedation has worn off and keep that patient NPO until their gag reflex comes back. You want to avoid any aspiration. 

You should provide oral care at least every 12 hours on your patient while they’re NPO, because dry mouth from an NPO status can cause the buildup of bacteria and fungus in the mouth resulting in ulcerations, thrush, cavities, and even pneumonia. Assess their mouth, look for any dry crusty chunks that might be stuck in the back of the mouth, because those can break out and obstruct the airway. Swab the mouth every two to four hours or as needed and you can use a toothbrush without toothpaste, just to clean the teeth, the gums, and the tongue, get any of those secretions out, and you can suction as needed to avoid aspiration. 

 

For your patient with inflammatory bowel disease, you’re going to administer medications per order, or facility protocol. These medications might help to decrease the inflammation, relieve pain, decrease diarrhea, or treat anemia infection as needed. 

 

Our next nursing intervention is to educate the patient to perform stoma care if an ileostomy was necessary. You will teach them how to assess, clean and change the bag and keep the area clean and free from infection or ulcerations. You’ll want to prevent that bag from overfilling. I like to empty it when it’s at least a third full, just so that way it doesn’t get too full and break off and cause a big mess. You’ll want to encourage your patient to make healthy lifestyle choices. This is going to help to decrease flare ups as a lot of foods can cause inflammation in the bowels. You want to decrease things like dairy. You’ll want to tell them to try to avoid caffeine, alcohol, and try to tell them to work on having a low fat diet, because that’s going to make it a little easier to digest. Encourage your patients to find ways, I know it’s hard, but find ways to decrease stress because that will help limit that irritation and the flare ups. Encourage them to also eat frequent small meals and increase their fluids. We want to keep them hydrated. They should also try to limit their fiber such as raw fruits, or raw vegetables, because when you have all that fiber in there it kind of makes things even worse. 

 

We love you guys. Now go out and be your best self today and as always, happy nursing!

 

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