Application Nursing Care and Practice for Patients with Irritable Bowel Syndrome - Essay Example

? Application nursing care and practice for patients with irritable bowel syndrome October Application nursing care and practice for patients with irritable bowel syndrome Abstract The scope of nursing that include provision of care, administration of involved processes, teaching, and counseling requires background information on healthcare issues and applicable strategies to resolving the issues. This paper reviews background information of irritable bowel syndrome. Introduction Nursing is one of the professions in health care sector and ensure care provision to people and groups towards desired health standards. Nurses ensure that individuals and groups such as families and communities achieve high level health standards through preventive measures and that proper management initiatives are put in place to ensure treatment of diseases and infections and to facilitate recovery from effects of the diseases and infections. The scope of nursing further identifies functions such as provision of care, educative roles, counseling, administration, and clinical specialist services. Proper background of health issues is fundamental to a practicing nurse and such knowledge bases as causes of a health problem, its symptoms, and preventive and control measures are therefore necessary for a practicing nurse. This paper demonstrate this competence through exploration of irritable bowel syndrome, its signs, symptoms, and causes, medical and alternative interventions, nursing care assessment and considerations in acute care settings, and plans for community follow up and support systems for management of irritable bowel syndrome. Signs, symptoms, and causes of IBS Irritable bowel syndrome is symptomatic, offering a basis for prediction among the public and diagnosis by care personnel. The primary symptom of the syndrome is pain in the victim’s abdomen. Degree of the pain may vary from a mere discomfort to extreme levels of pain. The pain is further associated with abnormal bowel behavior. While movements of the bowel are normal, irritable bowel syndrome is associated with change in movement pattern that may assume relatively lower or higher frequencies and this variation can be associated with the experienced pain or discomfort by a victim. A slight variation in either direction may initiate discomfort wile extremely lower or higher changes in movements may lead to extreme levels of pain. Observable changes are also made on stool that may be adverse and change with variations in bowel motions. Some cases of irritable bowel syndrome report loose stools that worsen to be more watery while others report harder stools that normally experienced by patients. A number of secondary symptoms also exist to suggest existence of the syndrome. The loose or watery stool may be experienced frequently to define diarrhea, more tat three watery stools per day, and may be associated with sudden need for bowel movement. Frequent hard stools in a week are another secondary indicator of the syndrome and victims may have trouble with bowel movement. Another symptom is the “feeling that a bowel movement is not complete” and this may lead to longer periods of trying to pass out stool (Digestive, 2012, p. 1). Other symptoms are “passing mucus” and “abdominal bloating” (Digestive, 2012, p. 1). The symptoms must however have been reported for a minimum of three days in a month in order to suggest existence of irritable bowel syndrome in a patient. The exact cause of irritable bowel syndrome is not yet ascertained but many health complications are believed to initiate the syndrome, either individually or collectively. “Brain-gut signal problem,” impaired coordination between the brain and nerves in the small intestines is one of the factors. Coordination between the brain and the nerves regulate the intestines’ functionality and poor coordination initiates variation in movements towards changed bowel behavior and associated pain (1). Complications with gastrointestinal movements are another cause of the syndrome. Slow movements or lack of movements causes constipation while increases frequency motions lead to watery stool and even diarrhea. Drastic and massive muscle contraction that relapses and resume has been associated with reported pain among people who experience the bowel syndrome. Hypersensitivity is another identified cause of the syndrome as it increases susceptibility. Those who are hypersensitive are likely to report levels of pain and changed nature of stool into diagnosis than those whose bodies are more tolerant. Even though no clear relationship has been developed to explain the relationship between mental disorders and irritable bowel syndrome, such disorders as “panic disorder, anxiety, depression, and post traumatic stress” have identified high rates of the syndrome than normal mental conditions (Digestive, 2012, p. 1). Intestinal bacteria, secreted chemicals in the body, and genetic factors are other causes of irritable bowel syndrome (Digestive, 2012; Calibre, 2010). Medical interventions, diagnosis, medications, and treatments of IBS United Kingdom’s National Institute of health offers a systematic approach to diagnosing irritable bowel syndrome. Initial assessment involves a series of symptomatic reviews before a person can be subjected to clinical tests. The reviews aim at eliminating cases that do not relate to the bowel syndrome. Existence of “abdominal pain or discomfort,” “bloating,” and “change in bowel habit” for a minimum of half a year is the initial step to classifying a person as a potential victim of the syndrome (National Institute for Health and Clinical Experience, 2008, p. 11). Those who have had the symptoms for the period can then be examined for warnings whose existence requires referral care facilities. The warnings are “unintentional and unexplained weight loss, rectal bleeding, a family history of bowel or ovarian cancer,” and persistent variation in bowel behavior for at least six weeks (National Institute for Health and Clinical Experience, 2008, p. 11). Clinical evaluation for complications such as “anemia, abdominal masses, rectal masses, and inflammatory markers for inflammatory bowel disease” should then be conducted and positive results considered as potential cases of irritable bowel syndrome. A consideration of abdominal pain that ceases upon defecation or changes with bowel movements together with at least any two of the following symptoms confirms existence of irritable bowel syndrome. The symptoms are changes in tool passage, “abdominal bloating,” deterioration of symptoms after meals, and “passage of mucus” (National Institute for Health and Clinical Experience, 2008, p. 12). Other clinical tests such as full blood count, erythrocyte sedimentation rate, c-reactive protein and antibody testing for celiac disease are further necessary to eliminate possibility of other complications (National Institute for Health and Clinical Experience, 2008, p. 11). Treatment is the available medical intervention for the complication. While no cure has been established, symptoms can be managed through “changes in eating, diet, and nutrition, medications, probiotics,” and management of mental complications (Digestive, 2012, p. 1). Other medications are laxatives, anticholinergic agents, antidiarrheal agents, and antibiotics (MedlinePlus, 2013). A variety of over the counter drugs are also available for the syndrome and alverine, colofac, kolanticon, fybogel, and spasmonat are examples (NHS choises, n.d.).   Alternative treatments: Naturopathic and homeopathic remedies and radical diets Naturopathic alternatives relies on the principle that the body can manage health complications through eliminating harmful factors, availing necessities for well being, and initiating psychological strategies. Removal of harmful organisms is an example of naturopathic approach to irritable bowel syndrome and involves elimination of disease causing microorganisms such as bacteria and yeast from the body. The body also eliminates food substances that threaten its stability and examples of such foods are foods with high levels of refined sugar. The syndrome is associated with deficiencies and replacement concept of naturopathic treatment offers remedies. Factors such as stress and lack of essential nutrients cause bowel malfunction towards the syndrome and the body supplies the depleted elements. The body also reinoculates with other organisms to manage effects of the syndrome and aid functionality of the bowel. Inoculation also helps to prevent microorganisms, which may inhabit the bowel, from infesting the bowel and inhibiting its functionality. Repair of the gut is another naturopathic treatment for irritable bowel disorder and include “regeneration and healing” of “glutamine, essential fatty acids, zinc, and pantothenic acid” (Wilson, 2010, p. 32). Homeopathic alternatives to treatment of irritable bowel syndrome have also been proposed through use of herbs through validity of their effectiveness remains uncertain (National Institute of Health, 2008). Eating style is another important non-medicinal approach to management of the syndrome. Eating small volumes of food at intervals, rather that consumption of large volumes is one of the management strategies and can help in preventing occurrence of the syndrome’s symptoms. Large quantities of meals are for example associated with diarrhea and stomach cramps and avoiding such consumptions will prevent occurrence of the symptoms or reduce their significance. Certain types of food, such as carbohydrates and foods with minimal fat content, also help in managing the syndrome’s symptoms. A number of food items have also been associated with risks of irritable bowel syndrome and restraining from their consumption can help in prevention and management of the symptoms. Examples of such foods are foods that induce gas in the gastrointestinal track, food with sweetener additives, alcoholic products, and milk (Digestive, 2012). Knowledge of fibre content of different types of foods is another important tip to managing the symptoms. Insoluble fibre, for instance, worsens diarrhea among patients and a reduction in its consumption is necessary for effective management of the symptom while soluble fibre and water helps in managing constipation and is encouraged for managing constipation based irritable bowel syndrome (NHS choises, n.d.). Exercise also plays a significant role in managing the symptoms through stress management. This is because of the role of stress in moderating symptoms and regular and intensive exercise highly suppresses symptoms (Virginia, 2010). The medicinal and alternative treatment measures should contain symptoms but persistent symptoms, extending to more than one year, requires psychological intervention measures that focuses on empowerment towards techniques for self-management of symptoms. Hypnotherapy, “psychodynamic interpersonal therapy,” and “cognitive behavioral therapy” are examples of commonly used psychological treatments (NHS choises, n.d., p. 1). Hypnotherapy helps to change a person’s consciousness and attitude towards the conditions and symptoms and helps in managing pain. Its techniques can be learnt and applied in health facilities or at home by the patient. Psychodynamic interpersonal therapy involves the aid of a therapist towards self-awareness. It is based on the assumption that a person’s “unconscious thoughts, beliefs, and attitudes” influences his or her thoughts, actions and emotions and understanding such unconscious background can empower a person to changed perceptions, emotions, and behaviors for better management of irritable bowel syndrome symptoms. A therapist helps the victim to explore his or her past in order to develop the desired consciousness (NHS choises, n.d., p. 1). Cognitive behavioral therapy also applies interpersonal communication for a changed attitude in a patient. It relies on the assumption that emotions determine a person’s thoughts and that positivity reduces the level of pain that a person can feel from the symptoms (NHS choises, n.d.). Specific nursing care assessments and considerations for IBS in an acute care setting Manning, Rome I, and Rome II are the commonly applied assessments for irritable bowel syndrome in acute care settings. Manning is a traditional assessment approach and was established before the modern Rome assessment criteria. Each of the assessments has considerations for determining presence of irritable bowel syndrome. Considerations for Manning include pain in the abdomen that stops after bowel movements, watery stool that accompany experience of pain, and increased rate of tool once the pain begins. Feeling of incomplete passage of stool and discharge of mucus are other considerations under the manning assessment. Rome I criteria was developed in the year 1992 and offers refines assessment for the syndrome towards diagnosis and monitoring and evaluation of progress. Its major consideration is pain in the abdomen that varies with passage of stool. Criteria for the pain must identify existence for more than three months and a relationship with the rate of passage of stool. Changed pattern in passage of stool is another consideration of the Rome I criteria and the change may be with respect to frequency of passage, nature of the stool, whether watery or hard, the passage process that may be associated with difficulty, urgency, and the feeling that the passage is not complete. Changes in passage consideration also include mucus and bloating factor. Considerations for Rome II criteria are 12 weeks of pain in the last one year that is further associated with relief upon passage of stool, realization of pain upon change in rate of stool passage, and realization of the pain upon change in form of stool. Any pair of the three conditions is sufficient. Another assessment, Rome III criteria identifies symptoms whose prevalence for a minimum of three days per month for six or more months diagnoses irritable bowel syndrome (Abraham, 2008). Potential plans for community follow-up and support systems Plans for community follow-up include monitoring and evaluation of progress in prevention and management of irritable bowel syndrome symptoms. The proposed follow up plan will be about awareness and advocacy of psychological management strategies and patient education and advocacy for lifestyle changes among the public. A review of literacy level, among the public, over symptoms of the syndrome will be core to the follow up initiative and sample of irritable bowel syndrome victims and healthy people will be collected on a time series basis to determine sustainability of disseminated information, on the syndrome, in the society. Plans for follow up will also include a review of success in lifestyle modification for better health based on education on homeopathic remedies and the role of diet and exercise in managing symptoms of irritable bowel syndrome. Review on lifestyle modification will focus on implementation of proposed modifications and consistency in maintaining adapted healthy lifestyles (Rfiles, 2008). Collaboration will be made with Patients Canada, an organization of patients that seeks a voice, follow up and support system. The organization works towards active participation of patients and caregivers in provision of care and therefore offers an opportunity for identification and implementation of appropriate support systems. Its research based scope and its core objective of raising members experiences will offers a suitable basis for follow up and development of support systems (Patient Canada, 2013). Relevance of the knowledge to nurses and potential impacts on their care The information has significant and diversified relevance to nurses. Knowledge of signs, symptoms, and causes of the syndrome is important to diagnosis. This allows for implementation of assessment criteria and clinical diagnosis and empowers nurses to efficiency in managing the syndrome. Knowledge of the different intervention options, their financial implications, and patients’ perceptions is also relevant to effective control, especially with the identified psychological aspects of the symptoms, and means that some treatment alternatives are more effective than others are. Knowledge of care assessments and consideration and of follow up and support centers is also relevant to nurses because of its correspondence to nursing’s scope of care provision, administration, and clinical specialist to facilitate roles of nurses. The knowledge will affect nurses’ care by empowering them to accurate diagnosis and appropriate selection of treatment strategy. Follow up and established support system will inform nurses of success of their care initiatives towards corrective measures. Conclusion Irritable bowel syndrome is symptomatic and offers grounds for diagnosis. A series of consideration of the symptoms identifies the complications and assessment criteria such as Manning, Rome I, Rome II, and Rome III facilitate this. Test procedures also exist to eliminate doubts of other complication. Many treatment measures exist against irritable bowel syndrome and include medicinal alternatives, such as application of laxatives, anticholinergic agents, antidiarrheal agents, and naturopathic, homeopathic remedies as well as behavioral strategies. Plans for monitoring and evaluation of community and self based initiatives towards management of the syndrome’s symptoms and support systems, with the aid of Patients Canada, is proposed. The developed information is relevant to nurses because it empowers them towards accurate diagnosis and effective management of the syndrome. References Abraham, P. (2008). ECAB clinical update gastroenterology hep. Mar- April issue 2. New Delhi: Elsevier India. Calibre. (2010). The ultimate collection of tips to flush out irritable bowel syndrome. KMSPublishing.com. Digestive. (2012).Irritable bowel syndrome. National Digestive Diseases Information Clearinghouse. Retrieved from: http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/#7. National Institute for Health and Clinical Experience. (2008). Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care. National Institute for Health and Clinical Experience. Retrieved from: http://www.nice.org.uk/nicemedia/pdf/cg061niceguideline.pdf. NHS choises. (n.d.). Irritable bowel syndrome- Clinical trials. National Health Service. Retrieved from: http://www.nhs.uk/Conditions/Irritable-bowel-syndrome/Pages/clinical-trial.aspx.   Patient Canada. (2013). Patients Canada. Patient Canada. Retrieved from: http://www.patientscanada.ca/index.cfm?pagepath=About_Us&id=51204. Rfiles. (2008). Drug treatment for IBS. Rfiles. Retrieved from: http://www.rxfiles.ca/rxfiles/uploads/documents/GI-IBSyndrome.pdf. Virginia. (2010). Irritable bowel syndrome. Virginia Tech. Retrieved from: http://www.healthcenter.vt.edu/assets/docs/MCInfoSheet-IBS.pdf. Wilson, K. (2010). Natural treatment of irritable bowel syndrome. The Pain Practitioner. Retrieved from: http://www.aapainmanage.org/pain_management_news/NEW_newsletter/email/images/naturopathic_IBS.pdf. Read More