Whats are Chronic Gastrointestinal Symptoms ,Causes Chronic Gastrointestinal Symptoms,Nursing Care Management,Nursing Care As A Challenge.
When a chronic gastrointestinal pathology cannot
be identified, it is more generally diagnosed as irritable bowel syndrome (IBS)
or functional bowel disorder (FBD) (Heitkemper, Jarrett, Caudell, & Bond,
1998).
IBS
is a recurrent disorder characterized by chronic abdominal pain, bloating, and
altered bowel patterns. It is the most common disorder treated by
gastroenterologists (American Gastroenterological Association, 2002; Faussett
al., 2001) and is more commonly found among women than men.
IBS has also been
found to contribute to lowering of economic and other quality-of-life factors.
One study showed that 15.4 million people in the United States suffer from IBS
regularly, with most missing three times as many work days as those without
symptoms (13.4 days vs. 4.9 days), costing employers $1.6 billion in direct
costs and another $19.2 billion in indirect costs (American Gastroenterological
Association).
Although
the etiology of IBS has not been clearly identified, it is thought to be
related to such factors as the following:
(a) abnormal Gul motility, described
as high-amplitude propagating contractions or delayed transit of gas
(b)
visceral hypersensitivity
(c) enteric infection
(d) autonomic dysfunction
(e) dysregulation of brain-bowel interactions.
In addition, stress and
psychological affection are important psychosocial factors in IBS (American
Gastroenterological Association, 2002; Fauss et al., 2001); however, these are
only partially correlated with symptoms and are not sufficient to explain
reports of chronic, recurrent IBS. Although there are several pathophysiology's
of IBS based on this etiology, further studies are needed to clarify such
findings.
Causes Chronic Gastrointestinal Symptoms
There
are multiple potential causes for IBS, and the diagnosis of each case must be
based relative to the symptoms (Rome criteria).
Symptoms include at least 12
weeks of abdominal discomfort or pain in the preceding 12 months, accompanied
by two or three of the following additional features:
(a) the pain or
discomfort is relieved with defecation
(b) the onset of the pain or discomfort
is associated with a change in the frequency of the movement of the stool,
and/or
(c) the onset of the pain or discomfort is associated with a change in
the form of the stool.
In addition, cumulatively supportive symptoms include:
(a) abnormal stool frequency (for research purposes, "abnormal" may
be defined as more than three times a day and less than three times a week)
(b) abnormal stool form (lumpy/ hard or loose/watery stool)
(c) abnormal stool
passage (straining, urgency, or feeling of incomplete evacuation)
(d) passage
of mucus
(e) bloating or feeling of abdominal distention (Thompson et al.
, 2000).
Nursing Care Management
Management
of IBS is based on the dominant symptoms, their severity, and psychosocial
factors. It is also imperative in the management of IBS that the patient take
responsibility as an active participant in his or her treatment.
Nurses can
engage patients by encouraging them to write down their symptoms and times of
occurrence in a diary, which can also be used to monitor the daily food intake,
activities, and events of the patient in order to identify possible
exacerbating factors.
If, on examination of the diary, symptoms prove mild,
prescription medication may not be needed, though in general the patient will
benefit from normal daily activities that include dietary and lifestyle
modification (Rangel, Sperber, & Drossman, 2001).
Once the patient has
monitored symptoms for 2 to 3 weeks by writing them in the symptom diary,
certain foods and other agents that worsen symptoms can be identified and
avoided. However, nurses should remind patients not to be overly restrictive in
their diet to avoid the risk of malnutrition.
Some studies recommend a high
fiber diet to resolve symptoms, even though it may initially cause bloating and
flatulence. However, although helpful in treating constipation, maintaining
high levels of fiber intake is controversial when used to relieve diarrhea and
abdominal pain (American Gastroenterological Association, 2002).
In cases in
which individuals with IBS do not respond to physiological treatments,
psychological factors should be considered. Several psychological procedures
have been studied in IBS patient therapy trials, including cognitive-behavioral
treatment, stress management, dynamic/interpersonal psychotherapy,
hypnotherapy, and relaxation/arousal reduction training (Ringel, Sperber, &
Drossman, 2001; Drossman, 1995).
Due to methodological limitations, however,
there are as yet no comparative data demonstrating that one psychological
intervention is superior to any other for any given patient group or set of
conditions (American Gastroenterological Association, 2002).
Several recent
findings in nursing research have focused on the relationship between
gastrointestinal symptoms and women (Heitkemper et al., 1998), the effects of
coping with stress among women with gastrointestinal disorders (Drossman et
al., 2000), differences in patients and physicians ' Perceptions about women
with IBS (Heitkemper, Carter, Ameen, Olden, & Cheng, 2002), and the sense
of coherence and quality of life in women with and without IBS (Motzer, Hertig,
Jarrett, & Heitkemper, 2003) .
These studies supply information suggesting
that GI symptoms in some women are linked to the following:
(a) reproductive
cycling (increased GI symptoms at menses)
(b) negative health outcome due to
maladaptive coping and decreased self-perceived ability concurrent with or in
response to a history of abuse
(c) discordance between patients' and
physicians' views about IBS
(d) reduced sense of coherence and holistic
quality of life.
Nursing Care As A Challenge
The
care of patients with chronic GI symptoms is particularly challenging because
the diagnosis is never assured and symptomatic treatments are not always
successful. Diagnosis and treatment tailored on the basis of individual need
should be carefully performed.
In addition, establishing an effective
relationship between the patient and the health provider requires patience,
education, and reassurance for vital therapeutic management. Future studies are
needed to determine the degree to which the modification of management will
improve symptom treatment, clinical outcomes, and the patient's overall quality
of life.
Finally, the treatments that are consistently effective for all
symptoms should be further investigated.
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