Nursing Care Chronic Gastrointestinal Symptoms

Afza.Malik GDA

Nursing Care for GI Syndrome

Nursing Care Chronic Gastrointestinal Symptoms

Whats are Chronic Gastrointestinal Symptoms ,Causes Chronic Gastrointestinal Symptoms,Nursing Care Management,Nursing Care As A Challenge.

Whats are Chronic Gastrointestinal Symptoms 

    Chronic    gastrointestinal (GI) symptoms which include frequent bowel-related abdominal pain, reflux, dyspepsia, constipation, painless diarrhea, and fecal incontinence (Talley et al., 2001)-may be common among the public (Talley et al.), but for the health provider they are also among the most difficult conditions to read and treat. 
    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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