CUES SUBJECTIVE: Gapinandiho ako it mabasa. Pilang beses eot-a., as verbalized by the patient.

OBJECTIVE: Frequent passage of watery stools (4-6 times a day) Hyperactive bowel sounds(72cpm) Abdominal guarding due to cramping pain weakness

NURSING DX Fluid volume deficit related to damage and loss of epithelial cells due to inflammation as evidenced by increased bowel sounds, passage of watery stools, and cramping abdominal pain

OBJECTIVES General: To provide nutrition to all body cells. Specific: After 8 hours of effective nursing interventions, the patient will be able to: >decrease frequency of defecation in a range of 1-3 times a day. >decrease bowel sounds to the acceptable range of 335cpm to be assessed via auscultation >be free of evidence of pain: facial grimace and guarding

NURSING INTERVENTIONS INDEPENDENT: Obtain the patients initial vital signs. Observe and record stool frequency, characteristics, amounts and precipitating factors. Promote bed rest, provide bedside commode.

RATIONALE

To provide baseline data for monitoring the patient. A thorough and good assessment is vital for carrying out correct interventions to correct the patients current condition 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 the risk for incontinence and falls if facilities are not close at hand. Reduce noxious odors to avoid undue client embarrassment, and to provide an environment conducive for rest. Avoiding intestinal irritants promotes intestinal rest.

Remove stool properly. Provide room deodorizers.

Identify foods and fluids that precipitate diarrhea.

Encourage to eat foods like banana and apple. Avoid foods that are oily, spicy and caffeine. Encourage and offer fluids gradually. Offer clear liquids hourly; avoid cold fluids.

Fruits that are stool former.

Foods that may precipitate gastric cramping.

Provides colon rest by omitting or decreasing the stimulus of foods/fluids. Gradual resumption of fluids may prevent cramping and recurrence of diarrhea; however, cold fluids can increase intestinal motility. Presence of disease with unknown cause that is difficult to cure and that ma require surgical intervention can lead to stress reactions that may aggravate condition. May signify that toxic megacolon or perforation and peritonitis are imminent/have occurred, necessitating immediate medical intervention.

Encourage or provide opportunity for patient to verbalize or discuss feelings related to the disease process. Monitor and observe for fever, lethargy, leukocytosis, decreased serum protein, anxiety, and

prostration. Provide good perianal care.

Diarrheal stool is oftentimes highly acidic. This causes anal soreness and irritation in the perianal area Used to decrease acute inflammatory process when symptoms are refractory to sulfasalazine and 5-aminosalicylic acids, or for a sudden flare-ups of the disease process. Immunosuppresant may be given to block inflammatory response, decrease steroid requirements, promote healing of fistulas. Used for treatment and maintenance of moderate to severe refractory or fistulizing CD. Drug blocks the inflammatory agents activity, leading to decreased inflammation and promoting intestinal healing. Used when exacerbation is caused by or accompanied by infection, or may be part of a long-term treatment regimen.

COLLABORATIVE: STEROIDS (hydrocortisone, prednisolone, prednisone, butesonide)

IMMUNE-MODULATING AGENTS(azathioprine, 6mercaptorurine, methotrexate, cyclosporine) BIOLOGIC RESPONSE MODIFIERS (monoclonal antibodies such as IV infliximab)

ANTI-INFECTIVES (metronidazole, ciprofloxacin)

ANTIDIARRHEALS (diphenoxylate, loperamide, anodyne suppositories)

Decreases GI motility/propulsion(peristalsis) and diminishes digestive secretions to relieve cramping and diarrhea Used with caution in ulcerative colitis because they may precipitate toxic megacolon and are contraindicated in the presence of infection. May be useful for clients who do not respond to standard interventions.

ANTISPASMODIC (Lhoscyamine, dicyclomine, hyoscamine/atropine/scopola mine/phenobarbital) Assist with/prepare for surgical intervention---ileostomy, total colostomy, percutaneous abcess drainage

May be necessary if perforation or vowel obstuction occurs or disease is unresponsive to medical treatment. Total colectomy is considered curative for UC (which affects only the colon). However, it may not resolve extraintestinal manifestations. In Crohns disease, surgery may be performed to remove a diseased

section of bowel, but is not curative, as inflammation can occur anywhere in the GI tract. The client ma require a temporary or permanent colostomy.