Inflammatory Bowel Disease

Question: Describe about the Inflammatory Bowel Disease. Answer: As Mrs. Greenway is diagnosed with inflammatory bowel disease, there is high possibility of diarrhea and malabsorption because of inflammation. Both these diarrhea and malabsorption leads to deficiency of electrolytes and as result malnutrition in Mrs. Greenway. Mrs. Greenway should be informed about following diet and lifestyle changes. Mrs. Greenway should take more fluid and diet rich in protein, vitamins and iron. This diet in the form of fluid helps Mrs. Greenway, in reducing irritation in GI tract due to inflammation and also helps to reduce pain. Mrs. Greenway should eat more soluble fibers as compared to insoluble fibers. These soluble fibers comprises of oatmeal, flaxseeds, beans, strawberries, apples, oranges, pears, dried peas, blueberries, cucumbers, celery, and carrots (Fichera Krane, 2015). Mrs. Greenway should drink more water to keep hydrated because more water loss may be there due to diarrhea. Mrs. Greenway should perform light exercise to improve functioning of GI tract and also to improve mood and to get relief from the stress. Mrs. Greenway should eat fermented foods because beneficial bacteria in the GI tract are helpful in promoting digestion. Due to inflammatory bowel disease, Mrs. Greenway reduced her capability to digest the food. Hence, she should consume food more frequently in less quantity. This also helps to maintain blood sugar level and boost mood of Mrs. Greenway (Fichera Krane, 2015). Mrs. Greenway should eat on regular timings. Mrs. Greenway should not take Advil because it is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs have adverse effects on GI tract like bloody diarrhea and stomach upset. Mrs. Greenway has habit of smoking. She should also stop smoking because it is well established that smoking can exaggerate inflammatory bowel disease (Tindall et al., 2013). I would like to present this information to Mrs. Greenway in the form of nursing care plan prepared based on her diagnosis and this nursing care plan include medication, diet and lifestyle changes. Prednisone is an active metabolite of prednisolone and it is a glucocorticoid. Prednisone has anti-inflammatory activity, immunosuppressant activity and it useful in the autoimmune disease. Mrs. Greenway is diagnosed with inflammatory bowel disease. In this disease there is inflammation in the colon and small intestine, immune system is activated and there is also autoimmune component plays important role. Hence, this drug cures Mrs. Greenway by acting on all these components of Mrs. Greenways inflammatory bowel disease (Saenz, 2006). Following are the side effects of prednisone: increased appetite, weight gain, increased susceptibility to infection, hypertension, skin thinning, skin rash, hyperglycemia, nausea, swelling of stomach lining, abdominal distension, menstrual abnormalities, osteoporosis, convulsions, vertigo and behavioral disturbance (Saenz, 2006). Mrs. Greenway is taking prednisone for inflammatory bowel disease. This prednisone has immunosuppressive action. Use of immunosuppressive drugs for long duration can cause hyperglycemia, hypertension, peptic ulcer, muscle atrophy, convulsions, vertigo and most importantly increased susceptibility to infection. Due to the consumption of prednisone there may be the possibility of immune suppression in Mrs. Greenway (Saenz, 2006). Hence, she should give more attention to her hygiene. She should not expose herself to the infectious environment and she should not go to crowded places. She should wash hands properly before taking meal and avoid touch to most frequently used articles like electricity button and money. She should also keep in mind that, short term use of immunosuppressive drugs would not harm much to her health. On the other hand these drugs help to improve diseased condition by treating inflammation and by suppressing the immune system. If she wishes to take extra drug she can take a course of antibiotic that help to prevent these infections. People consuming immunosuppressive drugs are more prone to cancer development because of suppressed immune system. Hence, she should inform to doctor about any of the tumor like occurrence in her. She should think much about the side effects and take regular meal even though there is no appetite because these drugs can cause loss of appetite. She should keep her mood happy because that can help to prevent shaking of hands, which is one of the problems with consumption of immunosuppressive drugs (Workman LaCharity, 2015). Corticosteroid suppository is prescribed to Mrs. Greenway for treating inflammatory bowel disease and related conditions. Medication in the form of suppository produce pharmacologically same effect like treating inflammatory swelling, itching, hemorrhoids, rectal pain, bloody diarrhea, bleeding and other consequences of the inflammation (Lichtenstein, 2014). Advantage of the suppository is that, it produces more effective in pharmacological action due to local action and it has lesser systemic adverse effects because it absorption is limited to the lower GI tract. Mrs. Greenway should use corticosteroid suppository 2-3 times daily. If she feels severity is more she can increase the frequency of its use. She should not handle suppository for longer time because it can melt in her hand. Most importantly she should take precaution to maintain hygiene while administering suppository because chances of infection are more. She should use disinfectant for her hands and use gloves while administering suppository. She should unwrap the suppository immediately before the administration. She should moisten tip of suppository with little water. She should lie down on left side and her right knee should be bent. She should gently insert suppository in the rectum with the figure and pointed end should be pushed first. It should be inserted deep enough that it should not come back. She should be in the same position for next few minutes after administration of suppository. For next one hour she should not have bowel movement so that suppository has enough ti me to produce its effect. She should remove gloves and disinfectant her hands. She should follow this procedure at each time. Frequency of its use should be optimum. It should not be very high or very less. Very high use may produce side effects and very less use may not produce desired effect. She should let doctor know effect of suppository on her condition, so that doctor can amend the dose and frequency accordingly (Dandiya et al., 2010; Potter et al., 2013). I would like to ask Mrs. Greenway following questions: a) Whether she taking her medicine as per prescribed dose and schedule? She should not miss a single dose of medicine at the same time she should take more medicine if she feels more problems because consuming medicine in high dose can produce adverse effects. b) Whether she is taking enough water and other fluids to prevent dehydration? Whether she is rinsing her mouth regularly and if she is maintaining her oral hygiene to stay away from drying her mouth? c) Whether she is taking her diet according to diet plan mentioned in the nursing care plan? As she has diarrhea, there may be possibility of electrolyte imbalance and moreover she is feeling lethargic. To maintain electrolyte balance and to feel energetic she should take proper diet (Vallerand et al., 2011). References: Dandiya, P.C., Bapna, J.S., Khilnai, G. (2010). Complete Family Medicine Book, 10/e. (10th ed.). Orient Paperbacks. Fichera, A., Krane, M.K. (2015). Crohns Disease: Basic Principles. Springer. Lichtenstein, G.R. (2014). Medical Therapy of Ulcerative Colitis. Springer. Saenz, R.E. (2006). Hardcore Pharmacology. Lippincott Williams Wilkins. Tindall, W. N., Sedrak, M., Boltri, John. (2013). Patient-Centered Pharmacology: Learning System for the Conscientious Prescribe. F.A. Davis Company. Potter, P. A., Perry, A. G., Stockert, P. A., Hall, A. M. (2013). Fundamentals of Nursing (8th ed.). St. Louis, Missouri: Elsevier Mosby. Vallerand, A. H., Sanoski, C. A., Deglin, J. H. (2011). Davis's Drug Guide for Nurses (13th ed.). Philadelphia, PA: F. A. Davis Company. Workman, M.L., LaCharity, L. A. (2015). Understanding Pharmacology: Essentials for Medication Safety. Elsevier Health Sciences Publisher.