Continuing Care
Patients with chronic inflammatory disease are managed at home with follow-up care by their physician or through an outpatient clinic. Those whose nutritional status is compromised and who are receiving PN need home care nursing to ensure that their nutritional requirements are being met and that they or their caregivers can follow through with the instructions for PN. Patients who are medically managed need to understand that their disease can be controlled and that they can lead a healthy life between exacerbations. Control implies management based on an understanding of the disease and its treatment. Patients in the home setting need information about their medications (ie, name, dose, side effects, and frequency of administration) and need to take medications on schedule. Medication reminders such as containers that separate pills according to day and time or daily checklists are helpful. During a flare-up, the nurse encourages patients to rest as needed and to modify activities according to their energy levels. Patients should limit tasks that impose strain on the lower abdominal muscles. They should sleep in a room close to the bathroom because of the frequent diarrhea (10 to 20 times per day); quick access to a toilet helps alleviate the worry of embarrassment if an accident occurs. Room deodorizers help control odors. Dietary modifications can control but not cure the disease; the nurse recommends a low-residue, high-protein, high-calorie diet, especially during an acute phase. It is important to encourage patients to keep a record of the foods that irritate the bowel and to eliminate them from the diet and to remind patients to drink at least eight glasses of water each day. The prolonged nature of the disease has an impact on the patient and often strains his or her family life and financial resources as well. Family support is vital; however, some family members may be resentful, guilty, and tired and feel unable to continue coping with the emotional demands of the illness and the physical demands of caring for another. Some patients with IBD do not socialize for fear of being embarrassed. Many prefer to eat alone. Because they have lost control over elimination, they may fear losing control over other aspects of their lives. They need time to express their fears and frustrations. Individual and family counseling may be helpful.
Evaluation
EXPECTED PATIENT OUTCOMES
Expected patient outcomes may include the following:
1. Reports a decrease in the frequency of diarrhea stools
a. Complies with dietary restrictions; maintains bed rest
b. Takes medications as prescribed
2. Has reduced pain
3. Maintains fluid volume balance
a. Drinks 1 to 2 L of oral fluids daily
b. Has a normal body temperature
c. Displays adequate skin turgor and moist mucous membranes
4. Attains optimal nutrition; tolerates small, frequent feedings without diarrhea
5. Avoids fatigue
a. Rests periodically during the day
b. Adheres to activity restrictions
6. Is less anxious
7. Copes successfully with diagnosis
a. Expresses feelings freely
b. Uses appropriate stress reduction behaviors
8. Maintains skin integrity
a. Cleans perianal skin after defecation
b. Uses lotion or ointment as skin barrier
9. Acquires an understanding of the disease process
a. Modifies diet appropriately to decrease diarrhea
b. Adheres to medication regimen
10. Recovers without complications
a. Maintains electrolytes within normal ranges
b. Maintains normal sinus or baseline cardiac rhythm
c. Maintains fluid balance
d. Experiences no perforation or rectal bleeding