I.

INTRODUCTION

Irritable bowel syndrome (IBS) is a functional disorder of motility in the intestines. There
is no organic disease or anatomic abnormality, nor are there any genetic markers. It is not life
threatening, nor is it associated with development of cancer. Other descriptive names for this
condition are spastic colon, irritable colon, nervous indigestion, spastic colitis, intestinal neurosis,
and laxative or cathartic “colitis.” IBS is the most common GI disorder in Western society,
accounting for 50% of subspecialty referrals and the writings of more than five million
prescriptions annually.

There is no specific test for irritable bowel syndrome. Many cases are diagnosed based on
the symptoms history or patient will undertake routine blood and stool test. Initial treatment should
include education, reassurance, stress management, and relaxation techniques.

Researches also categorized irritable bowel syndrome based on the type of bowel
movement problems patient experience. Types include IBS-C (Irritable Bowel Syndrome with
Constipation), IBS-D (Irritable bowel syndrome with diarrhea), and IBS-M (Irritable bowel
syndrome mixed with bowel habit).

1|I R RI TAB L E B OW EL S YN DR OM E
 II. PATIENT’S PROFILE

NAME: Ms. NL

AGE: 28

DATE OF BIRTH: July 22, 1994

PLACE OF BIRTH: Purok 3, Bascaran, Solano, Nueva Vizcaya

ADDRESS: Purok 3, Bascaran, Solano, Nueva Vizcaya

EDUCATIONAL ATTAINMENT: College Graduate (BSBA)

OCCUPATION: Manager

MARITAL STATUS: Single

RELIGION: Roman Catholic

ETHNIC GROUP: Tagalog

HOSPITAL ADMITTED: MMG Hospital

HOSPITAL ROOM: Ward 12

ATTENDING PHYSICIAN: Dr. Roderick Tambuyat, MD, GI

DATE ADMITTED: June 23, 2022

TIME ADMITTED: 10:30 AM

CHIEF COMPLAINT: Severe abdominal pain for more than three days for the last three months
associated with pain related to defecation and frequency of stool

ADMITTING DIAGNOSIS: To consider Irritable Bowel Syndrome as evidenced by severe

abdominal pain on the left lower quadrant

FINAL DIAGNOSIS: Irritable Bowel Syndrome

DISCHARGE DATE AND TIME: June 24, 2022 at 12:15 PM

2|I R RI TAB L E B OW EL S YN DR OM E
III. NURSING HISTORY

A. PAST HEALTH HISTORY

Ms. NL verbalized that she rarely experienced common illnesses like flu, cough, colds,
body pain, and fever especially during cold weather. She stated that whenever she gets sick she
takes over-the-counter drugs. She mentioned that she has been hospitalized when she was 8 years
old due to dengue hemorrhagic fever and experienced chicken pox when she was 12 years old. It
was further indicated that she has no allergy to medications but she has an allergy to food like
seafood. She received her complete vaccines when she was a child.

B. PRESENT HEALTH HISTORY

Ms. NL stated that 2 months ago, she often experienced diarrhea and it was usually 2-3 days
per week but she just let it pass and takes Loperamide 2mg, 2x a day. Last month, she mentioned
that she was constipated and bloated, and often experiences abdominal pain which is not common
to her that's why she went to Rural Health Unit for a check-up. They advised her to go for a check-
up with a Gastroenterologist to know the cause of her complaint. The Dr. in Rural Health Unit
gave her medication, Dicyclomine 20mg (21 tablets), 3x a day for 1 week to ease the pain in her
abdomen.

One day prior to admission, Ms. NL experienced severe abdominal pain located in the left
lower quadrant while having a meeting with the Investors of Alay Kapwa. She excused herself and
went to the ER of the nearest hospital which is MMG Hospital. She was seen by ER nurse and
took her vital signs; temperature: 37.7°C, PR: 116 bpm, RR: 24 bpm, BP: 100/60 mmHg, and O2
Sat: 96%. She described that her pain scale was about 9/10. Dr. Tambuyat did a physical
assessment and the findings are the following; severe pain to the abdomen with focal tenderness,
the abdomen is hard with positive bowel sounds to the left quadrant, no acute epigastric tenderness,
and negative for nausea, vomiting, and diarrhea. Dr. Tambuyat ordered a diagnostic examination
for the following such as; Urinalysis, Hematology, Stool Examination, and Abdominal Ultrasound.
Ms. NL stated that her usual defecation is about 2-3 days that's why Dr. Tambuyat gave a
suppository and was administered for further observation.

3|I R RI TAB L E B OW EL S YN DR OM E
 At around 12:15 PM, after medical assessment and ordered examination, the Doctor
established an initial diagnosis of Irritable Bowel Syndrome.

C. SOCIO-ECONOMIC HISTORY

Ms. NL has an income of ₱55,000 pesos monthly as a manager at Alay Kapwa Bank. She
stated that it is not easy to lose loved ones but she keeps on moving because there is her stepsister
who loves and strengthens her. She stated that food is her first priority. Electric bills including
internet bills and water bills are the second priority. Transportation is the third priority. She also
finances the schooling of her stepsister studying at La Patria College, Santiago. She is currently
paying ₱36,364 pesos monthly for the land she purchased amounting to ₱800,000 pesos. She’s
currently paying for 1 year but she deposited ₱400,000 on June 22, 2022.

MONTHLY PERCENT
Foods 5.5%
Electric Bills 4.5%
Transportation 3.8%
Educational Needs 10.2%
Land Installment 66.1%
Other needs 10.9%
TOTAL: 100%

Allotment of Health Expenses

(This was paid by her company, Alay
Kapwa Bank)

4|I R RI TAB L E B OW EL S YN DR OM E
D. OCCUPATIONAL HISTORY

Ms. NL is a graduate of Business Administration at Saint Marys University (SMU). She

finished her Bachelor's Degree when she was 19 years old at the year 2013. She is currently
working at Alay Kapwa, Solano, Nueva Vizcaya as a manager for almost 7 years and a half. She
mentioned that she is the one responsible for their company monthly payments, maintaining
records of individual customer’s payments and sometimes she is the one training new employees
in their company. She works for 8 hours, 7:30 AM to 5:00 PM but she does overtime until 6-7 PM
depends on the number of customers and paperworks. She has a motorcycle that she uses to go to
work and travel to her stepsister’s place in Santiago. She stated that she experiences high stress
because of too much exposure in the computer, toxic environment and hectic schedule. After her
work, sometimes she buys cooked food or she’ll cook at home.

E. ENVIRONMENTAL HISTORY

She has a stepsister studying at La Patria College, Santiago that's why she lives alone in
their house because her stepsister is currently living with their Aunt (Stepfather's side). Her mother
handed over their house to her before she died. Her house is located near the highway for 15 meters
and the nearest hospital (PLT Hospital) is within walking distance for 3 minutes and the Rural
Health Unit clinic is 10 minute's drive from her house using a motorcycle. The house has a small
porch, living room, kitchen, laundry area, dining area, garage, three bedrooms, and one comfort
room. The living room is 340 square meters. The master bedroom is 165 square meter and the two
bedrooms is 108 square meters. Her toilet is elongated, 35 square meters, and it is near in the
kitchen. Every room has a complete light. Appliances such as; a refrigerator, air conditioner, two
electric fans, microwave, washing machine, and smart TV are also present. The backyard was
planted with papaya, horseradish, and bougainvilleas. She added that she has very generous and
good heart neighbors because sometimes they offered her viand to eat and help her in times of
need which she really appreciates even though they are not related to each other.

Furthermore, her drinking water is acquired from an electric deep well while she uses a
manual deep well for bath and washing purposes. In cooking her food, she uses a gas stove. She

5|I R RI TAB L E B OW EL S YN DR OM E
also mentioned that her garbage is segregated into biodegradable, non-biodegradable, and
recyclable which trash collectors collect every Saturday and Sunday.

F. FAMILY HISTORY

According to Ms. NL, her family belongs to a Blended Family. She has a stepsister who
has asthma and their gap is 10 years. She mentioned that her stepfather died 10 years ago due to a
car accident and has hypertension and arthritis. Three years ago, her mother was admitted to the
hospital three times due to an asthma attack before finally passing away that's why she lives with
her stepsister for almost 2 years now. She never met her biological father since she was born but
she has a photo of her father wishing she'll gonna meet him someday.

6|I R RI TAB L E B OW EL S YN DR OM E
G. LIFESTYLE AND RECREATIONAL ACTIVITIES

Ms. NL stated that she walks every Sunday before and after church and added that Sunday
is her only free time to clean her house which serves as her exercise. She also visits her stepsister
once in a while in Santiago to make quality time. She added that she has no time to do cooking
every morning (working days) that's why her breakfast is usually coffee and sliced bread. For the
night, she eats adobong manok, sometimes noodles or she buys cooked foods like pinakbet, kare-
kare and grilled chicken in karenderya before going home specially when she has overtime and
exhausted from work. She is a nonsmoker and has no illicit drug use but has social drinking with
her friends and co-workers. She mentioned that during her break time and lunchtime, she makes
content on TikTok, and scrolls on Facebook which serve as her stress reliever. She mentioned that
she has poor diet choices, oftentimes from the fast food since she lives alone but she sees to it to
drinks 7-8 cups of water every day.

7|I R RI TAB L E B OW EL S YN DR OM E
 IV. PHYSICAL ASSESSMENT
DATE OF ADMISSION: JUNE 23, 2022
TIME OF ASSESSMENT: 11:00 AM

GENERAL APPEARANCE:
The patient is conscious, well aware of her condition, and could not immediately answer
the question due to severe abdominal pain. The patient looked pale and distressed; her hair color
is black and a little bit messy. The client is observed to be a grimacing because of abdominal pain.
According to some findings, the pain may be triggered by eating specific foods, following a meal,
emotional stress, and constipation.

INITIAL VITAL NORMAL ACTUAL ANALYSIS/INTERPRET

SIGNS FINDINGS FINDINGS ATION

Blood Pressure 120/80 mmHG 100/60 mmHg ABNORMAL

Pulse Rate 60-100 bpm 116 bpm ABNORMAL

Respiratory Rate 12-20 bpm 26 bpm ABNORMAL

Temperature 36.1-37.5°Celsius 37.5℃ NORMAL

MEASSUREMENTS

HEIGHT 5’2 inches

WEIGHT 61 kg

BMI= kg/h(cm)2
BMI= 61kg/5’2inch (157.48)2
BMI= 24.6 (Normal)

8|I R RI TAB L E B OW EL S YN DR OM E
SKIN

AREA TO INTERPRETATION&
NORMAL ACTUAL
BE TECHNIQUE ANALYSIS &
FINDINGS FINDINGS
ASSESSED REFERENCES
Skin lesions Inspection Skin is smooth The patient NORMAL
without skin is smooth
lesions. Striae, without
freckles, lesions. Striae,
healed scars, freckles,
moles and healed scars, Source: Health
birthmarks are moles and Assessment in Nursing
common birthmarks are 6th Edition
findings. common
findings.
Skin color Inspection Evenly colored Evenly colored
skin tones skin tones
NORMAL
without without
unusual or unusual or
prominent prominent
discoloration. discoloration. Source: Health
Assessment in Nursing
6th Edition

Temperature Inspection, use Must be in The patient NORMAL

thermometer to normal range temperature is
measure from 36.5-37 within the
temperature. .5°C. normal range, Source: Health
37.5°C. Assessment in Nursing
6th Edition

9|I R RI TAB L E B OW EL S YN DR OM E
HEAD
AREA TO
NORMAL ACTUAL INTERPRETATION
BE TECHNIQUE
FINDINGS FINDINGS & REFERENCES
ASSESSED
Face/Shape Inspection Symmetrical The patient
and either with a face is NORMAL
Symmetry round, oval, symmetrical
elongated and either with a
square round, oval, Source: Health
appearance. elongated and Assessment in Nursing
square 6th Edition
appearance.
Cranial Inspection, Test The patient is The patient is
Nerve VII motor function able to smile, able to smile,
(Facial by asking client frown, close frown, close
Nerve) to smile, frown eyes tightly, lift eyes tightly,
NORMAL
and wrinkles eyebrows, show lift eyebrows,
forehead, show teeth and puff show teeth
teeth, puff out cheeks. and puff
Source: Health
cheeks, purse cheeks.
Assessment in Nursing
lips, raise
6th Edition
eyebrows and
close eyes
tightly against
resistance.

SKULL AND SCALP

AREA TO
NORMAL ACTUAL INTERPRETATION
BE TECHNIQUE
FINDINGS FINDINGS & REFERENCES
ASSESSED
Shape and Inspection and Symmetrical The patient face NORMAL
Symmetry palpation with a round, is round and
oval, elongated symmetrical.
and square Source: Health
appearance. Assessment in
Nursing 6th Edition

10 | I R R I T A B L E B O W E L S Y N D R O M E
Masses and Inspection and Depression and Without any NORMAL
Depression palpation masses are depression and
absent. masses palpated.
Source: Health
Assessment in
Nursing 6th Edition

HAIR
AREA TO
NORMAL ACTUAL INTERPRETATION
BE TECHNIQUE
FINDINGS FINDINGS & REFERENCES
ASSESSED
Evenness of Inspection Hair is evenly Hair is evenly NORMAL
growth, distributed and distributed,
thickness/thi thick. however slightly
nness thin. Source: Health
Assessment in
Nursing 6th Edition
Texture and Inspection Smooth, firm The patient hair NORMAL
oiliness and silky. is smooth, firm
and silky.
Source: Health
Assessment in
Nursing 6th Edition

SINUSES
AREA TO
NORMAL ACTUAL INTERPRETATION
BE TECHNIQUE
FINDINGS FINDINGS & REFERENCES
ASSESSED
Maxillary Palpation Non-tender Non-tender NORMAL
and frontal when palpating when palpating
and no pain and no pain
when putting when putting Source: Health
pressure. pressure. Assessment in
Nursing 6th Edition

11 | I R R I T A B L E B O W E L S Y N D R O M E
EYES
AREA TO
NORMAL ACTUAL INTERPRETATION
BE TECHNIQUE
FINDINGS FINDINGS & REFERENCES
ASSESSED
Eyelashes Inspection Equally The lashes are
distributed, evenly NORMAL
curved distributed and
pointing sweeping
outward. upward from the Source: Health
upper lids and Assessment in
downward from Nursing 6th Edition
the lower lids.
Eyelids Inspection and The upper and The upper and
Observation lower lids lower lids close NORMAL
close easily easily and meet
and meet completely when
completely closed. No Source: Health
when closed. presence of Assessment in
No presence of swelling. Nursing 6th Edition
swelling.
Cornea Inspection Translucent, The cornea is
smooth and translucent,
NORMAL
avascular. smooth and
avascular.

Source: Health
Assessment in
Nursing 6th Edition
Pupil Inspection/Obs Round with The pupils are NORMAL
ervation regular border, equal in size.
has both equal
sizes. Source: Health
Assessment in
Nursing 6th Edition
Conjunctiva Inspection Free from The conjunctiva NORMAL
swelling or is free from
lesions. swelling or
lesions. Source: Health
Assessment in
Nursing 6th Edition

12 | I R R I T A B L E B O W E L S Y N D R O M E
 Sclera Inspection The sclera is The sclera is NORMAL
white in color white in color

Source: Health
Assessment in
Nursing 6th Edition
Iris Inspection Proportional to The iris is
the size of the proportional to
eye, round, the size of the NORMAL
black or brown eye, round, black
and or brown and
symmetrical. symmetrical. Source: Health
The anterior The anterior Assessment in
chamber of the chamber of the Nursing 6th Edition
iris is iris is
transparent. transparent.
Lacrimal Inspection No edema, No edema,
gland, tenderness tenderness over
lacrimal sac over the the lacrimal NORMAL
and lacrimal gland gland and tearing
nasolacrimal and tearing on on the lacrimal
gland the lacrimal sac and Source: Health
sac and nasolacrimal Assessment in
nasolacrimal duct. Nursing 6th Edition
duct.

Visual Inspection The patient is The patient is

acuity/Eye able to see the able to see the
movement stimulus at stimulus at about
about 90° 90° temporally,
temporally, 60° nasally, 50° NORMAL
60° nasally, superiorly and
50° superiorly 70° inferiorly.
and 70° She is able to see
Source: Health
inferiorly. She objects at the
Assessment in
is able to see same time and
Nursing 6th Edition
objects at the normal distant
same time and visual acuity is
normal distant 20/20.
visual acuity is
20/20.

13 | I R R I T A B L E B O W E L S Y N D R O M E
EARS
AREA TO
NORMAL ACTUAL INTERPRETATION
BE TECHNIQUE
FINDINGS FINDINGS & REFERENCES
ASSESSED
Auricles Inspection/Pal Color same as Color same as
pation facial skin, facial skin, NORMAL
symmetrical, symmetrical,
auricle aligned auricle aligned
with outer with outer
Source: Health
canthus of eye, canthus of eye,
Assessment in
about 10 about 10
Nursing 6th Edition
degrees from degrees from
vertical. vertical.
External ear Inspection/Pal No lesions and The ear canal
canal pation nodules, has (-negative
NORMAL
tympanic cerumen) or
membrane absence of
pearly gray in cerumen.
Source: Health
color and
Assessment in
semitransparent,
Nursing 6th Edition
soft or hard
cerumen.
Hearing Inspection The patient is The patient is
acuity able to hear able to hear
whispered whispered NORMAL
words from 1-2 words from 1-2
feet, able to feet, able to
hear watch tick hear watch tick Source: Health
from 1-2 inches. from 1-2 inches. Assessment in
Nursing 6th Edition

NOSE
AREA TO
NORMAL ACTUAL INTERPRETATION
BE TECHNIQUE
FINDINGS FINDINGS & REFERENCES
ASSESSED
Patency of the Inspection Able to inhale Able to inhale NORMAL
nose and exhale on and exhale
both nostrils

14 | I R R I T A B L E B O W E L S Y N D R O M E
 Perform nasal without freely without Source: Health
patency test difficulty freely any difficulty Assessment in
without any Nursing 6th Edition
difficulty

MOUTH
AREA TO
NORMAL ACTUAL INTERPRETATION
BE TECHNIQUE
FINDINGS FINDINGS & REFERENCES
ASSESSED
Lips
Symmetry of Inspection Pinkish, Pinkish,
NORMAL
contour, smooth, moist smooth, moist
color, texture and and
symmetrical symmetrical
Source: Health
with lip margin with lip margin
Assessment in
and without and without
Nursing 6th Edition
lesions lesions
Teeth
Color, Inspection 32 teeth, The patient has NORMAL
number, smooth surfaces white, shiny
condition and edges, teeth enamel.
pearly white No missing Source: Health
and shiny. teeth and no Assessment in
cavities. Nursing 6th Edition
Gums
Color and Inspection Moist, firm by Moist, firm by
condition
texture and texture and NORMAL
no lesion. no lesion. Source: Health
Assessment in
Nursing 6th Edition

Tongue /floor of the mouth

15 | I R R I T A B L E B O W E L S Y N D R O M E
 Color and Inspection and -Pink in color, -Pink in color,
condition Palpation central position. central position.
-Raised -Raised
papillae. - papillae. -
Moves freely, Moves freely, NORMAL
no tenderness. no tenderness.
-Frenulum is at -Frenulum is at Source: Health
the midline the midline Assessment in
straight and straight and Nursing 6th Edition
thin. thin.
-Smooth tongue -Smooth tongue
base with base with
prominent vein prominent vein
Palates
Color and Inspection and Light pink, The skin NORMAL
condition Palpation smooth, soft appears light
palate. pink in color,
smooth and Source: Health
upwardly Assessment in
movable. Nursing 6th Edition
Uvula
Color and Inspection Positioned in Positioned in NORMAL
condition the midline of a the midline. It’s
soft palate, pink pinkish to red in
color. color. There is Source: Health
no swelling or Assessment in
lesion noted. Nursing 6th Edition

NECK
AREA TO
NORMAL ACTUAL INTERPRETATION
BE TECHNIQUE
FINDINGS FINDINGS & REFERENCES
ASSESSED
Tonsils Inspection and Pink in color The patient’s
and tonsillar tonsil is pink in NORMAL
Palpation
pillars color,
symmetrical, symmetrical
tonsils present

16 | I R R I T A B L E B O W E L S Y N D R O M E
 and without and normal in Source: Health
exudate, uvula size. Assessment in
at the middle Nursing 6th Edition
and rises on
phonation.
Neck muscle Inspection and -Muscle equal The patient’s
Palpation in size, head neck is straight.
centered, No visible mass
coordinated or lumps. It’s
smooth symmetrical
movement with and has no
no discomfort, NORMAL
jugular venous
range of motion distension.
from upright
position: Source: Health
flexion-45 Assessment in
degrees, Nursing 6th Edition
extension-55
degrees, lateral
abduction- 40
degrees,
rotation-70
degrees.
Lymph Nodes Palpation The lymph The lymph NORMAL
nodes are round nodes are round
and movable and movable
and it is not and it is not Source: Health
enlarged or enlarged or Assessment in
tender tender Nursing 6th Edition
Trachea Inspection Central midline The trachea is NORMAL
of neck, space palpable. It is in
is equal in both line position
sizes. and straight. Source: Health
Assessment in
Nursing 6th Edition
Thyroid gland Palpation Isthmus must Isthmus must be
be visible with visible with no NORMAL
no presence of presence of
nodules. nodules.

17 | I R R I T A B L E B O W E L S Y N D R O M E
 Source: Health
Assessment in
Nursing 6th Edition

BREAST
AREA TO
NORMAL ACTUAL INTERPRETATION
BE TECHNIQUE
FINDINGS FINDINGS & REFERENCES
ASSESSED
Breast Inspection and Round in shape. Round in
symmetry, size palpation Skin uniform shape and size. NORMAL
and color color, same in No obvious
appearance. No mass noted. Source: Health
tenderness, Skin is Assessment in Nursing
masses, nodules uniform in
or nipple color, same in 6th Edition
discharge. overall skin
appearance.
Areola Inspection The color may The patient’s NORMAL
vary from dark areola varied
pink to dark from dark pink
brown, to dark brown, Source: Health
depending on depending on Assessment in Nursing
th
the the 6 Edition
client’s skin client’s skin
tone. tone.

Nipple Inspection They are equal They are equal NORMAL

bilaterally in bilaterally in
size and are the size and are
same in location the same in Source: Health
on each breast, location on Assessment in Nursing
nipples are each breast, 6th Edition
everted but they nipples are
be inverted and everted but
flat. Color may they be
vary from inverted and
pinkish to brown flat. Color
to dark varied from

18 | I R R I T A B L E B O W E L S Y N D R O M E
 pinkish to
brown to dark
Sub clavicular Palpation No tenderness & No signs of NORMAL
& masses. tenderness and
Supraclavicular masses.
Source: Health
Assessment in Nursing
6th Edition

ABDOMEN

AREA TO BE NORMAL ACTUAL INTERPRETATION

TECHNIQUE
ASSESSED FINDINGS FINDINGS & REFERENCES
Abdominal Inspection Abdominal Abdominal NORMAL
skin skin is slightly skin is
lighter to the slightly
general skin lighter to the Source: Health
tone because general skin Assessment in Nursing
the skin is so tone because 6th Edition
seldom the skin is so
exposed to the seldom
natural exposed to
elements. the natural
elements.
Abdomen Inspection/Palpa Abdomen is Severe pain on ABNORMAL
tion soft, the abdomen
symmetrical, with
and non-tender tenderness,
without positive bowel
distention. sounds to the Abdominal discomfort
left quadrant, or pain with at least two
no acute of the following
epigastric characteristics relation
tenderness. to defecation,
association with the
change of frequency of
stool, and consistency
of stool.

19 | I R R I T A B L E B O W E L S Y N D R O M E
 Source: Physical
Examination & Health
Assessment

UPPER EXTREMITIES

AREA TO BE NORMAL ACTUAL INTERPRETATION

TECHNIQUE
ASSESSED FINDINGS FINDINGS & REFERENCES
Grip strength Inspection, Equal strength The grip NORMAL
Perform Test by in both sides strength is
asking patient to equal in both
raise arm. sides. Source: Health
Assessment in Nursing
6th Edition
Joints Inspection, No tenderness, No
NORMAL
Palpation no swelling, and tenderness, no
joints move swelling, and
smoothly and joints move
Source: Health
without smoothly and
Assessment in Nursing
difficulty without
6th Edition
difficulty
Brachial and Palpation Present and Present and NORMAL
radial pulse equal equal

Source: Health
Assessment in Nursing
6th Edition
Sensation Hair clip and Able to Able to NORMAL
cotton distinguish distinguish the
sharp and dull sharpness and
sensation dullness Source: Health
sensation Assessment in Nursing
6th Edition

20 | I R R I T A B L E B O W E L S Y N D R O M E
LOWER ETREMITIES

AREA TO BE NORMAL ACTUAL INTERPRETATION

TECHNIQUE
ASSESSED FINDINGS FINDINGS & REFERENCES
Joints Inspection and No tenderness, No tenderness,
NORMAL
palpation no swelling, and no swelling,
joints move and joints
smoothly and move
Source: Health
without smoothly and
Assessment in Nursing
difficulty without
6th Edition
difficulty
Feet Inspection and No tenderness, No tenderness,
palpation no swelling, no swelling,
NORMAL

Source: Health
Assessment in Nursing
6th Edition

21 | I R R I T A B L E B O W E L S Y N D R O M E
V. GORDON’S 11 PATTERNS OF FUNCTIONING

Date of Assessment: June 23, 2022 at 1:00 PM

Pattern Before During Analysis and
Hospitalization Hospitalization Interpretation
Health The patient claimed Patient stated that she Her health perception
Perception/Health that she is not healthy feels that she’s not and management did
Management physically and healthy due to her not changed because
mentally. She lives in condition. She thought of her condition.
unhealthy lifestyle for that the signs and
not being physically symptoms that she Health and illness are
active like she just sits had right now can defined according to
in her office during worsen and think that individual perception.
work for 8 hours and she will not recover or Health often includes
eating unhealthy foods be healed. conditions previously
like burgers, fries, and considered to be
coke. illness.

Source:
Fundamentals of
Nursing 9th Edition
pg. 66

Nutrition Typical daily food Patient consume the Patient nutritional

Metabolic Pattern intake: food that is prescribed status has been
Breakfast – 1 cup by her doctor. Low changed due to her
coffee and 1 slice of FODMAP Diet diet.
bread (Fermentable
Lunch- 1 piece fried Oligosaccharides, Nutrition is a basic
chicken, 1 cup rice, Disaccharides, component of health
and 1 cup coke Monosaccharides and and is essential for
Snack - 1 burger and 1 Polyols); it restricts normal growth and
cup coke certain carbohydrates development, tissue
Dinner- 1 cup rice and that trigger the maintenance and
chicken adobo symptoms. repair, cellular
metabolism, and organ
For the past 2 months Typical daily food function. The human
patient lost 5 intake: body needs an
kilograms due to Breakfast - 1 banana, adequate supply of
initial onset of 1 boiled egg, and 1 nutrients for essential
symptoms of the cup of white rice functions of cells.
present illness. Lunch - 1orange,
chicken tinola, and 1 Source:
cup of white rice Fundamentals of

22 | I R R I T A B L E B O W E L S Y N D R O M E
 Typical daily fluid Snack - 1 cup boiled Nursing 9th Edition
intake: peanuts by Potter-Perry pg.
Water – 1,400 mL – Dinner - Chop Suey 1054
1,600 mL (5-7 cups) (bean sprouts, onion,
per day carrots,a nd pork) and
Coffee – 1 cup per day 1 cup of white rice.
amounting to 250 mL
Typical daily fluid
intake:
Water – 1,500 mL –
1,600 mL (6-7 cups)
per day

Elimination The patient stated that The patient’s urine is Her defecation pattern
Pattern she urinated nearly 6 clear in color. She changed due to the
times per day. She also stated she voids medication given to
defecates once in three 5-6 times per day. She her.
days hard lumps and defecates once a day
brown in color. soft and brown in Regular elimination of
Urine color: clear color. bowel waste products
Amount of urine: Amount of urine: is essential for normal
1000-1500 milliliters 1,000 milliliters per body functioning.
per day (1.5L per day (1L per day). Alterations in bowel
day). elimination are often
early signs or
symptoms of problems
within either the GI
tract or other body
systems.

Source:
Fundamentals of
Nursing 9th Edition
pg. 1149

Activity and The patient stated that During Patient is unable to

Exercise Pattern she does walking hospitalization, the perform some of her
every Sunday before patient was advised to unusual activities since
and after church. Her do walk around the she is weak because of
day off is the only free room. Do breathing her stomach pain.
time to clean her exercise like
house which serves as Diaphragmatic Regular physical
her exercise. She also Breathing also called activity and exercise
stated that during her deep breathing to contribute to both
leisure time she makes promote relaxation for physical and emotional
content on TikTok. the pain and it is well-being. Knowing

23 | I R R I T A B L E B O W E L S Y N D R O M E
 The patient is able to taught to GI patients the physiology and
perform the basic to help them manage regulation of body
activities of daily stress caused by GI mechanics, exercise
living by herself like conditions. The and activity helps
eating, bathing, patient can do the provide individualized
grooming, walking, basic activities by patient care.
toileting, dressing and herself like eating,
undressing. grooming, toileting, Source:
dressing and Fundamentals of
undressing. But the Nursing 9th Edition
patient need some pg. 787
assistance if she will
take a bath and do
walking because she
is still weak because
of stomach pain.

Sleep and Rest Typical sleep pattern: Typical sleep pattern: There is a change in
Pattern Bedtime – 10 PM Bedtime – 10 PM her sleep pattern
Hours slept – 7 hours Hours slept – 6 hours because of discomfort.
Nap time – 30
Patient NL states that minutes Individuals need
sometimes she wakes different amounts
up in the middle of the The patient claimed sleep and rest. Without
night because of the that she had fewer proper amounts, the
pain in her abdomen. hours of sleep during ability to concentrate,
She manages to get her hospitalization make judgements, and
back to sleep in few due to change in her participate in daily
minutes. environment, activities decreases;
interruption during and irritability
vital signs taking, and increases.
when she is going to
take her medication. Source:
Her sleep pattern Fundamentals of
shifted to 6 hours. Nursing 9th Edition
pg. 992

Cognition and Patient can respond to Patient can respond to The patient is exposed
Perception stimuli both verbally all the questions to a sufficient amount
and physically and accurately. The of learns how to think
does not have sensory patient has no critically using proper
deficit. Patient is cognitive disturbances cognition and
oriented to time, or memory problems. perception.
place, and people. She also show no
signs of sensory A fully conscious
impairment. Patient is patient responds to

24 | I R R I T A B L E B O W E L S Y N D R O M E
 Patient is able to write oriented to time, questions quickly and
and has no difficulty place, and people. expresses ideas
learning, can hear logically
whispers, can read
newsprint, and grasp Source:
ideas and questions. Fundamentals of
Nursing 9th Edition
pg. 600

Self- She verbalized that She stated that she The patients
perception/Self- she was confident stayed calm, always understanding about
concept Pattern enough to show her choose to relax. her self-enabled her to
imperfections and Patient has a low self- participate more
content with what she esteem because she actively during her
has now. didn’t expect that she hospitalization.
She also mentioned would get sick.
that she is an Self-concept, or how a
approachable, person thinks about
friendly, and jolly oneself, directly
person. affects self-esteem, or
how one feels about
oneself.

Source:
Fundamentals of
Nursing 9th Edition
pg. 701

Role and Patient stated that she During The patient and her
Relationship had no complaints hospitalization, some step sister, as well as
Pattern regarding her family of her friends visited her friends, have a
especially her her to cheer her up solid relationship.
stepsister. She doesn’t and show support. She
worry because her also mentioned that Family durability is a
step sister always give she felt relief because system of support and
her assurance and of the support from structure within a
sincerely shows her her love ones. family that extends
love and care for her. beyond the walls of the
She is also the household
manager of Alay
Kapwa Bank. Source:
Fundamentals of
Nursing 9th Edition
pg. 117

25 | I R R I T A B L E B O W E L S Y N D R O M E
 Sexuality and Because the patient During There is no change in
Reproductive has been single for a hospitalization, the her sexuality pattern
Pattern long time, the patient patient has no because she has no
claimed that she not satisfactory satisfying relationship.
now have a satisfying relationship because
relationship. The she has been single Sexuality is part of a
patient had an intimate for 3 years. Because person’s personality
relationship 3 years of her condition, and is important for
ago. being in a relationship overall health.
is the least thing that
she want to do. Source:
Fundamentals of
nursing 9th Edition
pg. 716

Coping Stress Patient states that her During To handle and cope
Tolerance Pattern stress reliever during hospitalization, with something, the
her break time is patient states that patient has to express
making content on praying and talking her feelings.
TikTok, and scrolling with her stepsister via
on Facebook. Also videocall is her stress Coping is the person’s
praying and walking reliever. cognitive and
when she is going to behavioural efforts to
church. Having some manage a stressors. It
quality time with her is important to
stepsister by visiting physical and
her in Santiago. psychological health
because stress is
associated with a range
of psychological and
health outcomes.

Source:
Fundamentals of
Nursing 9th Edition
pg. 773

Value Belief Patient states that Patient prays every There’s no change in
Pattern religion is important time for her to be safe her belief and she still
in her life and that and strong enough to prays for her health
praying helps her surpass problems and her step-sister
when difficulties arise. about her condition. also.
She is a Christian and She believes that
goes to church every Jesus Christ is the A person’s health
Sunday morning. She divine son of God. depends on a balance
believes that salvation of physical,

26 | I R R I T A B L E B O W E L S Y N D R O M E
through the Catholic psychological,
Church is the only sociological, cultural,
way to heaven. developmental, and
spiritual factors.
Spirituality helps
individuals achieve the
balance needed to
maintain health and
well-being and cope
with illness.

Source:
Fundamentals of
Nursing 9th Edition
pg. 733

27 | I R R I T A B L E B O W E L S Y N D R O M E
 VI. ANATOMY AND PHYSIOLOGY

The lower gastrointestinal (GI) tract is the last part of the digestive tract. The lower GI tract consists
of the large intestine and the anus. The large intestine consists the cecum, the colon, the rectum
and the anal canal.

The cecum is the proximal end of

the large intestine where it joins with
the small intestine at the ileocecal
junction. The cecum is located in the
right lower quadrant of the abdomen
near the iliac fossa. The cecum is the
sac that extends inferiorly about 6 cm
past the ileocecal junction. Attached to
the cecum is the appendix.

28 | I R R I T A B L E B O W E L S Y N D R O M E
Colon

The colon is about 1.5 to 1.8 m long and consists of four parts: (1) the ascending colon, (2) the
transverse colon, (3) the descending colon, and (4) the sigmoid colon. The ascending colon extends
superiorly from the cecum to the right colic flexure, near the liver where it turns to the left. The
transverse colon extends from the right flexure to the left flexure near the spleen, where the colon
turns inferiorly; and the descending colon extends from the left colic flexure to the pelvis, where
it becomes the sigmoid colon. The sigmoid colon forms an S-shaped tube that extends medially
and then inferiorly into the pelvic cavity and ends at the rectum.

The rectum is a straight, muscular

tube that begins at the termination of
the sigmoid colon and ends at the anal
canal. The muscular tunic is
composed of smooth muscle and is
relatively thick in the rectum
compared to the rest of the digestive
tract.

29 | I R R I T A B L E B O W E L S Y N D R O M E
Anal Canal

The last 2-3 cm of the digestive tract is the anal canal. It begins at the inferior end of the rectum
and ends at the anus. The smooth muscles layer of the anal canal is even thicker than that of the
rectum and forms the internal anal sphincter at its superior end. The external anal sphincter at the
inferior end of the anal canal is formed by the skeletal muscle.

Functions of the Large Intestine

Normally, 18-24 hours are required for material to pass through the large intestine, in
contrast to the 3-5 hours required for chyme to move through the small intestine. Chyme is
converted to feces in the colon. Feces formation is due to the absorption of the water and salts, the
secretion of mucus, and extensive action of microorganisms. The colon stores the feces until they
are eliminated by the process of defecation.

Every 8-12 hours, large parts of the colon undergo several contractions called mass
movements, which propel the colon contents a considerable distance towards the anus. Each mass

30 | I R R I T A B L E B O W E L S Y N D R O M E
movement contraction extends over 20 or more centimeters of the large intestine, which is much
longer part of the digestive tract than that covered by a peristaltic contraction. These mass
movements are very common following some meals, especially breakfast.

The defecation reflex occurs when feces distend the rectal wall. The defecation reflex
consists of local and parasympathetic reflexes. Local reflexes cause weak contractions of the distal
colon and rectum. Parasympathetic reflexes cause strong contractions, and are normally
responsible for most of the defecation reflex. Action potentials produced in response to the
distention of the rectal wall travel along sensory nerve fibers to the defecation reflex center in the
sacral region of the spinal cord. There motor action potentials are initiated that reinforce peristaltic
contractions in the lower colon and rectum. These action potentials from the defecation reflex
center also cause the internal anal sphincter to relax. The external anal sphincter, which is
composed of skeletal muscle and is under conscious cerebral control, prevents feces from moving
out of the rectum and through the anal opening. If the sphincter is relaxed voluntarily, feces are
expelled. The defecation reflex persists for only a few minutes and quickly subsides. Generally,
the reflex is reinitiated after a period that may be as long as several hours. Mass movements in the
colon are usually the reason for the reinitiation of the defecation reflex.

Defecation can be initiated by voluntary actions that stimulate a defecation reflex. These
actions include a large inspiration of air, followed by the closure of the larynx and forceful
contraction of the abdominal muscles. As a consequence, the pressure in the abdominal cavity
increases and forces feces into the rectum. Stretching of the rectum initiates a defecation reflex.
The increased abdominal pressure also helps push feces through the rectum.

31 | I R R I T A B L E B O W E L S Y N D R O M E
 VII. BRIEF DESCRIPTION

Irritable bowel syndrome is a long-term condition on the digestive system. It is often

lifelong but can be successfully managed with the right strategies and medication. Some people
control their symptoms by managing diet lifestyles and stress. Irritable bowel syndrome is often
complained by patients as abdominal pain, discomfort associated with defecation and sensation of
bloating. Though irritable bowel syndrome’s exact cause isn’t known it can be triggered by food
and medications. Conditions can become worst often during times of stress or eating certain food.
It occurs at any age. It begins in teen and early adulthood. Most common on women because of
the high rates of oestrogen and progesterone that can slow down gut motility.

Irritable bowel syndrome doesn’t usually cause changes in bowel tissue or inflammation
which is a risk factor in colorectal cancer but long-term symptoms include sensation of incomplete
defecation and increases gas or mucus in the stool. The chronic pain (pain lasting 3-6 months or
longer) in IBS can be felt anywhere in the abdomen (belly), though is most often reported in the
lower abdomen. It may be worsened soon after eating, and relieved or at times worsened after a
bowel movement. It is not always predictable and may change over time.

RISK FACTORS:

 Female – When high rates of estrogen and progesterone interfere, it can slow down gut
motility. This is why women tend to suffer more from IBS-C than men do.
 Unhealthy Diet – a poor lifestyle and poor dietary habits, such as physical inactivity, sleep
disturbance, and irregular eating, increase the risk of IBS.
 Stress – Stress-induced alterations in neuro-endocrine-immune pathways acts on the gut-
brain axis and microbiota-gut-brain axis, and cause symptom flare-ups or exaggeration in
IBS. IBS is a stress-sensitive disorder; therefore, the treatment of IBS should focus on
managing stress and stress-induced responses.

32 | I R R I T A B L E B O W E L S Y N D R O M E
SIGNS AND SYMPTOMS:

 Abdominal pain (left lower quadrant)

 Constipation
 Bloated
 Weight loss

CLINICAL MANIFESTATIONS:

 Muscle contraction in the intestine

 Early life stress
 Changes in gut microbes

ASSESSMENT AND DIAGNOSTIC METHODS:

 Blood test
 Stool test
 Hematology
 Abdominal Ultrasound
 Urinalysis

PHARMACOLOGIC THERAPY:
 Lubriprostone 8mcg PO, 3x a day for one week
 Dicyclomine 20mg PO, 4x a day for one week
 Psyllium 25g 1 cap. PO, once a day for one week

33 | I R R I T A B L E B O W E L S Y N D R O M E
VIII. PATHOPHYSIOLOGY

34 | I R R I T A B L E B O W E L S Y N D R O M E
 IX. DIAGNOSTIC EXAMINATION
HEMATOLOGY
DATE: June 23, 2022

DIAGNOSTIC EXAM NORMAL RESULT INTERPRETATION/

RANGE ANALYSIS

Hemoglobin 12-16 g/dl 16.0 g/dl NORMAL

Hematocrit (%) 37-43% 38.1 % NORMAL

RBC 4.0-5.4 x 1023/L 5.0 NORMAL

WBC 4.5-10.5 x 109/L 7.0 NORMAL

Platelet 150-500 x 109/L 400 NORMAL

Test NORMAL RESULT INTERPRETATION/

RANGE ANALYSIS

Sodium 135-145 138 NORMAL

Potassium 3.5-5.0 4.5 NORMAL

Chloride 97-107 107.5 NORMAL

URINALYSIS REPORT
DATE: June 23, 2022

TEST RESULT REFERENCE VALUE

PHYSICAL ANALYSIS

Color Yellow Colorless to amber

Clarity Clear Clear to hazy

CHEMICAL ANALYSIS

Glucose Negative NEGATIVE

35 | I R R I T A B L E B O W E L S Y N D R O M E
 Protein Negative NEGATIVE

pH 6 4.4-8.0

Specific Gravity 1.015 1.001-1.035

MICROSCOPIC EXAMINATION

WBC 1 0-5(WBC/HPF)

RBC 1 4(RBC/HPF)

Epithelial cells 2 1-4(HPF)

Bacteria NONE NONE-FEW

STOOL ROUTINE REPORT

Name: NL
Age: 28
Sex: F
DATE: June 23, 2022

TEST RESULTS
MACROSCOPIC EXAM
Color BROWN
Consistency HARD
Mucus PRESENT
Frank Blood ABSENT
Reducing substances ABSENT

CHEMICAL EXAM
Occult Blood NEGATIVE
Reducing Sugar ABSENT

MICROSCOPIC EXAM
Ova of Hook worm ABSENT
Larva of S. Stercoralis ABSENT
Ascarris lumbricoides ABSENT

36 | I R R I T A B L E B O W E L S Y N D R O M E
 E. Histolytica ABSENT
E. coli ABSENT
Giardia Lamblia ABSENT
Trichomonas ABSENT
R.B.C. ABSENT
Pus Cells ABSENT
Macrophages ABSENT
Vegetable Cells ABSENT
Yeast Cells ABSENT
Fat globules ABSENT
Bacterial Flora ABSENT
Epithelial Cell ABSENT

ULTRASOUND REPORT

Name: NL
Age: 28
Sex: F
DATE: June 23, 2022

37 | I R R I T A B L E B O W E L S Y N D R O M E
Findings:

Liver Normal in size. Its surface contour is smooth. No focal lesion. The
intrahepatic bile radicles are not dilated. Hepatic veins/Portal vein is
normal.
Gallbladder Well distended with smooth walls. No calculi/wall thickening noted
Pancreas Normal in size and echotexture. No focal or peripancreatic mass is seen.
Pancreatic duct is not dilated.
Spleen Normal in size. Its surface contour and echo pattern are normal. The
splenic hilus is not dilated.
Kidneys Normal in size. The right kidney measures 9.0 cm. by 4.8 cm. by 4.3 cm.
while the left kidney measures 9.2 cm. by 4.6 cm. by 3.7 cm. (LWD).
Cortical thickness is normal bilaterally. The surface contour,
parenchymal echo pattern and central echo complexes of the kidneys are
normal. The perirenal spaces are unremarkable.
Urinary bladder Well distended with smooth and even walls. No intravesical abnormality
is seen.
Prostate Normal in size and measures 3.1 cm. by 3.5 cm. by 2.3 cm. (LWD). Its
contour is smooth. The echo pattern is heterogenous
Psoas muscles Normal

No mass lesion is seen in the abdomen, retroperitoneum and pelvis. There is no evidence of ascites.

IMPRESSION:

No free fluid in abdomen

Normal sonographic findings in the liver, biliary tree, pancreas, spleen, kidneys, urinary bladder,
prostate and psoas muscles.

38 | I R R I T A B L E B O W E L S Y N D R O M E
 X. DRUG STUDY
Date and time: June 23, 2022 11:00 am
Generic name: Lubiprostone
Brand name: Amitiza
Classification: Laxatives
Doctor’s Order: Lubisprostone 8mcg PO B.I.D for one week

Mechanism of Action Indications Contraindications Effects Nursing Responsibilities

Laxatives promote Used to treat certain Contraindicated in Side effects: Instruct patients to follow
movement of intestinal types of constipation patients with GI the dosing regimen
 Dizziness
contents through the (IBS) obstruction or prescribed by the
 Headache
colon and rectum in perforation and acute healthcare provider.
 Tiredness
several ways: bulk- surgical abdomen.
forming, emollient and
stimulant Instruct the patient not to
take drug during episodes
Adverse effects:
of severe diarrhea.
 Stomach pain
 Swelling of
the hands, Advise the patient to
feet, ankles or report any effects of the
lower legs drugs.
 Chest
discomfort

39 | I R R I T A B L E B O W E L S Y N D R O M E
Date and time: June 23, 2022 11:00 am
Generic name: Dicyclomine
Brand name: Bentyl
Classification: Anticholinergics, Antispasmodics
Doctor’s Order: Dicyclomine 20mg PO QID for one week

Mechanism of Action Indications Contraindications Effects Nursing Responsibilities

Inhibits action of Indicated for the Hypersensitivity to Side effects: Monitor any changes in
acetylcholine on treatment of functional dicyclomine or any irritable bowel symptoms
 Drowsiness
postganglionic, bowel disorder and IBS. anticholinergic drugs (decreased abdominal
 Weakness
decreasing GI motility. pain, decreased diarrhea,
 Vomiting
Drug possessess local improved appetite) to help
 Headache
anesthetic properties document whether drug
that may be partly therapy is successful.
responsible for
Monitor the vital signs
spasmolysis
Adverse effects:
Monitor I&O (esp. stool
 Upset and urine output)
Stomach
Tell the patient when take
 Bloating
drug and stress importance
 Loss of
appetite of doing so on time and at
 Blurred Vision evenly spaced intervals ad
report any effects of the
drug.

40 | I R R I T A B L E B O W E L S Y N D R O M E
Date and time: June 24, 2022 12:15 pm
Generic name: Psyllium
Brand name: Metamucil
Classification: Antidiarrheals: Mucilaginous Fiber
Doctor’s Order: Psyllium 25g 1 cap. PO O.D for one week

Mechanism of Action Indications Contraindications Effects Nursing Responsibilities

Psyllium are comprised Indicated for fiber Contraindicated in Side effects: Monitor for the
of dietary fiber which, supplementation, patients with GI therapeutic effectiveness.
 Nausea and
when mixed with water occasional constipation obstruction or
vomiting
forms a gel-like mass or help to promote and perforation or acute
 Stomach pain
that works as a mild maintain regularity. surgical abdomen. Monitor the vital signs.
 Itching
laxative Label. This gel-
 Stomach
like mass subsequently cramping
moves down a patient's Monitor for the frequency
digestive system and of defecation.
makes stools softer by Adverse effects:
increasing their water
 Difficulty in
contents Label. At the breathing Instruct the patient to
same time psyllium  Skin rash report promptly for any
lubricates the intestine,  Difficulty in complains of the
which improves the swallowing retrosternal pain after
transit of stools taking the drug.

41 | I R R I T A B L E B O W E L S Y N D R O M E
 XI. NURSING CARE PLAN

5 NURSING PRIORITIES AND 3 NURSING CARE PLAN

❶ABDOMINAL PAIN
- Abdominal pain related to bowel obstruction as evidenced by pain scale 9/10.
❷ CONSTIPATION
- Constipation related to low fiber diet as evidenced by consistency of stool. (Separate hard lumps)
❸ IMBALANCE NUTRITION: LESS THAN BODY REQUIREMENTS
- balanced Nutrition: Less than body requirements related to poor diet as evidenced by weight loss. Before: 61kg After: 59kg
4. BLOATED
5. KNOWLEDGE DEFICIENT

42 | I R R I T A B L E B O W E L S Y N D R O M E
ASSESSMENT DIAGNOSIS SCIENTIFIC PLANNING NURSING RATIONALE EVALUATION
EXPLANATION INTERVENTION
Subjective: Abdominal Infrequent bowel Short term: - Monitor Vital - Watch for Goal met, after
pain related to movement signs. fluctuations. 12 hours of
“Sumasakit
bowel nursing
ang tiyan ko” as
obstruction as Within 8 intervention the
verbalized by - Encourage bed - Rest
evidenced by hours of rest decreases patient’s pain
the patient
pain scale of Nursing intestinal reduced to a
Pain scale: 9/10 9/10. intervention motility tolerable level.
(Severe pain) Bowel the patient’s
Obstruction pain reduced
- Increase fluid - It will help
to a tolerable intake to maintain
Objective: level.
fluid
- Restlessness volume
- Guarding Abdominal Pain Long term:
Behaviour - Administer - Medication
-Rebound Dicyclomine helps to
Tenderness as prescribed relieve pain.
Within 12
by the
hours of
Physician
VITAL SIGNS Nursing
TAKEN: intervention
- Educate and - To promote
the patient’s
assist the relaxation
BP:130/90 pain reduced
patient in and pain
RR: 22bpm to a tolerable reduction
breathing and
level. relaxation
techniques.

- Applying heat
to the abdominal

43 | I R R I T A B L E B O W E L S Y N D R O M E
- Apply heat area not only
compress. ease the spasms
but also
improves the
blood flow to the
muscles in the
colon decreasing
cramps and
spasm.

44 | I R R I T A B L E B O W E L S Y N D R O M E
ASSESSMENT DIAGNOSIS SCIENTIFIC PLANNING NURSING RATIONALE EVALUATION
EXPLANATION INTERVENTION
Subjective: Constipation Low fiber diet Short term: - Monitor Vital - Watch for Goal met, after
related to low signs. fluctuations. 12 hours of
“Every 2-3 days Within 8
fiber diet as nursing
ako kung hours of
evidenced by intervention the
dumumi tapos Nursing - Encourage bed - Rest
consistency of rest decreases patient’s pain
lagi akong hirap intervention
stool intestinal reduced to a
sa pag iri” as the patient’s
Separate hard motility tolerable level.
verbalized by the - Separate pain reduced
patient hard lumps lumps to a tolerable
level. - Incease rfluid - It will help
Objective: intake to maintain
- Restlessness fluid
- Grimace Constipation Long term: volume
- Abdominal
Discomfort Within 12 - Administer - Medication
- Irritability hours of Dicyclomine helps to
Nursing as prescribed relieve pain.
CONSISTENCY intervention by the
OF STOOL: the patient’s Physician
pain reduced
- Separate
to a tolerable - Educate and - To promote
hard lumps
level. assist the relaxation
patient in and pain
VITAL SIGNS reduction
breathing and
TAKEN: relaxation
T: 37.1°C techniques.
RR: 18 bpm
- Apply heat - Applying heat
BP: 120/80 compress. to the abdominal
mmHg

45 | I R R I T A B L E B O W E L S Y N D R O M E
 area not only
ease the spasms
but also
improves the
blood flow to
the muscles in
the colon
decreasing
cramps and
spasm.

46 | I R R I T A B L E B O W E L S Y N D R O M E
ASSESSMENT DIAGNOSIS SCIENTIFIC PLANNING NURSING RATIONALE EVALUATION
EXPLANATION INTERVENTION
Subjective: Imbalanced Poor diet Short term: - Monitor - It is an ideal Goal met, after 2
Nutrition: patient’s tool in the weeks the
“Hindi ako Within 7 weight assessment of
Less Than patient will
makakain ng days of person’s
Body demonstrate
maayos” as nursing nutritional
Requirements adequate
verbalized by intervention requirements.
related to nutritional
the patient the patient
poor diet as Weight loss intake and meet
will - Refers the - A dietitian can
Weight Loss: evidenced by metabolic needs
demonstrate patient to the help the
weight loss: dietitian or medical team as evidenced by
Before: 61kg adequate
nutritionist. in assessing weight gained.
After: 59kg nutritional
intake and the patient
Before: 61kg nutritional
Objective: meet
Imbalanced status and
After: 59kg metabolic
- Weight loss Nutrition: less recommend
needs as food option
- Restlessness than body evidenced by
- Weakness that will
requirements weight gain. supplement
VITAL SIGNS the patient’s
nutritional
TAKEN:
Long term: gaps.
T: 37.1°C
Within 2
RR: 18 bpm - Start the - A record of
weeks of
PR: 90 bpm patient on a what the
nursing
BP: 100/60 food diary and patients eat
intervention
mmHg assess caloric can help direct
the patient intake
will treatment.
demonstrate
adequate

47 | I R R I T A B L E B O W E L S Y N D R O M E
nutritional - Explain - Understanding
intake and nutrition and the
meet patient’s importance of
metabolic personal maintaining
needs as nutrition proper
evidenced by needs. nutrition will
encourage the
weight gain.
patient to
become
proactive in
adhering to
the treatment
plan.

- Weight the - The patient’s

patient weight will
regularly and help in the
document evaluation of
readings. the patient
progress.

- Promote a - The patient’s

conducive environment
feeding can help
environment. induce
appetite and
promote the
intake of food.

48 | I R R I T A B L E B O W E L S Y N D R O M E
XII. DICHARGE PLANNING
Date and time of Admission: June 23. 2022 at 10:30 AM
Date and time of Discharge: June 24, 2022 at 12:15 PM
Date and Time of OPD Appointment: July 4, 2022 at 9:00 AM in Medical Mission Group Hospital

MEDICATIONS ENVIRONMENT AND TREATMENT DIETS SPIRITUALITY /

EXERCISE SEXUALITY

- Encourage patient to - Instruct patient to - Advice patient to

Lubiprostone regularly exercise for do follow up avoid caffeinated, - Encourage
patient to seek
- 1 tablet, twice a day atleast 15 to 30 checkup. carbonated, alcoholic
minutes everyday like and processed foods. help and
every 8:00 in the guidance with
morning (after meal) and walking, jogging, and - Tell patient to
yoga. the Almighty
evening (after meal) follow the advice of - Eating well balanced,
God.
the physician. high fiber diet,
- Keep the environment avoiding gas-forming
Psyllium clean. foods and avoid fluid
- Instruct patient to intake with meals.
- 1 tablet, once a day every take medications as
8:00 in the morning after prescribed and
meal immediately report - Instruct patient to
any adverse avoid having heavy
reactions to meals.
Plecanatide
physician.
- 1 tablet, once a day every - Tell patient to
8:00 in the morning after - Encourage patient practice FODMAP
meal. to increase fluid (Fermentable
intake. Oligosaccharides,
Disaccharides,

49 | I R R I T A B L E B O W E L S Y N D R O M E
- Tell patient to Monosaccharides,
practice proper and Polyols) diet
hand hygiene.

- Advice patient to
eat variety of high
fiber enriched
foods such as
okra, broccoli,
avocado and
beans.

- Instruct patient to
minimize or avoid
stress producing
situations
especially on
work.

- Advice patient to
chew food slowly
and thoroughly
when eating.

50 | I R R I T A B L E B O W E L S Y N D R O M E
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