Nursing Guide to Irritable Bowel Syndrome (IBS): Nursing Diagnosis, Interventions, & Care Plans

Irritable Bowel Syndrome (IBS) Etiology and Epidemiology

Irritable bowel syndrome or IBS is a gastrointestinal disorder described as a group of symptoms that occur together and is the most commonly diagnosed gastrointestinal disease. These symptoms include:

• Excessive gas
• Abdominal pain
• Cramps

IBS is a functional gastrointestinal disease that is in a group also referred to as gut-brain disorders and are related to issues with how the brain and gut work together causing the digestive tract to be sensitive.

Environmental factors contributing to IBS issues include:

• Stress in early life
• Food intolerance
• Medications, such as antibiotics
• Enteric infections
• Mental disorders such as depression

There are different types of IBS based on the individual’s bowel movements, and each will affect the treatment of IBS. The types of IBS include (Cleveland Clinic, 2020):

• IBS with constipation (IBS-C): Bowel movements are hard and lumpy.
• IBS with diarrhea (IBS-D): Bowel movements are loose and watery.
• IBS with mixed bowel habits (IBS-M): Constipation and diarrhea occur on the same day.

Studies show that the prevalence of IBS ranges between 10 to 15% but the majority of the individuals with IBS symptoms do not seek medical care (Patel & Shackelford, 2021). In the U.S, Canada, and Israel, IBS is more common in females than males and more likely to cause abdominal pain and constipation.

ICD-10 Code Category for IBS: K58

IBS Diagnosis

IBS is diagnosed by a thorough history intake and physical examination by the healthcare provider. Signs and symptoms of IBS include:

• Abdominal pain
• Diarrhea
• Constipation
• Bloating
• Distention
• Whitish mucus in stool
• Fatigue
• Anxiety

Diagnostic tests may include:

• Comprehensive metabolic panel (CMP)
• Complete blood count (CBC)
• C-reactive protein
• Stool samples
• Colonoscopy

IBS Management

Management and treatment of IBS may include:

• Changes in diet, such as:
  • Increase fiber intake.
  • Avoid gluten.
  • Increase fluid intake.
  • Limit cheese and milk.
  • FODMAP diet (Fermentable oligo-, di, monosaccharides, and polyols).
• Increase physical activity.
• Administer loperamide (Imodium®) for diarrhea.
• Administer rifaximin (Xifaxan®) as ordered.
• Administer lubiprostone (Amitiza®) for constipation.
• Administer antispasmodics for abdominal pain as ordered.
• Administer antidepressants as ordered.
• Administer probiotics as ordered.
• Referral to gastroenterologist.

IBS Nursing Care Plan & Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for irritable bowel syndrome are listed below.

Assessment

Assess for signs and symptoms, such as:

• Abdominal pain
• Bloating
• Constipation
• Diarrhea
• Fatigue

IBS Nursing Diagnosis/Risk For

• Imbalanced nutrition: Less than body requirements related to restricted intake, evidenced by:
  • Verbalization of no desire to eat
  • Weight loss
• Acute pain related to hyperperistalsis, evidenced by:
  • Verbalization of abdominal pain
  • Restlessness
• Ineffective coping related to stressors, evidenced by:
  • Verbalization of decreased coping strategies
  • Depression

Interventions

• Monitor daily weights.
• Avoid foods that exacerbate symptoms.
• Encourage small meals.
• Encourage participation in diet planning.
• Assess and monitor pain.
• Provide non-pharmacological interventions for pain control.
• Monitor vital signs.
• Assess individuals understanding of disease process.
• Educate on condition, treatment, and outcomes.
• Provide emotional support for individual and family.
• Identify coping strategies.
• Refer to resources as needed.

Expected Outcomes

• Achieves and maintains stable weight
• Achieves and maintains tolerable pain control
• Identifies effective coping mechanisms
• Verbalizes improvement in symptoms
• Maintains fluid and electrolyte balance

Individual/Caregiver Education

• Condition, treatment, and outcome
• Review prescribed medications and side effects
• Signs and symptoms of dehydration related to diarrhea
• Review dietary restrictions and foods to avoid
• Recommended follow-up with healthcare provider
• Notify healthcare provider or seek medical attention for the following:
  • Blood in stool
  • Severe abdominal pain
  • Fever

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2026

Course Contributor

The content for was created by Bobbi Whittington, RN, BSN.

Bobbi started her nursing career as a CNA in long term care and developed a passion for working with older adults in the post-acute setting. She obtained her LPN certificate in 1997 from South Central Area Vocational Technical School in Missouri. Continuing her education, she earned her Associate degree in nursing in 2007 from Texas County Technical Institute in Missouri then obtained her Bachelor of Science degree in nursing from Chamberlain College of Nursing in 2013. Bobbi has over 24 years clinical and managerial experience in the skilled nursing industry.

References

• Patel, N., & Shackelford, K. (2021). Irritable bowel syndrome. https://www.ncbi.nlm.nih.gov/books/NBK534810/
• Cleveland Clinic. (2020). Irritable bowel syndrome (IBS). https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs