Although the role of the inflammatory bowel disease (IBD) nurse will vary with each clinical setting, the fundamental goal is to address the multidisciplinary needs of this unique patient population. Due to the chronic nature of IBD and its unpredictable course of remissions and exacerbations, IBD patients generally require close, long-term medical care consisting of frequent follow-up appointments and phone calls to assess progression of symptoms and to provide appropriate reassurance. Therefore, building a trusting relationship and developing effective rapport with this patient population are critical. When interacting with IBD patients, the nurse should bear in mind that both ulcerative colitis (UC) and Crohn’s disease (CD) are chronic inflammatory conditions that profoundly affect the gastrointestinal (GI) tract as well as the body in general. The overall treatment objectives include achieving and maintaining remission with minimal side effects and improving the patient’s quality of life by correcting nutritional deficiencies, controlling the inflammatory process, and relieving symptoms, including abdominal pain, diarrhea, and rectal bleeding through a tailored medication regimen. Consequently, fundamental components of the nurse’s role include assessment and patient education regarding the disease process, medications, diagnostic and therapeutic tests, laboratory monitoring, and nutrition. Although nursing and medical care are essential throughout diagnosis and treatment, the ultimate aim is to foster a sense of independence.

The manifestations of IBD vary greatly from one individual to another, depending in part on the location and severity of the inflammation; therefore, the nurse will need to ask detailed questions targeting the signs and symptoms of IBD as well as its complications and extraintestinal manifestations in order to ascertain a thorough patient assessment. First, patients should be specifically questioned about the presence, severity, and location of pain. Assessment of intestinal symptoms should include inquiries about cramping and the pattern of bowel elimination, including the frequency, character, and amount of bowel movements each day. It is important to know if the stool is formed, loose, or watery and if mucous or blood is seen. Ascertaining the baseline number of bowel movements and other symptoms patients experience can help objectively determine if a patient is in remission or if they are experiencing an exacerbation of their disease, since each patient’s baseline condition may differ greatly from other patients.

In addition, an assessment of the patient’s nutritional status as well as their social situation should be performed, including available support, stressors, and occupation.

Moreover, while performing an assessment, the nurse should be alert for any signs and symptoms that may suggest the development of complications from IBD or its treatment, including fistulae, abscesses, stricture formation and intestinal obstruction, toxic megacolon (UC patients), and colonic carcinoma (UC patients).

In addition, because the inflammatory process associated with IBD is not limited to the GI tract, the nurse should assess for extraintestinal manifestations of this disease process as well. Extraintestinal manifestations may include oral, ocular, musculoskeletal, cutaneous, hematologic (anemia and thrombocytopenia), and urologic ( fistula formation with bacterial contamination) conditions, among others (1,2).

It is also important to ask the patient to explain in his own words how he is feeling and to have him relate any symptoms about which he is concerned, which may help gather important information that could otherwise be overlooked if patients only answer examiner-initiated questions.

Endoscopy with biopsy is widely regarded as the gold standard for the confirmation of an IBD diagnosis, but other diagnostic and therapeutic tests are often warranted. Therefore, knowledge and understanding of diagnostic testing is especially helpful, and specifically, understanding the results of small bowel follow-through studies, colonoscopies, and biopsies is very important. These studies are necessary to correctly diagnose IBD and can help differentiate patients with CD from those with UC. Understanding the various test results will not only help the nurse understand the disease more thoroughly, but also help them explain these results to their patients.

Routine testing to diagnose CD or UC includes colonoscopy and small bowel follow-through studies. The colonoscopy is necessary to provide direct visualization of the colonic mucosa and to obtain biopsies to help determine the source of inflammation or symptoms. After patients complete a colon cleansing preparation, an endoscope is inserted into the rectum to visualize the colon and is then advanced to the terminal ileum. A complete colonoscopy including terminal ileal biopsies is helpful in the diagnosis of IBD. (Please see Chapter 2, “Endoscopy in IBD” section.)

The small bowel follow-through study is helpful to identify lesions, strictures, and enteric fistulae in the small intestine. Patients are asked to drink a barium contrast liquid; a series of images are recorded and analyzed to monitor the flow of barium to determine if there are any findings consistent with CD in the small bowel. The small bowel follow-through is a standard diagnostic test to locate small intestine involvement in patients with IBD. (Please see Chapter 3, “Radiologic Testing in IBD” section.). It is important to note that radiologic contrast studies can be helpful in determining the extent of inflammation, but they do not confirm the diagnosis of either CD or UC.