A Nursing Care Plan

 

 

 

 

 

 

 

 

 

 

 

 

A Nursing Care Plan

Student Name

Institution Affiliation

Course Code

Due Date

 

 

 

 

 

 

 

 

 

 

Assessment

Metaparadigm concept of person: 40-year-old man

Metaparadigm concept of health:

Physical health:  Absence of bowel movement in over a week

Metaparadigm concept of the environment: Does not drink adequate water nor partake in physical activity.

Nursing Diagnosis

Actual Nursing Diagnosis

Constipation related to inadequate water intake and inadequate physical activity, as evidenced by the absence of bowel movement in over one week. (Gordon & CIMPRICH, 2014)

Potential Nursing Diagnosis

Risk for acute pain related to fecal impaction in the intestines. (Gordon & CIMPRICH, 2014)

Planning

Potential outcome statement: Jack, the patient, returns to the normal passage of stool-maintains passage of soft and formed stool at a frequency he perceives normal. (Gordon & CIMPRICH, 2014)

Implementation (Nursing Interventions)

First Nursing Intervention

The nurse will give the patient stool softeners and laxatives as prescribed by the medical doctor. This will help in softening the stool and facilitating the passage of the already impacted feces. (Janečková & Třísková, 2012) To ensure proper intake of the drug regimen, the patient will be advised against the long-term use of laxatives and will be asked to verbalize instructions and given a chance for clarification. The nurse may alternatively administer a suppository or an enema if the feces are quite severely impacted. The patient will also be instructed on careful monitoring of the stool passage to note the return of normal habits of stool elimination. All this will be coupled with the encouragement of increased fluid intake 2 liters to 3 liters a day, especially in hot conditions, and increases urination. (Janečková & Třísková, 2012) The intake of fluids should be within the renal and cardiac reserve. This will be to improve stool consistency by making the fecal mass soft.

Second Nursing Intervention

The nurse will instruct and encourage the patient to perform a lot of physical activities. This will include frequent changing of positions in bed, avoidance of prolonged bed rest, and engaging in a range of abdominal and motion exercises that include significant involvement in long walks. (Janečková & Třísková, 2012) Increased abdominal muscle exercises while taking deep breaths will help strengthen the muscles that facilitate defecation. Physical activities will help in mental relaxation and also promote peristalsis, thereby facilitating the passage of stool.

Third Nursing Intervention

The nurse will educate and emphasize to the patient on crucial ingredients for normal bowel movements. (Janečková & Třísková, 2012) This will include a daily balanced diet that contains adequate fiber-adds bulk to the stool making passage of stool easier, fruits, and vegetables. It will also include adherence to a regular schedule that includes eating habits and habitual heeding of defecation warning signs.  Defecating after the first meal, breakfast, is also recommended as the gastrocolic reflex is strongest.

Additionally, privacy for defecation is vital to help in relaxation and comfort during defecation. (Janečková & Třísková, 2012) A deep breath will also be encouraged to assist in the relaxation of pelvic muscles that play a role in evacuation.

Evaluation

The nurse will then determine the return to normal bowel movements.  This will be through assessment and recording of any signs and symptoms that suggest continued constipation. Progress made on the recommended fluid intake, and activity level will be assessed. (Gordon & CIMPRICH, 2014) The patient’s history of stool amount, color, consistency, and frequency of passage will also be analyzed. This will be followed by auscultation of bowel movements.  In case of success, the patient will be urged to adhere to the established habits. Any red flags, such as a persistent unexplained change in bowel functioning, will necessitate a referral.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Gordon, M., & CIMPRICH, B. (2014). Manual of Nursing Diagnosis. AJN, American Journal Of Nursing, 83(2), 319. https://doi.org/10.1097/00000446-198302000-00046

Janečková, B., & Třísková, Z. (2012). Constipation as a nursing problem, its diagnosis, and possibilities of affecting this condition. Kontakt, 14(3), 315-330. https://doi.org/10.32725/kont.2012.034