Critical thinkers...S.O.S....S.O.S....S.O.S... - page 2

Hello gang, I was hoping to get some thoughts on the following question that appeared on my nursing exam last week: Which action is most important when teaching your client about the intake of... Read More

  1. by   sun_chica
    Definetely "D"...& as for types of fluids, usually you encourage/recommend water when talking about "8 glasses a day", but also teach about other beverages that will hydrate them if they hate water, but you're right in trying to discourage soda & sugary drinks.
  2. by   chiefswife
    I have to agree with what I've read so far...D is the "most correct".
  3. by   chiefswife
    Alexander,

    was the question challenged? did you get credit for it?
  4. by   LesJenRN
    my only thought is what about CHF in some of these constipated older folks? or Renal Failure? dont want to send them into fluid overload..... i am sure the answer is D though..... i have never tried 3 T of bran in the morning but the thought makes me gack...
  5. by   VivaLasViejas
    Fluid overload in the frail elderly is rarely caused by drinking too much........they usually don't drink anywhere near enough! Even in the hospital, we very seldom restrict fluid consumption in elderly CHF patients (unless their sodium and/or potassium levels are too low); we just give them diuretics and avoid IV fluids.

    (That said, there are some patients who consume excessive fluids, to the point where their electrolytes are completely out of whack. This is seen in some dementias and mental illnesses, as well as SIADH and diabetes insipidus.)

    As for relief of constipation, I've all too often seen (and dealt with) the results when bulk-forming substances like bran and Metamucil are used in the absence of sufficient oral fluid intake. The stuff acts more like cement---ask anyone who's ever disimpacted a resident from a nursing home that uses these things on a regular basis. When I started at one LTC as a resident care manager, the facility had just received several F-tags relating to fecal impaction, which is known as a "sentinel event" in survey lingo. I found out why very quickly: almost every resident was on Metamucil, Perdiem, or Fiberall, and the staff, who were already overworked, didn't offer fluids as often as they should have.

    So I took almost all of my residents off these preparations and got orders for stool softeners for those who really needed help moving the mail, so to speak; I also created a "hydration station" with carafes of water, lemonade, Crystal Light, and herbal teas for the residents that the hospitality aides took around to the rooms twice a shift. We didn't solve every case of constipation, of course, because you can't MAKE people drink if they don't want to, but we did reduce the number of impactions, which got us out of trouble with the state survey team, and even the few residents who refused to give up their Metamucil did a little better.
  6. by   hock1
    Quote from Alexander
    Good responses, but let me ask:

    Answer d. says "fluids" not "water". Fluids include things like Pepsi, tomato juice, milk, beer, etc. I dunno, am I grabbing at straws?
    According some recent studies, any fluid is acceptable for hydration as long as it doesn't contain caffiene or alcohol. The answer I would have chosen would be 'D'. Fiber without fluid intake=constipation.
  7. by   Pab_Meister
    Okay... Okay...!!! It's d.!!

    Yes Sara, the question is being challenge, and with the instructors clarifying comment, I'd guess rightfully so. Especially since points in Nursing school are like gold. I know if it weren't for the instructor's 'clarification' in class, I would have stayed with d. In the end, I guess it doesn't really matter - on with the program.

    Thanks again for all of your responses and rationales - it's great to be able to see how the veterans work through these questions.
  8. by   Mariannsi
    When I read that I just thought of a pt with diverticulitis - funny how the mind works. Thank goodness for spring breaks.
  9. by   unknown99
    The answer is D.
    Because if you take C and don't have D then you will get very constipated( with a capital C )!!!
  10. by   dosamigos76
    I'd go with C because the question asks about bran, not fluid intake.
  11. by   Pab_Meister
    dosamigos,

    that was the other rationale I used.

    thanks....
  12. by   michw2
    It you look at the Question the question asked what to do to facilitate Defecation after teaching about bran. If you dont give enough fluids to push out the bran a client would get constipated. The definition of facilitate is the action of process. and defecation is the empting of the large intestinal tract. I hope this helps. Michele
  13. by   Pab_Meister
    Hi Michele,

    Let me play devils advocate here:

    Let's say that instead of fluid intake, answer d. was:

    d. instruct the client to ambulate the length of the hall three times per day to promote bowel activity.

    Would you still pick answer d.?

    If you re-read the question, it does not state "...after teaching about bran", it says, "...when teaching about the intake of bran to facilitate defication." While both the increase of fluid intake and physical activity are important factors in bowel elimination, in regards to "bran intake", the only answer that makes any mention of bran intake is c.

    In my opinion, the question is generally about bowel elimination, which includes exercise, fluids, fiber, etc. and is specifically about *intake of bran*.

    I understand the other rationale too, that bran w/out water will not facilitate defication, but there are also a dozen other factors to consider when speaking generally about defication, and not specifically about bran intake.

    This is fun....

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