Can Nothing by mouth lead to Constipation?

[missems01]

I had a pt. who had an appendectomy 2 weeks ago. Pt presented in the with abdominal pain. Images were ordered and showed gas and general abdom. inflammation no abscesses yet. The doctor said that pt may need an Nasogastric tube if vomiting. Pt. then was placed nothing by mouth status and admitted as an inpatient. Bowels were hyperactive and tummy was distended during assessment, pt had diarrhea early the day before, but no BM within the last 40 hrs.

I chose for one of my nursing diagnosis to be dysfunctional gastrointestinal motility with an outcome goal of pt. will not need Nasogastric tube and will not experience constipation.

Interventions were basically to help keep the intestines moving, like to get up and walk the hallway as tolerated (ordered by doc), maintain ordered fluids, instruct pt to eat fiber foods once off nothing by mouth status, assess bowel sounds and any feelings of nausea frequently, have Nasogastric tube ready if vomiting, etc

My clinical instructor was just dumbfounded by my nursing diagnosis. She said the pt wasnt at risk for constipation because of nothing by mouth and the Nasogastric tube was only if vomiting and has nothing to do with constipation.

Looking at how I worded it I do see the need to have split the constipation part from it and just have had at risk for constipation as another diagnosis (We were only allowed 2 nursing diagnosis so I think my mind was trying to fit more into the last ND, the first diagnosis was risk for deficient fluid volume.)

Anyway, according to the clinical instructor constipation wasnt a risk because the pt was nothing by mouth and had diarrhea "yesterday" even though it was approaching 48 hrs. (which I do understand that no food in body, means nothing will come out, however pt will be eventually eating food again and what about the food eaten in the last 40 hrs?)I'm not understanding her rationale for this. I thought being nothing by mouth and having inflammation and trapped gas would be risk factors. AM I TOTALLY WRONG IN THIS THINKING???

Also, isnt the need for an ng tube slightly related to constipation? I mean if its coming out the end its suppose to then there wouldnt be a back up causing vomiting.

[Esme12, ASN, BSN, RN]

Yes we learned about ADPIE and yes it is an ADN program. It was just that one CI that didnt really teach our group of 6. Everyone else instructor actually had a formal teaching of the care plans. The way he did it wasn't that bad it made us critically think, but did hurt me in how I need to word stuff and what terminology to use. I do have a NANDA book now Im just just trying to figure things out with it.

Well...you can't make a good are plan without critical thinking. He should be sticking with the proper way of using NANDA to teach students the basics and adhering to the curriculum that the schools requires. Now your grades are at risk because he was a cowboy and didn't follow the proper curriculum. I am sure at the time it seemed like a good idea...however it will be difficult to catch up.

Let's use this as an example...tell me about your patient and the patient assessment. Let's go from there and see if we can fill in the blanks.

[nurseprnRN, BSN, RN]

Your instructor is not correct. The nursing diagnosis of Constipation is not the same as the one for Dysfunctional GI Motility (which is, after all, a better one for this patient). Although they have some defining characteristics in common, and a few related factors in common, they are defined differently. As to outcomes, what are other things besides constipation you observe as evidence that GI motility perking up? Use those for your outcomes and it makes a lot more sense.

There is only one "NANDA book," and that's the NANDA-I 2012-2014, $29 and free 2-day delivery at Amazon, or $24 and instant to your Kindle or iPad. If that's not the one you're using, you're cheating yourself and shooting some blanks. :)