Can Nothing by mouth lead to Constipation?

JustBeachyNurse, LPN · Jul 21, 2014

No the NG tube has nothing to do with potential for constipation. Your instructor is correct.

Look up ileus. The NG tube was most likely for decompression of upper GI gas/distention and alleviate the build up of gastric secretions if the small and large intestines have decreased peristalsis due to reduced/lack of oral intake and slowed intestinal motility.

K+MgSO4, BSN · Jul 21, 2014

Bowels not opening in this situation is not constipation, it is more likey an ilus. Research that then think what would happen if you gave aperients to this pt.

Esme12, ASN, BSN, RN · Jul 21, 2014

Welcome to AN! The largest online nursing community!

First...not all people defecate everyday. Second 40 hours isn't a long time without a BM.

What is the definition of constipation?

Constipation is most often defined as having a bowel movement less than 3 times per week. It usually is associated with hard stools or difficulty passing stools. You may have pain while passing stools or may be unable to have a bowel movement after straining or pushing for more than 10 minutes...(also known as costivenessor dyschezia) refers to bowel movements that are infrequent or hard to pass.Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.

This is not your patient.

The nursing diagnosis is good....your AEB is not. What NANDA/care plan resource are you using?

What is the definition of dysfunctional gastric motility? Definition: increased, decreased, ineffective, or lack of peristaltic activity within the gastrointestinal system

risk factors: abdominal surgery; aging; anxiety; change in food; change in water; decreased gastrointestinal circulation; diabetes; food intolerance; stress.......

How does this apply to your patient?

Esme12, ASN, BSN, RN · Jul 21, 2014

Care plans are all about the patient and the patients problems. Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first.

Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly.

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics.

Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are.

What I would suggest you do is to work the nursing process from step #1.

Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you.

What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient.

Did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list.

This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

Another member GrnTea say this best......

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. He has this because he has ___(related factor(s))__."

"Related to" means "caused by," not something else.

Esme12, ASN, BSN, RN · Jul 21, 2014

So how can your ND be re-worded to apply?

decreased gastric motility related to surgery AEB....your patient assessment findings.

Bowels were hyperactive and tummy was distended during assessment, pt had diarrhea early the day before, but no BM within the last 40 hrs.

What is the number one cause of gastric issues in the post op abdominal patient?

Ileus... hypomotility of the gastrointestinal tract in the absence of mechanical bowel obstruction. This can be caused by surgery and manipulation of the bowel, anesthesia, narcotics, and trauma.

Do you see how what you said did not apply to the diagnosis? Constipation is it's own nursing diagnosis.

missems01 · Jul 21, 2014

Thanks everyone for the response. I really am weak at nursing care plans. For some reason my school never does any formal training on them and leaves it up to the clinical instructors to teach us and depending on the CI depends on how much you learn. My first clinical instructor did not allow care plan books and we had to use common sense and pathophys knowledge for nursing care plans. This semester we had a different CI each clinical day with only needing to turn in one nursing care plan at the end of the semester so there was no formal training this semester either. I guess I really need to find a book that walks you through the process and learn it on my own.

As for the constipation, an ilieus makes more sense. I think I had the thought there but not the right terms. I wished the CI would have mentioned that while talking to me, lol

loriangel14, RN · Jul 21, 2014

Common sense and knowledge of pathophysiology is a good way to approach a care plan.

vintagemother, BSN, CNA, LVN, RN · Jul 21, 2014

MissEMS...I'm a new grad and I totally empathize with your difficulties learning how to do care plans when your instructors all require or teach different ways to do them.

I used to obsess over care plans! Hours and hours for just 1!

Now, I absolutely love care plans and I do them in my head all the time while caring for pts.

My suggestions are: 1) use the nanda book!! It's awesome 2) keep them simple! As the OP said, base your care plans on what you see and what the pt complains of (signs and symptoms). Don't focus too much on the medical diagnosis, though it helps to know the pathophysiology of their health condition.

As an aside, my appendectomy mentally hurt me for many years. All those digital exams as an adolescent female in puberty and the pain and being undiagnosed for weeks while in pain made me distrust medicine for a long time and made me uncomfortable with doctors touching me. Not sure if there a care plan for that, though (-; And I wouldn't recommend your trying to write a care plan for that! Like I said, keep your care plans simple and focused on the observed signs and reported symptoms.

Good luck and hope this helps!

Esme12, ASN, BSN, RN · Jul 21, 2014

Thanks everyone for the response. I really am weak at nursing care plans. For some reason my school never does any formal training on them and leaves it up to the clinical instructors to teach us and depending on the CI depends on how much you learn. My first clinical instructor did not allow care plan books and we had to use common sense and pathophys knowledge for nursing care plans. This semester we had a different CI each clinical day with only needing to turn in one nursing care plan at the end of the semester so there was no formal training this semester either. I guess I really need to find a book that walks you through the process and learn it on my own.
As for the constipation, an ilieus makes more sense. I think I had the thought there but not the right terms. I wished the CI would have mentioned that while talking to me, lol

That is a shame....how can you possibly make a care plan without a NANDA resource. Are you in a ADN program?

You should make a care plan according to the patient assessment and the pathophysiology. You plan your care according to assessment of the patient. Once you identify the problems you can think about which diagnosis applies according to the NANDA definition.

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: ADPIE

Assessment (collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
Planning (write measurable goals/outcomes and nursing interventions)
Implementation (initiate the care plan)
Evaluation (determine if goals/outcomes have been met)

Did you learn about the nursing process?

Esme12, ASN, BSN, RN · Jul 21, 2014

[h=3]Nursing Diagnoses: Definitions and Classification 2012-14[/h]

missems01 · Jul 22, 2014

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.