Care Plan - Bowel Resection

If you recall from anatomy, the large bowel is responsible for re-absorbing water back into the system. When part of the large bowel has been removed, there is going to be diarrhea and loose stools because the bowel has been shortened. And, I can attest to that because I had a right hemicolectomy back in June and went through this.

It takes several months for the bowel to adjust and sometimes it never does necessitate that the patient takes something like Questran to bulk up their stools in order to overcome diarrhea. My surgeon made it very clear to me why I would be having this diarrhea as a result of the altered anatomy of my bowel.

You need to understand this etiology of this patient's diarrhea in order to develop the 3-part nursing diagnosis. You also need to be a little more specific about diarrhea.

How many stools is the patient having a day?

Are they pure liquid?

Or, are they mushy and unformed?

This is information that should have been picked up during an assessment. As I mentioned in my other post this would be diarrhea r/t shortened bowel AEB [you need to state how many diarrhea stools the patient is having a day]. Here is a website where you can see the Nanda information on this particular diagnosis: diarrhea.

Every diagnosis has symptoms. look at the symptoms (defining characteristics) that are listed for the nursing diagnosis of diarrhea and see if you missed any of them in your patient.

Since she's incontinent, is her skin at risk of breaking down?

What is being done to protect her skin?

Skin breakdown is either an actual or potential problem that needs to go on the care plan and there is a nursing diagnosis for this: impaired skin integrity or risk for impaired skin integrity.

Something else that we should be assessing is this lady's incision. What is going on with the incision? Are there sutures or staples? What does the incision look like? Is there any special care being done for the incision? If so, this needs to be included in the care plan. An incision is impaired tissue integrity [definition: damage to mucous membrane, corneal, integumentary or subcutaneous tissues.].

Figuring nursing diagnoses out is all about determining what the patient's symptoms are. Doctors diagnose by first assessing a patient and determining what the symptoms are. They consider the symptoms and that determines what medical diagnosis they finally decide upon. It is no different with nursing diagnoses.

Nanda taxonomy has given us the signs and symptoms (they call them defining characteristics) for each of the current 188 nursing diagnoses. It is very important that you thoroughly assess a patient and make a list of their symptoms. Before you can assign any nursing diagnosis to them you have to check to make sure that they have one or more of the signs/symptoms of the nursing diagnosis. To choose a nursing diagnosis any other way is irresponsible.

I don't know how loud I have to scream this...a care plan is based upon the patient's symptoms.

The nursing diagnosis is only a small part of the care plan. It is not something that anyone should be having such anxiety over. They can be easily found by checking a reference as long as you have the patient symptoms. The symptoms are everything; They are the foundation that everything in the care plan is built upon.

The real problem, however, is in assessment. But it is understandable. It takes years to become proficient in assessment and knowledge of the pathophysiology of these many disease conditions.

You must follow the steps of the nursing process in writing a care plan with a major focus on step #1:

1. Assessment - collect data from medical record, do a physical assessment of the patient, assess ADL's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology
2. 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
3. Planning - write measurable goals/outcomes and nursing interventions
4. Implementation - initiate the care plan
5. Evaluation - determine if goals/outcomes have been met