concept map for bowel elimination

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Hello all,

I'm writing a concept map for bowel elimination for simulation lab. I need just one nursing diagnosis, and my teacher told me to use "alteration in elimination", but my diagnosis book doesn't have that...and I can't really find it online.

Here's the scenario:

My "patient" has an ileostomy due to fecal drainage into an abdominal wound. They diverted the stool to allow the abd wound to heal better.

I essentially was thinking: Alteration in elimination R/T ileostomy bowel diversion AEB...and that's where I struggle. I want to say AEB a pouch attached to her abdomen and stool in it! But I'm sure that wont be acceptable.

Please help!

Thank you all in advance,

Sophie

I believe I have seen this as a nursing care plan at my facility. If your instructor says it's fine, then use it! I would suggest Altered Elimination r/t abdominal wound AEB need for bowel diversion via ileiostomy.

I think we've all seen things done at one facility or another that doesn't meet evidence-based standard. That doesn't mean they're OK.

If it's not in the NANDA-I 2012-2014, it's not a real nursing diagnosis, and shame on your faculty member for not knowing that.

Other students: Don't you have the book YET? Be the first kid on your block to get this right! Amazon, $29 and free 2-day deliver, or $25 and instant to your Kindle or iPad.

OP: Why not look at the bigger picture? You have risk for compromised human dignity, at least, here-- page 280. Bowel issues are huge for that. Situational low self-esteem works, too, p. 287. Disturbed body image, too, p. 291.

Be bold and pick something that is more nursing-related, looks at the greater care needs of this (even hypothetical ) patient. Make a case for it. You can do this.

And I am starting (belatedly) to learn that somehow the idea in nursing school these days is to "pick" a nursing diagnosis. No, it's not. Begin to learn how to OWN your nursing practice-- you MAKE a nursing diagnosis based on the evidence you see before you, just exactly like physicians make diagnoses based on evidence.

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Specializes in NICU, Labor and Deliver, ED.

Thank you, very much! I guess being bold is always a worry when what my teacher suggested I use isn't really even in the realm of what it seems makes the most sense. I was definitely thinking something along those lines, and maybe something along the lines of risk for injury (this is not exact, I'm not looking in my book, which I do have :) ) based on her ostomy being a ileostomy, and the high acidity of the contents that come out of that section of bowel. And my "patient" hasn't had this for long, so she doesn't know how to take care of it on her own.

Thank you again! You're absolutely right, a nursing diagnosis is no more arbitrary than a medical diagnosis.

Thanks!

Sophie

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Specializes in Complex pedi to LTC/SA & now a manager.

More risk for impaired skin integrity or risk for infection. You need to look at the risk factors for risk dx and related factors & defining characteristics for actual nursing dx.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thank you, very much! I guess being bold is always a worry when what my teacher suggested I use isn't really even in the realm of what it seems makes the most sense. I was definitely thinking something along those lines, and maybe something along the lines of risk for injury (this is not exact, I'm not looking in my book, which I do have :) ) based on her ostomy being a ileostomy, and the high acidity of the contents that come out of that section of bowel. And my "patient" hasn't had this for long, so she doesn't know how to take care of it on her own.

Thank you again! You're absolutely right, a nursing diagnosis is no more arbitrary than a medical diagnosis.

Thanks!

Sophie

How does she feel about her altered body image? Was her surgical wound delayed healing due to stool? Has this extended her hospital days? She has a huge learning deficit.

altered elimination was an old ND from 2009

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Specializes in NICU, Labor and Deliver, ED.
How does she feel about her altered body image? Was her surgical wound delayed healing due to stool? Has this extended her hospital days? She has a huge learning deficit.

altered elimination was an old ND from 2009

Yes, her hospital stay was extended due to stool in her wound, but not like it was something she was doing...her original incision is due to a hemicolectomy..so somehow that caused her bowel to leak stool into the site. So, they performed a bowel diversion to allow her abdominal (hemicolectomy) wound to heal.

There wasn't much talk about her having altered self concept...but it could probably be safe to assume. It's not my favorite to use in this case though...I feel probably a deficient knowledge makes more sense?

Thanks,

Sophie

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Yeah, well, if it were your belly gaping open after two surgeries, oozing stool, infected, strangers poking around in it a couple of times a day, and keeping you away from your home and normal activities and comforts of life, what would be on your mind more? The fact that your body has totally gone to hell, or the fact that you don't know something the nurse thinks you need to know?

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Specializes in NICU, Labor and Deliver, ED.

Agreed, that certainly seems more troublesome. Without a patient to speak to, only my teachers "scripting" when she's not busy with the other bed, mannequin and students she's assigned for the day, sometimes the emotional side of things gets lost in the technical side of things, the skills and knowledge I need to be learning and displaying. I agree, I believe that an altered body image is most likely to be at the top of the worry list.

I will post my final dx this evening.

Thanks very much

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

SO you have Delayed Surgical Recovery. Deficient Knowledge (specify). Disturbed Body Image. Acute Pain. Risk for Infection. Anxiety.....

Personalize it....what would you or a loved one NEED right now?

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Specializes in NICU, Labor and Deliver, ED.
SO you have Delayed Surgical Recovery. Deficient Knowledge (specify). Disturbed Body Image. Acute Pain. Risk for Infection. Anxiety.....

Personalize it....what would you or a loved one NEED right now?

I naturally want to go with Delayed surgical recovery...but I feel like that's sort of old news? Although, it's not really, the day I had this patient, she had just had her ileostomy placed one day prior. My teachers personality is what's making this so confusing...I honestly feel like she could just call whichever I feel is most pertinent as "wrong"... which doesn't seem right.

Second place is a tight one for disturbed body image...

I never have such a hard time deciding on my priority, I don't know whats so different about this one.

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Specializes in NICU, Labor and Deliver, ED.

Oh crap. I forgot to mention that the hemicolectomy site had dehisced, THEN there was stool in it...does that change anything? I suppose my worry is that our focus right now is bowel elimination...and although delayed surgical recovery makes sense...it doesn't technically have anything to do with bowel elim...

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Specializes in Complex pedi to LTC/SA & now a manager.

But it does. Do you have the NANDA-I book or a care plan book? There is no elimination dx other than what I listed earlier. Delayed surgical recovery seems like best fit.

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Specializes in NICU, Labor and Deliver, ED.

Right. yes, I do have a book. That's why I know there isn't one that fits...I just worry that my teacher will have something to say about it.

Ok, so then how about this.

Delayed surgical recovery R/T extensive or prolonged surgical procedure AEB dehiscence hemicolectomy wound site secondary to ileostomy to divert stool away from wound bed.

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