Critical thinkers...S.O.S....S.O.S....S.O.S...

Carolanne · Mar 12, 2004

Three tablespoons of bran each morning is too much. I'd go with the fluids.

My rationale exactly.

sun_chica · Mar 12, 2004

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.

BunnyBunnyBSNRN, ASN, BSN · Mar 12, 2004

I have to agree with what I've read so far...D is the "most correct".

BunnyBunnyBSNRN, ASN, BSN · Mar 12, 2004

Alexander,

was the question challenged? did you get credit for it?

LesJenRN · Mar 12, 2004

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...

Long Term Care Columnist / Guide · Mar 13, 2004

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. :)

hock1 · Mar 13, 2004

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.

Pab_Meister · Mar 13, 2004

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.

Mariannsi · Mar 13, 2004

When I read that I just thought of a pt with diverticulitis - funny how the mind works. Thank goodness for spring breaks.

unknown99, BSN, RN · Mar 13, 2004

The answer is D.

Because if you take C and don't have D then you will get very constipated( with a capital C )!!!

dosamigos76, RN · Mar 13, 2004

I'd go with C because the question asks about bran, not fluid intake.

Pab_Meister · Mar 13, 2004

dosamigos,

that was the other rationale I used.

thanks....