Feedback needed on first care plan!

i am in my 4th week of nursing school and getting ready to turn in my first care plan. i am pretty happy with it but wanted to see if you all had any feedback (this is a group assignment and we are allowed to use any sources). the (fictitious) client is a post-op hip replacement patient who is c/o inability to defecate. she states that she feels the urge but is unable, and she feels abdominal "fullness". she has not had a bowel movement in 4 days. she is on tylenol-3 for pain and docusate for constipation. vital signs and bowel sounds are are normal for her. here is the care plan we came up with (citations are from our 2 texts and we were asked to include page numbers). for evaluations, we were asked to create an evaluation plan.

nursing diagnosis:

- constipation r/t insufficient physical activity, pain, lack of privacy and analgesic usage

goals/outcomes:

-client will pass soft, formed stools every 1-3 days without straining

- client will state relief from discomfort of constipation within 2 days

interventions with rationale:

- provide prescribed analgesic medication to reduce pain of ambulation (rationale – bedrest and immobility contribute to constipation, controlling pain will encourage increased activity) (ackley and ladwig, 2008, p. 248))

- encourage client to ambulate (flat-footed gait with walker) at least 4 times per day, provide assistance if needed (rationale – even minimal physical activity increases peristalsis) (potter and perry, 2009, p.1193)

- assist client to the toilet at client’s normal time of elimination, and provide privacy (rationale – keeping to client’s normal bowel elimination routine will promote elimination; providing privacy will ensure client comfort) (ackley and ladwig, 2008, p.248)

- encourage fluid intake of 6-8 glasses per day (rationale – sufficient fluids are necessary for normal bowel movements) (ackley and ladwig, 2008, p. 247)

- encourage fiber intake of 20-25 g per day by providing high-fiber foods (rationale – increasing bulk in the diet increases frequency of stools) (ackley and ladwig, 2008, p. 247-248)

- educate client about techniques for managing constipation – fluid intake, eating regularly, balanced diet with adequate fiber, bulk fiber products, stool softeners (rationale – providing patient education will help the patient to remain compliant with the plan of care and will aid in adequate bowel elimination once the client returns home) (ackley and ladwig, 2008, p. 250)

- evaluate client for fear of pain in passing stool (rationale – fear may inhibit bowel movement, nurse may identify need to consult physician about ordering a stool softener) (ackley and ladwig, 2008, p. 247)

evaluation methods:

-evaluate client’s incisional pain at each shift change

- note number of times per day that the client ambulates

-evaluate bowel pain and/or fullness at each shift change

- assess bowel sounds and palpate for abdominal distension at each shift change

- monitor for frequency and quality of bowel movements each day

-monitor client’s understanding of constipation management by asking client to “teach back” techniques

any feedback is much appreciated!

joy