Feedback needed on first care plan!

[dlkjmk]

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

[Daytonite, BSN, RN]

i am not clear about why pain and lack of privacy are etiologies of her constipation. neither was mentioned in the scenario. is the pain of having a bowel movement so bad that she holds the fecal matter in--that's what using pain as an etiology implies. if so, then care to her rectal area needs to be addressed. if this is a psychological thing it would be better expressed as "emotional stress".

where is the evidence supporting the problem? the aeb stuff? the defining characteristics? it was mwntioned in the scenario: "not had a bowel movement in 4 days"

i would write a 3-part diagnostic statement that says: constipation r/t insufficient physical activity and analgesic usage secondary to orthopedic surgery aeb no bowel movement for 4 days.

otherwise, the rest looks ok.

[kgh31386, BSN, MSN, RN]

yea make sure you put an AEB(very important). the only way you don't put that part is if you say "risk for ______". also don't put a R/t that has stuff that isn't presented like stated above. another AEB you might be able to mention is the fact that she's prescribed a stool softener, oh and you can say AEB pt. states,"she feels the urge but is unable"

[Daytonite, BSN, RN]

yea make sure you put an AEB(very important). the only way you don't put that part is if you say "risk for ______". also don't put a R/t that has stuff that isn't presented like stated above. another AEB you might be able to mention is the fact that she's prescribed a stool softener, oh and you can say AEB pt. states,"she feels the urge but is unable"

R/T's are the etiologies of the problem. The NANDA taxonomy lists them out for you for each diagnosis.

AEB's are symptoms. "the fact that she's prescribed a stool softener" is a treatment and not a symptom, so it is not an AEB item.

[kgh31386, BSN, MSN, RN]

see that's the problem with my school this semester. each teacher is saying something different. i said it would be an AEB because one of my teacher said that you can add that sort of thing. and i asked one of them today and they said you could not. also when doing an Accuchek, one teacher said wipe away the first drop of blood...one said not to. each teacher is basically going against the other. plus i'm still stuck with my med/surg teacher who is going against the book. she asks a question and we answer point blank what the book says, and she goes,"well maybe...but maybe not." and never gives a straight answer. we have our first test monday in there, so i don't know what to do if she's going to base it on her personal opinion and not care about what we haven't experienced yet.

[Daytonite, BSN, RN]

Answers based on principles rather than personal opinions can be proven by finding those principles in textbook after texbook. A teacher is never the final word. A fingerstick procedure can be written differently by more than one facility. Get written copies of both ways to prove the inconsistencies if the question gets asked on a test. I tested my blood for several years because I am insulin resistant. I always wiped away the first drop of blood so the alcohol didn't mix with the blood.

[dlkjmk]

Do most instructors require the "aeb"? Ours has not asked for it but we may be able to wow her by adding it :) We post these on an online discussion board for our class and she asks us questions to confirm our comprehension. I have seen in my Nursing Diagnosis book that they have formats for both a 2 part and a 3 part nursing diagnosis. The 3 part has the aeb, while the 2 part does not.

Thanks to everyone for the help!

Joy

[kgh31386, BSN, MSN, RN]

the AEB refers to the symptoms that are present. the only time you don't have the AEB is if you use a dx that is "risk for_________". when you use risk for, it hasn't happened YET so there aren't any symptoms currently. but in any other case where you don't use risk for....gotta have the AEB.