Need Nursing Diagnosis help!!!!

ADN 2002 · Jan 18, 2002

Hi Sara,

I feel your pain, I hate diagnosing.

The first thing that comes to mind is Risk for Infection related to altered peristalsis (inadequate primary defenses). I got that out of Nurse's Pocket Guide: Diagnoses, Interventions, and Rationales (7th ed) by Doenges and Moorhouse. (This is a really good dx book if you're looking to buy another -- I had to get another book b/c the book my program recommends is really crummy.)

Hope this helps!

:cool:

StudentSandra · Jan 18, 2002

originally posted by sararnin2003
i need help finding a nursing diagnosis for a 2 day post op patient who is still npo due to hypoactive bowel sounds. nothing in my ackley is helping me. anyone out there have an idea of what i should use. i need to use this type of diagnosis regarding the patients lack of peristalsis as my primary diagnois according to my clinical instructor. please help!!!!

thanks a bunch!!!
sara

how about:

constipation r/t reduced peristalsis. or risk for constipation.

risk for altered nutrition: less than body requirements r/t intestinal dysfunction s/t reduced peristalsis.

2 days po of what?

SaraRNin2003 · Jan 18, 2002

Patient is post op exploratory Lap, lysis of adhesions, partial omenectomy, removal of pelvic cysts.

According to my instructor she should be off NPO by the second post op day and that is why I need to use the peristalsis diagnosis.

I found the constipation one and the less than nutritional requirements diagnosis's after I posted! Thanks for all the help!!!

SARA

WalMart_ADN · Jan 19, 2002

Originally posted by SaraRNin2003
I need help finding a nursing diagnosis for a 2 day post op patient who is still NPO due to hypoactive bowel sounds.

I have a question. Wouldn't the patient have hypoactive bowel sounds related to being NPO? Or am i completely missing the point???

anyhow, i would go with Risk for constipation r/t decrease in peristalsis and risk for altered nutrition, less than body requirements r/t NPO status due to decrease in intestinal motility, i think someone else said that, StudentSandra, maybe it was. Anyhow, the point of my post was to ask the aforementioned question....NPO would obviusly lead to hypoactive bowel sounds...right???? :confused: :confused:

crnasomeday · Jan 19, 2002

WalmartADN, I understand how you're thinking, but NPO status, especially when we're just talking about a day or two, should not lead to absent or extremely hypoactive bowel sounds. Think about times when you've skipped meals during the day. Your stomach still rumbles, acid is still secreted, and intestinal motility still continues even if there's no food in it. It's more than likely the medications used for anesthesia and post-op pain as well as lack of activity and ambulation that leads to the hypoactive bowel sounds. Patients have to have return of peristalsis before beginning to eat again otherwise you do risk constipation, impaction, and infection.

Blakpepa · Jan 21, 2002

crnasomeday...

When you are doing a procedure that involves a general anesthetic and an abdominal incision, how could you expect the bowel sounds to be present in such a short time? With all that manipulation of the bowels, the general anesthetic, all the pain relievers...plus of course the PCA (if given)

Any patient that is in my care who can relate to this situation, this what i would keep in mind and act appropriately. If i were to go to my clinical instructor and tell her this situation and say bowel sounds are present and the person has been NPO for 3 days...she would tell me to get a new stethescope and do my research!!!!

You are NPO prior to surgery then after surgery you go from NPO - DAT, i wouldnt anticipate normal bowel sounds until atleast 3 days post op - at this point the patient has regained some energy, are more active and is eating.

Just thought everyone opinions were very interested, just had to respond :-) :rolleyes:

crnasomeday · Jan 22, 2002

I'm not sure I understand why you're being so nasty to me, but Before you roll your eyes at me again, :rolleyes: , Blakpepa, I think you should return and reread what I originally wrote. I said that being NPO is not THE factor leading to hypoactive or absent bowel sounds which is what WalmartADN had asked about. I said that anesthesia, post op meds, yadda yadda etc. were factors to consider about why the BS are hypoactive or absent. And as far as at what point BS return, I didn't say that BS should be normal right away, but what factors do you think you're looking at when you advance the diet? Until there is a return of peristalsis (I did not say normal level of peristalsis....just peristalsis) you're going to constipate that person if you advance their diet too fast.

Blakpepa · Jan 22, 2002

I had no idea i was being nasty to you, i dont know you so i cant understand why i would be. Anyways, it's interesting that we all have different perspective on the same scenario. These type of scenarios not only enhance our critical thinking skills, but we learn something as well.

My response was merely based on how I seen the situation and thats it...just like when you posted your answer, it was based on how you would assess the situation. If i were to bring that situation to my instructor, that REALLY is what she would say!!!!! I dont think that there is a wrong answer, but even if there is...who am i to judge or dismiss anyways, thats not what my intention/response was all about...i am STILL learning - just like any other nursing student up here.

P.S - i picked that icon because i liked it.