Help with care plan for 11 year old with chronic constipation

[smurfet]

I have an 11 year old patient with chronic constipation. I know her through my peds rotation at a school and she is constantly coming in for stomach pains because of constipation. It is marked in her school records about the problem. I have do do a care plan on the young lady and am a little confused at where to start when I do not have access to a lot of info on her. All I am able to get is sharp pains across the back flank area and in the lower abdominal areas. This start off sharp and then ease off a little. She is on miralax and does have some leakage and has to wear a pad for the leakage some times which does embarrass her at times.

Thanks for your help

[Daytonite, BSN, RN]

Why does this 11 year old have constipation? You need to know this in order to formulate your nursing diagnostic statement. Is she not eating enough veggies? The diagnosis is Constipation R/T [etiology] AEB stomach pains, lower abdominal pain, and sharp pain across the flank.

You can also diagnose Bowel Incontinence R/T laxative use and decline in muscle tone AEB dribbling of liquid stool.

Does this child have an eating problem like anorexia?

[smurfet]

I spoke with her a little bit about her constipation she said that she had surgery when she was five to remove a fist size blockage in her and she has always had problems every since she was little. She is not anorexic she weighs 90 lbs and her muscle tone is good. She did have a bit of a distended stomach and it was hard. She told me also that she doesnt go to the bathroom except maybe once or twice a week and it is usually very hard and hurts and that is why she is on the medicine, which of course she says she hates.

Thank you very much for the help.

[Daytonite, BSN, RN]

The BM once a week is the etiology for the constipation. However, either her muscle tone is not good, she has no sensation in her anal area as a result of the surgery or she is receiving too much laxative if she is leaking stool and having to wear a pad. Just my thoughts on this. She is about to enter puberty. This "leakage" is going to create a body image problem for her. If I were her I would be worried about what boy would want to date me, let alone think about having sex. You know sex is on kid's minds. It is what they think and talk about.

[cursedandblessed]

I had one with Hirshprungs? during my first peds rotation. He had surgery when he was young and had a temp colostomy. Risk for disturbed body image or risk for Situational low self-esteem R/T fecal smell (wow that's not very scientific:bugeyes:) is all I can come up off the top of my head.

Fiber, fluids, applesauce, prunes/prune juice, walking 20-30 minutes daily

[smurfet]

Thank you very much for the help

[Daytonite, BSN, RN]

i had one with hirshprungs? during my first peds rotation. he had surgery when he was young and had a temp colostomy. risk for disturbed body image or risk for situational low self-esteem r/t fecal smell (wow that's not very scientific:bugeyes:) is all i can come up off the top of my head.

fiber, fluids, applesauce, prunes/prune juice, walking 20-30 minutes daily

risk for disturbed body image

i have written into my nursing diagnosis reference book for this diagnosis the following related factors:

• fear of rejection by others
  
  
• functional impairment
  
  

i think i may have picked them up from a psych resource, probably for anorexia or bulimia.

situational low self-esteem r/t fecal smell

with this diagnosis the related factor can be something that causes a negative perception of the self and a functional impairment (such as this stool leakage caused by what? the laxatives and the weak rectal structures would do it. the thing is to figure out how to word it concisely.)

[smurfet]

Thank you very much for all of your help