Nursing Diagnosis Help

[Steelers52]

I have a case study that I'm writing a nursing diagnosis for and I need help finding what my problem would be secondary to. The case study is this:

The patient has a history of colon cancer and had a colectomy performed and creation of a colostomy 2 months ago. She came to the emergency room complaining of abdominal distention, pain, and no output from the colostomy for 3 days. Her medications include a Fentanyl transdermal patch every 72 hours and Percocet 2 tabs every 6 hours prn, which she has been using 2-3 times daily. Abdominal x-rays show the colon is full of stool.

The diagnosis I have is:

Constipation related to opioid analgesics secondary to ?

Would this be secondary to the pain or the colon cancer? Is there a better diagnosis to be used?

Thanks.

[RN403, BSN, RN]

I would think it would be secondary to pain. Remember, you are not to use medical diagnoses within your nursing diagnoses.

[Esme12, ASN, BSN, RN]

Welcome!

What semester are you? I take it this isn't a real patient. This really grates on my nerves since a care pan is al about the assessment of the patient....and they provide no real assessment.

A nursing diagnosis goes like this.... GrnTea say this best......

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. He has this because he has ___(related factor(s))__."

Related to" means "caused by," not something else.

Look at your NANDA resource

NANDA defines Constipation as....Decrease in normal frequency of defecation, accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool

Defining characteristics of....Feeling of rectal fullness; feeling of rectal pressure; straining with defecation; unable to pass stool; abdominal pain; abdominal tenderness; anorexia; atypical presentations in older adults (e.g., change in mental status, urinary incontinence, unexplained falls, elevated body temperature); borborygmi; change in bowel pattern; decreased frequency; decreased volume of stool; distended abdomen; generalized fatigue; hard, formed stool; headache; hyperactive bowel sounds; hypoactive bowel sounds; increased abdominal pressure; indigestion; nausea; oozing liquid stool; palpable abdominal or rectal mass; percussed abdominal dullness; pain with defecation; severe flatus; vomiting

Related to....

Functional

Abdominal muscle weakness; habitual denial; habitual ignoring of urge to defecate; inadequate toileting (e.g., timeliness, positioning for defecation, privacy); irregular defecation habits; insufficient physical activity; recent environmental changes

Psychological

Depression, emotional stress, mental confusion

Pharmacological

Aluminum-containing antacids; anticholinergics, anticonvulsants; antidiarrheal agents, antidepressants, antilipemic agents, bismuth salts, calcium carbonate, calcium channel blockers, diuretics, iron salts, laxative overdose, nonsteroidal antiinflammatory drugs (NSAIDs), opioids, phenothiazines, sedatives, and sympathomimetics

Mechanical

Neurological impairment, electrolyte imbalance, hemorrhoids, Hirschsprung’s disease, obesity, postsurgical obstruction, pregnancy, prostate enlargement, rectal abscess, rectal anal fissures, rectal anal stricture, rectal prolapse, rectal ulcer, rectocele, tumors

Physiological

Change in eating patterns, change in usual foods, decreased motility of gastrointestinal tract, defecation disorder, dehydration, inadequate dentition, inadequate oral hygiene, insufficient fiber intake, insufficient fluid intake, poor eating habits

Ackley: Nursing Diagnosis Handbook, 10th Edition (Resources)

The diagnosis I have is:

Constipation related to opioid analgesics secondary to ?

So looking at the defining characteristics which ones apply to your patient?

[MSNce1]

She needs to focus on the physiological factors that are impairing the GI track

to .....

[MSNce1]

Think about the treatment for the pain and what it does to a branch of the CNS then that effect on the bowel.

[Steelers52]

Welcome!

What semester are you? I take it this isn't a real patient. This really grates on my nerves since a care pan is al about the assessment of the patient....and they provide no real assessment.

A nursing diagnosis goes like this.... GrnTea say this best......Look at your NANDA resource

NANDA defines Constipation as....Decrease in normal frequency of defecation, accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool

Defining characteristics of....Feeling of rectal fullness; feeling of rectal pressure; straining with defecation; unable to pass stool; abdominal pain; abdominal tenderness; anorexia; atypical presentations in older adults (e.g., change in mental status, urinary incontinence, unexplained falls, elevated body temperature); borborygmi; change in bowel pattern; decreased frequency; decreased volume of stool; distended abdomen; generalized fatigue; hard, formed stool; headache; hyperactive bowel sounds; hypoactive bowel sounds; increased abdominal pressure; indigestion; nausea; oozing liquid stool; palpable abdominal or rectal mass; percussed abdominal dullness; pain with defecation; severe flatus; vomiting

Related to....

Functional

Abdominal muscle weakness; habitual denial; habitual ignoring of urge to defecate; inadequate toileting (e.g., timeliness, positioning for defecation, privacy); irregular defecation habits; insufficient physical activity; recent environmental changes

Psychological

Depression, emotional stress, mental confusion

Pharmacological

Aluminum-containing antacids; anticholinergics, anticonvulsants; antidiarrheal agents, antidepressants, antilipemic agents, bismuth salts, calcium carbonate, calcium channel blockers, diuretics, iron salts, laxative overdose, nonsteroidal antiinflammatory drugs (NSAIDs), opioids, phenothiazines, sedatives, and sympathomimetics

Mechanical

Neurological impairment, electrolyte imbalance, hemorrhoids, Hirschsprung’s disease, obesity, postsurgical obstruction, pregnancy, prostate enlargement, rectal abscess, rectal anal fissures, rectal anal stricture, rectal prolapse, rectal ulcer, rectocele, tumors

Physiological

Change in eating patterns, change in usual foods, decreased motility of gastrointestinal tract, defecation disorder, dehydration, inadequate dentition, inadequate oral hygiene, insufficient fiber intake, insufficient fluid intake, poor eating habits

Ackley: Nursing Diagnosis Handbook, 10th Edition (Resources)

So looking at the defining characteristics which ones apply to your patient?

I'm first semester LPN to RN. No this isn't a real patient. I found it hard to really go off of this because of the assessment not being there. Thank you for you help though, this does clear it up a little more.

[Esme12, ASN, BSN, RN]

Your patient has constipation and pain....that is your care plan. Now use your resource for NANDA and use the definition and characteristics to develop your statement.

What NANDA resource do you have?