Nursing DX...is this right?

~Mi Vida Loca~RN, ASN, RN · Sep 19, 2009

Wouldn't the constipation be related to the pain meds not the pregnancy since she is postpartum?? Pain pills are known to cause constipation.

(BTW I don't have a Nursing Dx on hand, just going off the top of my head)

hero3679 · Sep 19, 2009

i was torn either to go with pain meds or pregnancy. i read that constipation is frequent with the postpartum bc of diminished bowel tone as a result of progesterone. don't know which one is the more dominant factor.

sub question to the forum: what would be the focal stimuli?

melmarie23, MSN, RN · Sep 19, 2009

hi im new here and thought i'd give the forum a shot...is this right?
Constipation related decreased peristalsis manifested by pregnancy.
pt is postpartum c-section and has not had a bm for 2 days, on reg pain meds (percocet)
thanks in advance to any help!

You can't have a diagnosis be rt or aeb pregnancy because the patient is no longer pregnant.

If you want to have your diagnosis rt to decreased peristalsis, it should read as "constipation rt decreased motility of gastrointestinal tract aeb hypoactive (or absent) bowel sounds." I would only use this if you in fact auscultated for bowel sounds and they were hypoactive or all together absent. Otherwise, you shouldn't use this as a diagnosis if you don't have evidence to back the diagnosis up.

Has the patient been ambulatory since the c-section? If not, her constipation might be related to her inactivity. So a diagnosis reflecting that could be "constipation rt insufficient physical activity."

Her medication may also be a contributing factor. Opioid analgesics can cause constipation. So that diagnosis could read as "constipation rt opioid analgesics"

Is the patient dehydrated? This could also be a contributing factor. What is she drinking?

hero3679 · Sep 19, 2009

thanks melmarie! i did listen to her bowel sounds and they were hypoactive. your advice is great. I can't believe i tried to use pregnancy! of course it can't be used. thanks alot

melmarie23, MSN, RN · Sep 19, 2009

You are welcome. And thank you. I could always use the practice of coming up with nursing diagnoses myself. Our professors do not require us to do care plans in clinical. I think its because all the hospitals that I have been have electronic charts with diagnoses and interventions and the like already in them...we just click and pick! This I think its mostly a good thing...it makes charting easier for the extremely busy nurse. But as a student, I think it can be a bit limiting at times.

Daytonite, BSN, RN · Sep 20, 2009

Your "manifested by" data is incorrect. The "manifested by" information is always the evidence of the problem, in this case, the evidence of constipation: no BM for 2 days. Your diagnostic statement should read: Constipation related to decreased peristatsis manifested by no BM for 2 days.

CRIMSON · Sep 20, 2009

Constipation r/t pain meds AEB inability to pass stool (have bm) x 2days.

Daytonite, BSN, RN · Sep 20, 2009

constipation r/t pain meds aeb inability to pass stool (have bm) x 2days.

not all pain meds produce constipation as a side effect. this needs more specificity. if these pain meds were of the type whose side effects produce constipation they should be generically identified. tylenol, which is a pain med and often given postpartum for pain, does not produce constipation as a side effect. percocet, which the patient was getting, is an opiate that does slow the gi track peristalsis down producing constipation. bit look at what the op originally told us. . .this patient had a c-section. with a c-section surgical peristalsis and of the bowel and no bm for several days is an expected complication (see

http://www.merck.com/mmpe/sec02/ch011/ch011g.html - ileus). since a pathophysiological reason is known for this constipation, the diagnostic statement can be written this way. . .constipation r/t decreased peristalsis secondary to surgical intervention and opiates aeb no bm for 2 days. assessment of bowel sounds should have been an included manifestation of the constipation here--as in there would have been no or very few bowel sounds present.

you have to mindful of the pathophysiology going on when identifying the etiologies of the diagnostic statements or your instructors are going to ding you and take away grade points.