Question

You are a visiting nurse checking in on your patient, a 93-year-old retired steelworker who lives alone with his two cats. You visit him on a weekly basis to monitor his blood glucose levels and refill his insulin syringes for his self-medicating throughout the week, as he is visually impaired. During your interview, he indicates that he has been experiencing irregularity and is quite anxious over developing a bowel obstruction.  

a. How would you assess his bowel elimination patterns?

b. Describe foods that impact bowel elimination either positively or negatively.

c. What activities could you recommend to maintain adequate bowel function?

d. Outline how fiber and fluid intake facilitate bowel elimination.

e. Which mechanical function of the bowel causes constipation?

Answer 1

a) *Check the usual bowel pattern of elimination, including frequency and consistency of stool - dry and hard stool are common characteristics of constipation.

*Check out usual dietary habits, eating habits, eating schedule and liquid intake - irregular mealtime, type of foods and interruption of usual schedule can lead to constipation.

*Assess the patient activity level - Lack of exercise prolonged bed rest and inactivity contributes to constipation.

*Classify current medications that may leads to constipation.

*Feel the need for privacy for elimination.

*Evaluate for fear of pain with defecation.

*Consider the degree to which the patient response to the presents of stool. The longer the stool stays in the rectum, the drier and the harder it becomes. This will make the stool difficult to pass.

*Know if there is a history of neurogenic disease, such as multiple sclerosis or parkinson's disease - Neurogenic disorders may decrease peristaltic activity.

b) One of the more obvious factors that influences patient ability to go to the bathroom: patient diet some foods contain fiber that promotes regularly and helps move food through the digestive tract. High fiber foods like fruits, vegetables, beans and whole grains - add bulk to patient digestive wastes, making it easier for the patient move his bowels. In contrast, some low fiber foods lead to constipation. Which is a difficulty with bowel elimination. Diary foods such as cheese and milk, are common foods that can contribute to constipation.

c) *Adequate intake of fluid - Intake of enough fluid to keep stool soft will promote healthy bowel movement.

*Provide fiber rich food

*Exercise and physical activity - movements of abdominal muscles will help peristalsis.

*Provide a regular, private time for defecation. Doing will help create a regular evaluation pattern.

*Suppositories may used to stimulate defecation.

d) Fiber adds bulk to the stool eliminates excess fluids, and promote more frequent and regular movements. With increasing fiber it is important to drink enough fluids. If fluid intake is inadequate, the stool becomes hard because less water is retained in the larger intestine.

e) Constipation could be a result of mechanical blockage of the bowel by scarring and constriction of the bowel channel or by narrowing of the channel due to growth of a tumour or mass. Diagnostic studies to evaluate constipation include, colonoscopy, barium enema, CT colonography, anorectal manometry, defecography.