Question

George Miller, a 68-year-old man who had a stroke 6 months ago, comes to the urgent care clinic complaining of abdominal pain and nausea. He lives alone in an assisted living complex. He was never married, and his only relative is a 70-year-old sister who visits him two to three times a week. She is independent and concerned that Mr. Miller is doing okay. Mr. Miller uses a quad cane to ambulate because of hemiplegia on his left side and eats his meals in the central dining room at the complex. The complex has no licensed health care workers. Sally Schmitt, a nursing student, is assigned to the urgent care clinic. Her assignment is to perform an initial assessment on Mr. Miller with the acute care nurse practitioner (ANP). While Sally takes his history, Mr. Miller tells her that he has not had a bowel movement in 4 days. On physical examination, Mr. Miller’s abdomen is hard, and he has hyperactive bowel sounds. The ANP determines that Mr. Miller has constipation and has a fecal impaction. Sally is to remove the impaction from Mr. Miller. Sally knows that it is not good for Mr. Miller to strain for a bowel movement. Why could straining cause concern for Mr. Miller?

Question 6

Mr. Miller is also to have a tap water enema to promote bowel evacuation. After getting her equipment ready, Sally should position Mr. Miller in what position on the table? Please detail the correct procedure of administering an enema as well as nursing interventions for any problems that might occur during the procedure.

Question 7

Mr. Miller’s sister has come with him to the urgent care clinic and asks Sally what could have caused Mr. Miller to get so constipated? Sally should explain that constipation can be caused by which factors?

Answer 1

#. Sally knows that it is not good for Mr. Miller to strain for a bowel movement because he had a history of stroke 6months ago . Straining should be avoided .

#. Enema procedure :-

Before/after I enter room: responsibilities (to pt./hospital)

Hi 5

1. Read provider orders and know procedure

2. Wash Hands

3. Gather equipment

4. ID client

5. Explain procedure

6. Assess Safety

Step 2

Apply clean gloves

Step 3

Assess rectal area, remove gloves

Step 4: Prep time

Prepare Enema:

1. add warm solution to enema bag

2. prime tubing

3. clamp tubing

4. lubricate tip if not pre-lubricated*

Step 5: I'm going to start touching the patient again, what must I do?

Apply clean gloves

Step 6: Patient is supine, what should I do about this?

Raise HOB to working height, stand on right side of client with right side rail down and left side rail raised

Step 7: Best client position?

Position in left-lying sims position with right knee flexed, provide privacy and drape client

Step 8

place pad under clients hips

Step 9

Place bedpan in easily accessible position

Step 10

Expose rectal area

#. Factors causing constipation :-

Primary causes of constipation are :-

diet and lifestyle choices, behavioral factors and primary colorectal dysfunction.

Secondary causes of constipation are :-

functional, anatomic or neurologic abnormalities that prevent normal passage of stool through the intestines.