Question

Jeanine Webb, 14 days old, is brought to the clinic by her parents for her 2-week check-up. Jeanine’s parents tell the nurse that they believe their little girl has a problem with constipation even though she is breastfed.

Jeanine’s mother tells the nurse that Jeanine did not pass a meconium stool within the first 2 days of life until the staff provided rectal stimulation. The neonate now has a bowel movement approximately once every 3 or 4 days and cries inconsolably when having a bowel movement, and the stool appears to be semiformed. (Learning Objectives 2, 3, 4, 6, 7, 8, and 10)

a. When performing a physical examination on Jeanine, what might the nurse find?

b. What diagnostic tests should the nurse expect to be done on Jeanine?

c. What nursing interventions would the nurse expect to provide to Jeanine and her family?

d. What would be important to include in a teaching plan for Jeanine and her family?

Answer 1

a) While performing the physical examination the nurse might find the following signs and symptoms :-

- abdominal distension

- lack of or decreased bowel sounds on auscultation

- rigid and hard abdomen

- weight loss

- cry vigorously due to pain

- fever due to infection

- abdominal pain

- blood in stool

- traces of liquid or clay-like stool in the diaper

- anal fissures

- intestinal protrusion out of anal canal ( in severe cases )

b) The diagnostic tests nurse expect to be done on Jeanine are :-

- Blood investigation like CBC ,LFT, RFT ( to detect anemia ,celiac disease , infection etc )

- Stool test to detect the presence of blood ,signs of infection and inflammation

- Urine test to detect bladder infection which could be caused by constipation

- Bowel function test

- X-ray

- Ultrasound abdomen

c) Nursing interventions provided to Jeanine and her family are:-

- Assess the vital signs of the infant

- Determine stool colour ,consistency , frequency and amount

- Auscultate bowel sounds

- Encourage parents to increase the fluid intake

- Assess the perianal skin condition for tears etc

- Administration of laxative and enemas

- Teach parents how to use stool softeners ,bulk forming and mild stimulants

- Teach parents the warning signs like intestinal protrusion ,blood in stool etc and when to reach the doctor .

d) Teaching plan for Jeanine and family should include the following :-

- Teach parents how to assess the stool colour ,consistency ,frequency and amount

- Teach parents how to use stool softeners ,bulk forming and mild stimulants

- Teach parents the warning signs like intestinal protrusion ,blood in stool etc and when to reach the doctor