Constipation etc.
The nurse is planning care for a child experiencing encopresis. Which collaborative intervention should be included? (Select all that apply.) A. Limiting fluid intake B. Behavioral modification C. Psychological treatment D. Pharmacologic treatment of constipation E. Collaboration with school nurses and teachers
Behavioral modification Psychological treatment Pharmacologic treatment of constipation Collaboration with school nurses and teachers Rationale: Appropriate therapies include psychological treatment, collaboration with school nurses and teachers, pharmacologic treatment of constipation, a high-fiber diet, and behavioral modification. A client experiencing encopresis should drink 6dash8 glasses of fluid per day.
The nurse is planning to teach a family about the causes of encopresis. Which topic should the nurse include? (Select all that apply.) A. Diet B. Stress C. Anger issues D. Fecal impaction E. Premature birth
Diet Stress Anger issues Fecal impaction Rationale: Encopresis is characterized by recurrent soiling or passage of stool at inappropriate times by a child who should have achieved bowel continence. The causes of encopresis include stress related to environmental changes, anger issues, diet, and fecal impaction. Premature birth is not a cause of encopresis.
The nurse is planning care for a client who has bowel incontinence. Which intervention should the nurse include? A. Use of cathartic medications B. Pelvic floor exercises C. Digital stimulation procedure D. Cardiovascular exercise
Pelvic floor exercises Rationale: Exercises to improve sphincter and pelvic floor muscle tone (Kegel exercises) may be of long-term benefit. Treatment of bowel incontinence depends on the underlying cause of the incontinence. Medications to control bowel incontinence include loperamide (Imodium) and bismuth subsalicylate (Kaopectate, Pepto-Bismol), not cathartic medications. Digital stimulation of the rectum is used to treat fecal impaction. Cardiovascular exercise will impact overall health and mobility, but Kegel exercises are more relevant to bowel incontinence.
Which factor may lead to constipation and fecal impaction? (Select all that apply.) A. Tumor B. Antacids C. Regular exercise D. Psychogenic factors E. Ingestion of a high-fiber diet
Tumor Antacids Psychogenic factors Rationale: Antacids containing aluminum or calcium salts, narcotics, many antidepressants, some antihypertensive agents, tranquilizers, sedatives, diuretics, and iron salts can all cause constipation and fecal impaction. A tumor can cause acute or chronic constipation. Voluntary suppression of the urge to defecate, perceived need to defecate on schedule, and depression contribute to constipation and fecal impaction. A lack of exercise contributes to constipation and fecal impaction. Highly refined low-fiber foods and inadequate fluid intake contribute to constipation and fecal impaction.
The nurse is caring for an older adult client suffering from chronic constipation. The nurse should monitor the client for which condition? A. Urinary tract infection B. Parkinson disease C. Renal calculi D. Stroke
Urinary tract infection Rationale: Constipation may predispose older adult clients to urinary tract infections. When the colon contains a large amount of hard stool, pressure is placed on the bladder, ureters, or urethra. This can result in the pooling of urine, leading to bacterial growth and infection.
The nurse instructs the client with chronic diarrhea to increase soluble fiber intake. Which statement by the client indicates an understanding of the instruction? A. "Fiber decreases the fecal volume." B. "Fiber increases the fluid in chyme." C. "Fiber increases the fecal volume." D. "Fiber pulls fluid from my body."
"Fiber increases the fecal volume." Rationale: Sufficient bulk (cellulose, fiber) in the diet is necessary to provide fecal volume. Bland diets and low-fiber diets lack bulk and therefore create insufficient residue of waste products to stimulate the reflex for defecation. A high-fiber diet provides the bulk needed to combat the issue of diarrhea. Fiber does not pull fluid from the body, but it does add bulk. Fiber does not have the ability to increase the fluid in chyme; it adds to fecal volume, thus eliminating diarrhea.
Which statement represents the rationale for encouraging a client with constipation to increase activity? A. Activity stimulates peristalsis. B. Activity strengthens the muscles in the abdomen. C. Activity prevent blood clots. D. Activity moves the chyme.
Activity stimulates peristalsis. Rationale: Activity stimulates peristalsis, facilitating the movement of chyme through the colon. Weak abdominal and pelvic muscles often are ineffective in increasing the intra-abdominal pressure during defecation or in controlling defecation. Weak muscles can result from lack of exercise, immobility, or impaired neurologic functioning. Clients confined to bed often experience constipation resulting from decreased peristalsis.
The nurse is planning to teach a client dietary changes to prevent diarrhea. Which intervention should the nurse include? A. Avoiding foods that contain cabbage B. Limiting fluid intake C. Avoiding spicy food D. Taking medications at night versus in the morning
Avoiding spicy food Rationale: Spicy foods produce diarrhea and flatus in some individuals. Fluid restriction would be for a client who is carrying excess fluid for one reason or another (dialysis, CHF, adrenal issues). Foods such as cabbage are gas-producing foods and may cause some bloating and discomfort. Medication should be taken as ordered by the healthcare provider. The only way a medication schedule should be altered is if it is approved by the healthcare team.
The nurse is caring for a client diagnosed with Parkinson disease. Which situation should the nurse anticipate while caring for this client? A. Constipation B. Alterations in fecal volume C. Changes in fecal composition D. Bowel incontinence
Bowel incontinence Rationale: Changes in neurologic function, such as those seen in Parkinson disease, affect the innervation of the bowel and can lead to fecal incontinence. Constipation results from decreased motility and slow movement of fecal matter through the intestines. A change in food or fluid intake (increase or decrease) can alter fecal volume and composition.
When performing a health history on a client admitted for fecal impaction, the nurse asks, "What is your pattern for defecation at home?" Which is the rationale for the nurse asking this question? (Select all that apply.) A. Determines normal bowel pattern B. Describes the usual pattern of defecation C. Supports plan for evacuation of the impaction D. Determines the extent of needed bowel training E. Identifies changes that may have caused the current issue
Determines normal bowel pattern Describes the usual pattern of defecation Identifies changes that may have caused the current issue Rationale: Collecting data regarding fecal elimination helps the nurse to identify the client's normal pattern. The nurse should obtain a description of usual defecation and any recent changes. The evacuation of an impaction would only be done once the initial exam was complete and an abnormality was found. Bowel training is not a usual plan for fecal impactions, but is quite useful for clients suffering from bowel incontinence.
The nurse is planning to teach a client about the consequences of persistent diarrhea. Which clinical manifestation should the nurse include? (Select all that apply.) A. Emaciation B. Weakness C. Dehydration D. Loss of appetite E. Skin breakdown
Emaciation Weakness Dehydration Skin breakdown Rationale: Persistent diarrhea generally results in irritation of the anal region, which can extend to the perineum and buttocks. Fatigue, weakness, malaise, and emaciation are the results of prolonged diarrhea. Dehydration can result for the loss of fluid and electrolytes.
The nurse is assessing an older adult client who presents with fecal incontinence. Which statement by the nurse indicates understanding of the etiology of fecal incontinence? A. "Older adults are not at an increased risk for fecal incontinence." B. "Fecal incontinence is abnormal and should be addressed in clients who are cognitively intact and physically able." C. "Older adults with fecal incontinence are not candidates for treatment to alleviate their condition." D. "Fecal incontinence is a normal response to the aging process."
Fecal incontinence is abnormal and should be addressed in clients who are cognitively intact and physically able." Rationale: The causes of fecal incontinence are multifactorial. Fecal incontinence is abnormal and should never be considered a normal part of the aging process. Older adults are at increased risk for fecal incontinence due to chronic disease, polypharmacy, inactivity, immobility, and decreased fluid intake. Older adults who are cognitively intact and physically able should be considered for treatment to alleviate the psychosocial effects associated with fecal incontinence and the undue burden to care providers and the healthcare system.
Which is a risk factor for constipation? (Select all that apply.) A. Immobility B. Lack of privacy C. Chronic laxative use D. Suppressing the urge to defecate E. Intake of high levels of dietary fiber
Immobility Lack of privacy Chronic laxative use Suppressing the urge to defecate Rationale: Lack of privacy and immobility can lead to constipation. Chronic use of laxatives and the dilation of the bowel with loss of smooth muscle tone in the colon can cause constipation. Ignoring the urge to defecate causes the muscles and mucosa in the rectal area to become insensitive to the presence of stool, which becomes more difficult to expel. High levels of dietary fiber and high fluid intake decrease the chance of constipation.
Which assessment should the nurse include when completing the health history of a client who has fecal incontinence? (Select all that apply.) A. Obstetrical history B. Psychologic history C. History of urinary disease D. History of radiation exposure E. History of neurologic diseases
Obstetrical history Psychologic history History of radiation exposure History of neurologic diseases Rationale: Causes of fecal incontinence include neurologic causes, local trauma, and inflammatory processes such as radiation exposure, psychological causes, and other physiological factors. A history of urinary disease would not likely contribute to fecal incontinence.
The nurse is auscultating the abdomen prior to palpating it. Which statement supports the rationale for this action? A. Palpation moves the bowel. B. Palpation can alter peristalsis. C. Palpation can be uncomfortable for the client. D. Palpation causes the client to move.
Palpation can alter peristalsis. Rationale: Auscultation precedes palpation because palpation can alter peristalsis. Palpation is used to feel for any abnormalities and would not physically move the bowel. The nurse should provide an explanation of what will happen during palpation, so that the client does not move during the exam. If the area is palpated correctly, it should not produce pain unless there is some underlying issue.
The nurse is planning care for a client who has fecal incontinence. Which intervention should the nurse include? (Select all that apply.) A. Administer a bulk laxative per order. B. Provide privacy when using the bathroom. C. Insert a glycerin suppository at the same time every morning per order. D. Demonstrate the correct positioning for bowel evacuation to avoid straining. E. Assist the client to the bathroom each day around the client's standard time of defecation.
Provide privacy when using the bathroom. Insert a glycerin suppository at the same time every morning per order. Demonstrate the correct positioning for bowel evacuation to avoid straining. Assist the client to the bathroom each day around the client's standard time of defecation. Rationale: A bulk laxative is appropriate only for a client who is experiencing constipation, not fecal incontinence. Having the client use the bathroom in a normal bowel routine will help promote defecation. To stimulate peristalsis, administer a cathartic suppository (e.g., glycerin or bisacodyl) 30 minutes before the client's usual defecation time. When the client experiences the urge to defecate, assist the client to the toilet or commode or onto a bedpan, and note the length of time between the administration of the suppository and defecation. Provide the client privacy for defecation and teach the client to lean forward at the hips and apply pressure to the abdomen with the hands to increase pressure on the colon and avoid straining.
The nurse is assessing a client who is taking an opioid analgesic. Which side effect should the nurse monitor? A. Muscle cramping B. Diarrhea C. Constipation D. Rectal bleeding
constipation Rationale: Large doses of tranquilizers or repeated administration of morphine or codeine decreases gastrointestinal activity, causing constipation. Muscle cramping would not be a side effect of using a PCA pump of morphine. Rectal bleeding or possibly hemorrhoids may be present as a result of the surgery. These are definitely symptoms to be reported to the healthcare team.
The client and the nurse are discussing fluid consumption to aid in decreasing the risk of constipation. Which statement demonstrates proper client understanding? A. "I should consume 2000dash3000 mL of fluid daily." B. "I should drink milk products only in the morning." C. "I should not drink fruit juice as I do normally." D. "I should consume 1000dash1500 mL of fluid daily."
"I should consume 2000dash3000 mL of fluid daily." Rationale: Healthy fecal elimination requires a daily fluid intake of 2000dash3000 mL, but even when fluid intake is inadequate or output (e.g., urine, vomitus) is excessive, the body continues to reabsorb fluid from the chyme as it passes along the intestinal tract. Drinking milk products is indicated for bone building in children and preventing osteoporosis in older adults. Avoiding fruit juice may be a direction given to the client who is newly diagnosed with diabetes, because some fruits are high in natural sugar.
The nurse is teaching a client about interventions to treat chronic constipation. Which client statement indicates that the teaching was effective? A. "I should eat small meals frequently." B. "I should increase my fluid intake." C. "I should take laxatives twice a day." D. "I should limit my fluid intake."
"I should increase my fluid intake." Rationale: For clients with constipation, interventions include encouraging increased intake of fluid and fiber and teaching about the impact of dietary choices on bowel elimination. Several strategies can help individuals prevent constipation. Dietary methods include eating foods high in fiber, limiting foods that are low in fiber, and drinking plenty of fluids. Fiber supplements may also be useful for preventing constipation, but they should be consumed with plenty of water. Behavioral methods include exercising regularly and not ignoring the urge to defecate. Stool hardens based on the length of time it remains in the intestinal tract because water is continuously absorbed; therefore, ignoring the urge to defecate can contribute to constipation. Overuse of laxatives can cause severe diarrhea and eventually incontinence. A dietitian may encourage eating small meals throughout the day as a way to lose weight.
The nurse is teaching a client with chronic constipation about ways to decrease the likelihood of fecal impaction. Which statement indicates understanding by the client? A. "I should strain to defecate." B. "Exercise will not help decrease impaction." C. "I should increase my intake of fiber." D. "I should limit my fluid intake."
"I should increase my intake of fiber." Rationale: Impaction is a mass or collection of hardened feces in the folds of the rectum. To decrease the likelihood of impaction, the client should increase fluid and fiber intake, take a stool softener daily, and increase activity. While straining during defecation is a manifestation of fecal impaction, straining will not prevent its development.
