16.10 Putting It All Together

Client Scenario

Mrs. Jones is a 38-year-old woman who presents to the pediatrician office with her three-year-old daughter Aubrey. Mrs. Jones explains that her daughter has been experiencing infrequent bowel movements. She states, “Aubrey only passes stool one to two times per week. She strains to pass the stool and it is dry and hard when it passes.” Aubrey nods and says, “My tummy hurts a lot when that happens.”

Applying the Nursing Process

Assessment: The nurse notes the mother’s report of Aubrey experiencing increased difficulty passing stool, infrequent bowel movements, and only passing stool one to two times per week with hard, dry feces. She records Aubrey’s complaint that her “tummy hurts a lot when that happens.” The nurse assesses Aubrey’s abdomen and finds it rounded and firm with decreased bowel sounds present in all four quadrants.

Based on the assessment information that has been gathered, the nurse creates the following nursing care plan for Aubrey:

Nursing Diagnosis: Constipation related to insufficient fluid and fiber intake as manifested by decreased stool frequency, hypoactive bowel sounds, straining with defecation, hard dry stools, and client reports “my tummy hurts a lot when that happens.”

Overall Goal: The client will have soft bowel movements without difficulty.

SMART Expected Outcome: The client will have a soft, formed stool every 24-48 hours.

Planning and Implementing Nursing Interventions:

The nurse will provide education to the client and her mother regarding the importance of adequate fluid sources and fiber intake, in addition to medications prescribed by the provider. The nurse will encourage water for hydration and provide education regarding beverage sources that may contribute to constipation. The nurse will discuss the value of fresh fruits, vegetables, and whole grains in diet and describe strategies for encouraging toddler consumption of these foods. The nurse will encourage scheduling regular times to attempt elimination. The nurse will provide positive reinforcement to the child regarding using of the toilet regularly for bowel elimination and encourage the mother to track bowel movements and intake using an elimination diary.

Sample Documentation:

Mother presents with the client to the clinic reporting infrequent bowel movements. She states, “Aubrey only passes stool one to two times per week. She strains to pass the stool, and it is dry and hard when it passes.” The client reports, “My tummy hurts a lot when that happens.” The client’s abdomen is firm and round with decreased bowel sounds present in all four quadrants. Health teaching was provided to improve bowel elimination.

Evaluation:

The nurse calls Aubrey’s mother in two days.  The mother reports that Aubrey had a soft, formed bowel movement on each of the past two days. The SMART outcome was initially “met.” The nurse encourages the mother to continue the planned interventions and to follow-up with the provider at the next clinic visit.