Chapter 47, Problem 1CAQ

Summary Introduction

To determine:

The patient (J) comes to the emergency department of the hospital with the absence of appetite and rectal pressure. The nursing assessment questions that nurse asks the patient (J)?

Concept introduction:

On the next visit of the patient (J) 2 days later, the home care nurse (J) found that the patient (J) is still had not had a normal movement of the bowel and his blood pressure is 160/92 and the patient (J) is tried to increase the intake of vegetables and fruits but he had a very small appetite and felt mildly nauseous after eating a meal. The patient (J) took every evening a laxative with a stool softener but the patient describes that small, liquid bowel movement 2 to 3 times a day. He takes his medicine but also he feels pressure in his rectum which is not relieved. The patient (J) is having elevated blood pressure, the absence of bowel movement and increasing discomfort for at least 9 days. The home care nurse (J) thinks that the patient (J) should go to the emergency department of his local hospital.

Explanation of Solution

The essential physical factors to defecation and bowel function include sensory awareness of the rectal contents and rectal distension, normal gastrointestinal tract function, sufficient rectal capacity, voluntary sphincter control and compliance. The defection is started with motion in the left colon and moving the stool in the direction of the anus. During the time of defecation, the outer sphincter relaxes and muscles in the abdomen contract, increase the pressure in intra-rectal area and forcing the stool away. The normal defection results in painless, moving of soft and formed stool.

The nursing assessment questions that nurse asks to the patient (J) in the given case follow:

1. 1. How long have you had the problems with constipation?
2. 2. When was your last bowel movement?
3. 3. How many bowel movements do you have in a representative week?
4. 4. Have you at any time needed to have a bowel movement manually removed?
5. 5. Which medicine do you take?
6. 6. How much water do you drink?
7. 7. What did you have to eat the day before today?

Conclusion

The patient is required to change the diet or intake of fluid if there is straining during the bowel movement. Doing regular exercise and drinking more water helps to for the normal stool movement through colon.