Managing the symptoms of constipation

A 25 years old woman who is at 34 weeks gestation arrives at the obstetrician’s office for her routine appointment; she is accompanied by her husband. The client informs the nurse that she has some generalized abdominal discomfort and has had firm stools recently that are hard to pass and less frequent than usual. Additionally, the client reports urine leakage that is especially noticeable with coughing, laughing or sneezing.

The client reports managing the symptoms of constipation with increased fluid intake but no other measures. The provider examines the client and determines the client demonstrates an otherwise normal assessment. The provider instructs the nurse to provide the client with directions on constipation management, including an over-the-counter stool softener and urinary incontinence related to pregnancy.

Assessment Questions

1. Identify the relevant subjective and objective assessment information related to the client’s condition and place the findings in the assessment data box below. (Recognizing Cues; Assessment)

2. Based upon assessment information, identify and prioritize the top 3 client problems. Write one client problem in each of the Client Problem boxes below. (Analyze Cues; Analysis and Prioritize Hypothesis; Planning)

3. Below each client problem, determine and enter the relevant assessment information that supports the identified client problem. (Analyze Cues; Analysis and Prioritize Hypothesis; Planning)

4. Identify important nursing interventions that should be taken to address each client problem and enter them in the related intervention box for the associated client problem. (Take Action; Implementation)

Discussion Questions

Educators may choose to instruct students to include relevant information identified during the discussion questions into the concept map.

1. Discuss special considerations to be made for clients from diverse backgrounds. (Recognize Cues; Assessment)

A. Teenage female with no support.

B. Clients from diverse backgrounds(i.e. Age, culture, socioeconomic status).

2. Identify potential client problems. (Analyze Cues; Analysis)

A. Instruct students to provide a rationale for their choices.

3. Discuss nursing interventions to address the identified potential client problems. (Generate Solutions; Planning)

A. Instruct students to provide a rationale for their choices.

4. Discuss the desired client outcomes related to the performed interventions identified in the concept map as well as for potential client problems. (Generate Solutions; Planning)

A. Discuss client responses that demonstrate an improvement of the client problem.

B. Identify client responses that indicate worsening of the client condition. (Generate Solutions; Planning)

5. Discuss safety considerations that should be included when planning care for this client (i.e. fall risk). (Generate Solutions; Planning)

6. Identify client education the nurse should provide for this client (i.e. diet, activity, ADLs). (Take Action; implementation) Discuss client outcomes you would anticipate based on the performed nursing interventions (i.e. improved SPO2 with raising head of bed, increasing amount of oxygen being delivered). Identify how achievement of client outcomes would be evaluated. (Evaluate Outcomes; Evaluation)

7. Discuss ways to modify or revise the plan of care when client outcomes are not me.(Evaluate Outcomes; Evaluation)

Concept Map

Admitting Diagnosis

Assessment Information

Client Problem 1:

Assessment information

Intervention

Client Problem 2:

Assessment information

Intervention

Client Problem 3:

Assessment information

Intervention