- a.Constipating: Processed cheese, lean meat, eggs,
pasta
b.Laxative: Certain fruits and vegetables, bran,
chocolate
c. Gas-producing: Onions, cabbage, beans, cauli-
flower - a.The patient will have a soft, formed bowel move-
ment every 1 to 3 days without discomfort.
b.The patient will explain the relation between
bowel elimination and dietary fiber, fluid
intake, and exercise.
c. The patient will relate the importance of
timing, positioning, and privacy to healthy
bowel elimination. - a.Constipation: Increase intake of high-fiber
foods and fluid.
b.Diarrhea: Prepare and store food properly, avoid
highly spiced foods or laxative-type foods,
increase intake of low-fiber foods, and replace
lost fluids.
c. Flatulence: Avoid gas-producing foods such as
beans, cabbage, onions, cauliflower, and beer.
d.Ostomies: A low-fiber diet is usually
recommended, although patients may
experiment with their diet to determine how
much fiber they can tolerate. - a.Abdominal settings: Lying in a supine position,
tighten and hold the abdominal muscles for 6
seconds and then relax them. Repeat several
times every waking hour.
b.Thigh strengthening: Flex and contract the
thigh muscles by slowly bringing the knees up
to the chest—one at a time—and then lowering
them to the bed. Perform several times for each
knee, each waking hour. - a.To relieve constipation or fecal compaction
b.To prevent involuntary escape of fecal material
during surgical procedures
c. To promote visualization of the intestinal tract
by radiographic or instrument examination
d.To help establish regular bowel function during
a bowel training program - a.Ileostomy: Allows liquid fecal content from the
ileum of the small intestine to be eliminated
through the stoma
b.Colostomy: Permits formed feces from the
colon to exit through the stoma - a.Timing: Patients should be allowed to heed the
natural urge to defecate.
b.Positioning: The squatting position best facili-
tates defecation.
c. Privacy: Most patients consider elimination a
private act, and nurses should provide privacy
for their patients.
d.Nutrition: Patients with elimination problems
may need a dietary analysis to determine
which foods and fluids are contributing to
their problem.
e.Exercise: Regular exercise improves
gastrointestinal motility and aids in defecation.
APPLYING YOUR KNOWLEDGE
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.What nursing interventions might the nurse imple-
ment for this patient?
The nurse should address methods to counteract the
constipating effects of the medication on Mr. Cobb’s
gastrointestinal system. The nurse could then prepare
a teaching plan for Mr. Cobbs that lists the foods
that he should eat to stimulate peristalsis. Nursing
interventions to remove the fecal impaction in a
competent manner should also be initiated.
2.What would be a successful outcome for Mr. Cobbs?
By next visit, Mr. Cobbs lists three foods to include
in his diet to prevent constipation
By next visit, Mr. Cobbs verbalizes having regular,
pain-free bowel movements
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: knowledge of the anatomy and physi-
ology of bowel elimination and variables, such as
medications, that influence bowel elimination
Technical: ability to perform digital extraction of
fecal matter in a safe and competent manner
Interpersonal: ability to interact in a nonjudgmen-
tal and professional manner when interacting in sit-
uations involving bowel elimination, a typically
private matter
Ethical/Legal: adherence to safety and quality when
performing nursing interventions to promote bowel
elimination
4.What resources might be helpful for Mr. Cobbs?
Consultation with a dietitian, printed or AV materi-
als discussing the effect of medications on the gas-
trointestinal system and appropriate interventions
PATIENT CARE STUDY
1.Objective data are underlined; subjective data are in
boldface.
Ms. Elgaresta, age 54, a single Hispanic woman, is
being followed by a cardiologist who monitors her
arrhythmia. Last month, she started taking a new
heart medication. At this visit, she says to the nurse
practitioner who works with the cardiologist:
“Right after I started taking that medication, I
got terribly constipated, and nothing seems to
help. I’m desperate and about ready to try dyna-
mite unless you can think of something else!”
She reports a change in her bowel movements
from one soft stool daily to one or two hard
stools weekly, stools that cause much straining.
The nurse practitioner realizes that regulating Ms.
Elgaresta’s heart is difficult and that her best cardiac
response to date has been with the medication that
is now causing constipation. Reluctant to suggest
substituting another medication too quickly, she
asks more questions, and Ms. Elgaresta responds,Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:402 ANSWER KEY
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