Nursing Case Study: Bowel Elimination Video

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  • 0:01 Case Study
  • 0:41 Assessment
  • 2:10 Diagnosis
  • 3:09 Planning
  • 3:55 Implementation
  • 4:47 Evaluation
  • 6:19 Lesson Summary
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Lesson Transcript
Instructor: Adrianne Baron

Adrianne has taught high school and college biology and has a master's degree in cancer biology.

This nursing case study takes a look at bowel elimination problems. Through this case study, you'll learn how to follow the nursing care process to address bowel elimination issues.

Case Study

You have recently started working at a skilled nursing facility. A new patient, Joyce, has just been admitted. You review her chart and see that Joyce is 72 years old and recovering from a CVA, commonly called a stroke, that occurred two months ago. The stroke has drastically reduced movement on the left side of her body. The doctor has prescribed several medications, including oxycodone, to improve Joyce's condition. Her doctor has also recommended that she begin physical therapy, but she was reluctant to do it while she was at home.

Now, it's time for you to use the nursing care process to determine the best care plan for Joyce.

Assessment

The first step in the nursing care process is to do an assessment. You interview Joyce to get more information from her. She tells you that she hasn't walked in about three months and is taking several medications for her condition, including oxycodone. Her daughter recently started her on some over-the-counter laxatives since she was complaining of constipation.

At this point, you should get more information in regards to Joyce's constipation complaint. Pause the video now and think about what questions you should ask Joyce.

Hopefully you came up with these questions:

  • How often do you have a bowel movement now?
  • How often did you have bowel movements before the constipation started?
  • How long have you felt constipated?
  • What color are your feces?
  • Are your feces solid, runny, or in between?

Joyce lets you know that she use to have bowel movements twice a day, and now she has them about once every three days for the last month and a half. The feces are solid, small balls that are dark brown in color.

As part of the assessment, you should attempt to pinpoint what could be causing Joyce's constipation. Take a minute now to consider possible causes based on the information Joyce has provided to you.

The factors that you should have come up with for causing the constipation are:

  • her recent stroke
  • immobility
  • the opioid medication that she is taking

Diagnosis

Putting this together brings you to the next step in the process, which is the nursing diagnosis. In order to come up with a diagnosis, you should obtain a couple of stool samples and do observation on Joyce for the first few days. You observe that Joyce has a bowel movement that looks just like she described on the day she arrives, and the next bowel movement isn't until day three and has the same characteristics.

Testing the stool sample for parasites and occult blood, which is blood in the feces that isn't visibly apparent, doesn't produce any abnormal results. During this observation time, Joyce doesn't feel the need to take oxycodone for pain, but she also doesn't get up from the bed. Pause the video now to determine your diagnosis in regards to Joyce's constipation.

The most likely nursing diagnosis for Joyce would be that she has constipation due to immobility induced by a recent CVA.

Planning

Now that we believe we know what has caused Joyce to be in this condition, we need to come up with a plan to help her recover. Joyce's constipation is related to her lack of movement. Pause the video to think about some nursing interventions that could help Joyce to have more bowel movements. Consider the desired outcome for Joyce in regards to her bowel movements.

Joyce is having bowel movements once every three days. A good outcome for Joyce is to get to at least one soft bowel movement each day that has the normal brown color and isn't forced. The nursing interventions could include getting Joyce out of the bed. Another advantageous intervention for Joyce is to start physical therapy to increase movement even more.

Implementation

We have our plan all set for Joyce. The next thing that has to happen is implementation of Joyce's care plan. Pause the video and think about ways to implement the nursing interventions in order to achieve the outcome we set for Joyce.

Here's what implementation of Joyce's plan should look like:

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