Nursing Care Plan


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Medical Diagnoses: Acute pain related to abdominal pain, Constipation related to pain meds and Ineffective coping related to addiction to narcotics.


2.  Acute pain related to abdominal pain.

 

:  Patient taking pain PO meds q4 hours.

 

:  Pain has been high as 7 on pain scale.

 

:  Patient states pain unbearable at times.

1.  Constipation related to pain meds  

 

:  Pain medications leading to a lack of bowel movement.

 

:  Decreased mobility and oral intake aid in difficulty of bowel movements.

3.  Ineffective coping related to addiction of narcotics.

 

:  Patient can’t function without pain meds.

:  Patient states he is in severe pain all of the time.

:  Patient will make his BP rise in order to receive his pain meds.

5.  Deficient Knowledge related to narcotic medication and proper use.

 

:  Patient has narcotic addiction.

 

:  Patient feels he must have his medication in order to function.

 

:  Patient will make his BP rise in order to receive his pain meds.

  35 Caucasian Male  Full Code

BP 106/68     Temp 98.2 F

HR 70  RR 18   Clear Lung Sounds

Height 6’0”   Weight 251lbs 

1 and ½ pack a day smoker

Hct and Cortisol slightly low      

 

Chief Complaint:  Constipation (no BM for over 2 weeks) pain in abdomen.  Chronic back/leg pain from previous injury resulting in narcotic addiction.

6.  Chronic pain related to back injury from 20XX.

 

:  Patient states that he is in constant pain/discomfort.

 

:  Patient states pain is a 10 on pain scale at times.

 

:  Patient states can’t get relief of pain.

4.  Sleep deprivation related to pain and  hospital environment.

 

:  Patient states he wakes up in pain.

 

:  Patient states he is not comfortable in the hospital and finds sleep difficult.

7.  Ineffective Denial related to inability to accept that he is addicted to narcotics.

 

:  Patient can’t and will not even try to go without his medication.

:  Takes medication even when not in severe pain.

: Unwilling to try other options for pain mgt.

8.  Risk for loneliness related to lack of socialization and lifestyle.

 

:  Patient states no real friends; relies on his mother for his care.

 

:  Patient no longer works so is home alone often. 


NANDA Diagnostic Statement: Constipation related to excessive narcotic use as evidenced by patient states no BM for over 2 weeks.

 

Behavioral Outcome / Goal: Patient to have regular healthy BM before leaving the hospital.  Patient to make dietary changes in order to promote regular BM by educating patient on healthy high fiber diet choices and to increase activity level to promote regular bowel movements. Work with patient and other health care members to reduce dependency on narcotics and develop other coping skills for pain management.

 

References:  Potter & Perry; Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales; Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.


Nursing Interventions:

 

1. Assess patient and try to determine cause of constipation.

 

2.  Find out what is normal bowel movement for patient.  (i.e. every day, every other day)

 

3.  Help client return to normal BM status.

 

4.  Give stool softeners/laxatives as prescribed by MD.

 

5.  Educate wellness and diet considerations to help patient return to normal BM status.

 

6.  Educate patient on other forms of pain management in order to help reduce need/dependency on narcotics. 

Rationale:

 

1.  Assessment provides baseline and history to help determine cause.            

 

2.  The nurse must know what is normal for the patient.

 

3. Encourage fluids and high fiber foods to promote colon health and passage of bodily waste. 

 

4.  Stool softeners and laxatives promote passage of waste.

 

5.  Regular activity and healthy high fiber fruits, vegetables and grains promote healthy stool consistency. 

 

6.  Relaxation techniques help with pain management.  Also music and other distractions. 

Client Response:

 

1.  Patient states no BM for over 2 weeks and has had previous issues with constipation but never this long.

 

2.  Patient states he usually has BM every other day; very rarely every day.

 

3.  At this time client is on a clear liquid diet in order to have colonoscopy.

 

4.  Patient states no improvement with stool softeners/laxatives at this time.

 

5.  Patient states he is a picky eater and can’t exercise due to back and leg pain.

 

6.  Patient states the only thing that helps him are his medications.

Summarize impressions of client progress toward outcomes / problem resolution:  Patient is stable and seems to be tolerating his pain well.  He continues to go outside often to smoke even though he has been advised to not do this and that a patch can be provided.  Patient has been on clear liquids for the last 24 hours due to scheduled colonoscopy and states even after drinking golytely he only had a watery bowel movement.  Patient is not at all receptive to any education and rebukes any given.  He seems to have underlying issues and I think the pain medications are a way to escape.  He lost his father suddenly a few years ago and that seems to be a significant loss for him.  He has poor social skills and is awkward at dealing with others. 


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