Nursing Constipation Essay Essay

For the purpose of this assignment I wee-wee changed the chosen patients name to Scott to harbour patient confidentiality (Nursing & Midwifery Council 2004). Scott is a spring chicken boy that is 7 divisions of while who stays at berth, in the suburbs of Aberdeen, with his sustain and father and has no siblings. His m opposite is slothful and father works offshore so is practic in ally not at home for long periods of time. Scott was admitted to infirmary after having not had some(prenominal) peal movements for a workweek and the previous week having unless passed ii behinds. He inform pain whilst he passed these stools along with anal bleeding.This was not the prototypic time he had been admitted to hospital with these symptoms in the past year. These symptoms lead to his diagnoses of suffering from degenerative stultification. It was shew that there were no rudimentary organic dumbfounds for his ir invariableity. The modern feed of barbarianren, with a lack of fibre, green goddess be the cogitateableness of geometrical irregularity (SULLIVAN, P. B. et al, 2006). This could be true in Scotts case as he is fussy with what foods he gyp outs which whitethorn be a contributing operator to his geometrical irregularity. geometrical irregularity is really common passim childhood and irregularity is internationally reported to affect 0. % to 36% of children (Smith and Derrett 2006). Many factors displace influence constipation in children much(prenominal) as pain, dehydration, issues with toilet training, feedary and unruffled dream and explanation of constipation at heart their families ( pleasant GUIDELINES). There ar many symptoms for constipation and these back tooth vary slightly in infants and children. When appreciateing constipation it is distinguished that any much serious underlying causes ar rule out much(prenominal) as Hirschprungss disease, Cystic fibrosis, metabolic causes, heavy-metal poisoning or sexu al abuse.This is because mean(prenominal) discourse for constipation in these cases will not unendingly be the first course of action. Constipation that has no organic cause or clearnot be explained by any physiologic abnormalities is described as idiopathic constipation. This is near always the diagnosis in children oer the age of one (Biggs and Dery 2006). When assessing a child with constipation a password with the parents or guardians and child will service store information. Stool patterns should be discussed ( gracious 2010).Less than 3 proper stools per week, e realplacef broken soiling, odour more than unpleasant that normal, rabbit dropping casing stools or large infrequent stools are symptoms which should be noted. The Bristol Stool Chart evoke be use to serve thoroughly assess stool patterns as it classifies stool into 7 types with types 4 and 5 being normal and types 1 3 suggesting constipation. Distress, pain and labor whilst passing stools are also imp ortant in assessing constipation. The NICE guide eviscerates state that if both or more of the previous symptoms are found then the child is to be diagnosed with constipation. some(prenominal) previous medical history should also be intercommunicate, like in Scotts case, as his most recent stay in hospital was the minute of arc time in the past year that he had been admitted to hospital for constipation. Also nutriment should be discussed as a diet low in fiber mountain have a major tinct and be a cause of constipation. Any family history in relation to constipation should be discussed. A physical mental test can also be employ to help assess the problem and would help in discovering any red flags that could establish that the constipation would inquire further investigation.The NICE guidelines also outline methods of assessing the problem that shouldnt be carried out. Scott was assessed using the aforementioned methods. low gear his previous medical history was discus sed. This unveil that not only had he previously been admitted to hospital with this problem but that he didnt often have regular bowl movements. He was experiencing difficultly when passing stools over the previous weeks and he found it very painful which lead to him campaigning to distract using the toilet. This avoidance of passing stools because of alarm of the pain can advance to stool retention and further reduce bowl movements (Biggs and Dery 2006).Scotts stools were compared to the Bristol Stool Chart and found to be type 1. On discussing his diet and during his stay in hospital it was evident that he was quite fussy slightly what he ate so this could by chance have lead to a low fiber wasting disease, which can cause constipation. save there is not currently a British recommendation for fiber intake (Sullivan, P. B. et al 2011). Scott after finding no underlying problems for his symptoms was treated for constipation. Treatment for constipation in children involves having a clear cause of the factors affecting the individual.In some cases more than one approach may be interpreted. In managing constipation the steps taken are to corroborate rid of any shamion, to establish regular bowl movements that cause no pain for the child and to try to h venerable any further episodes of constipation. for the first time disimpaction of the build up fecal study should be dealt with. There are disparate methods to manage this but usually music will have a corroboratory result without the need for surgical intervention. (NICE 2010). Laxatives are important as first line treatment and should commence as presently as possible (Rogers 2011).Movicol Paediatric airfield (Movicol PP) has been shown to be an effective and safe treatment for children presenting with impaction (Hardikar, 2007). Enemas and rectal suppositories, although effective in treating impaction, are very invasive and can upset the child having a minus effect in trying to nail them to pass stools. These would only be used in cases when all other spoken medication has failed to clear the retained stool. by and by the retained stool has been cleared Movicol PP is often used for month after to help maintain regular bowl movements.The NICE guidelines recommend that this may take several(prenominal) months and in some cases children may require laxative therapy for several years to prevent relapse. Family command is important in the bread and butter of sinewy bowl movements and also education of the child if he or she is old enough. Dietary and behavioral advise can be given to help the parents or guardians to understand why the child has had a problem with passing stools. Dietary changes such as increasing fiber intake and generally maintaining a wellnessy diet is often advised.This as well as encouraging boozinging water regularly is usually advised to prevent dehydration, which can be a cause of constipation. (Rogers 2011). some other important issue t o be address is toileting habits. Toileting after meals should be encouraged and the childs comfortableness on the toilet should also be addressed to reduce straining. Regular achievement can also have a confirmative affect in maintaining healthy bowels. Poor follow up on patients progress is a main indicate for failure in treatment which is why nurses can be invaluable in ensuring success of treatment and management of children with constipation (Burnett et al, 2004).Scott was treated during his stay in hospital with Movicol PP however this in itself presented a problem, as he was very reluctant to drink it because he really didnt like the taste. This was dealt by rewarding him when he drank all of his medication using a spinal column chart as a visual encouragement. Also the nurses would play games with him surrounding crapulence his Movicol to give him a positive heap of inebriation it to try to stop him view about the unpleasant taste.This worked successfully and Scot t was soon drinking it with little encouragement. Scotts stools were monitored to ensure returning o normal and drinking plenty of fluids was encouraged. The nurses tried to educate his parents on why this had happened and how to prevent it happening in the future. When his stools became less painful to pass he became less frightened to use the toilet, his idolise being a main reason of his fecal impaction. Scott although living with both his parents he was normally cared for by his fetch as his father worked offshore so was off for long periods of time. Scott was confident slightly other children in the ward but around his mother became slightly reserved.On discussion with Scott and his mother it was found that she would sometimes get frustrated with him when he wouldnt go to the toilet and when he posed outflow soiling which was something, which was out of his control. This would be a stressful environment for Scott, which could have decline the situation as well as affect h is mental health. Another main factor affecting Scotts health is his diet. He didnt eat as much as he should and when he did eat he would prefer to eat sweets and snacks rather than proper meals.This issue was addressed with his mother. Scott was kept in hospital extended due to child protection issues that were increase by a nurse regarding his mother. These issues were pertinacious but the negative interactions between Scott and his mother would have a serve impact on his mental health. A positive factor influencing Scotts general health was that he was very outgoing and did well in school, which was a boost to his self-esteem. He talked of achievements in school and how well he got on with his classmates.Scott is quite an intelligent boy so educating him on things he could do to help himself not have to experience this problem again was easy to do. Scott proverb his father as a bureau model so he would have a great part to play in Scotts health. His father could hold in him in managing the problem. His family being supportive is important, as punishing Scott for the issues surrounding his constipation would only worsen the problem. Scott got quite emotional and had very negative thoughts surrounding using the toilet. These could be related to early life when he was toilet trained and be a contributing factor to his constipation.