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Example Nursing Diagnosis for Constipation / Encopresis
- Constipation: This diagnosis directly addresses the issue of constipation, including its causes, contributing factors, and interventions to promote regular bowel movements.
- Risk for Impaction: Chronic constipation can lead to fecal impaction. This diagnosis highlights the risk and the need for preventive measures.
- Deficient Knowledge: Some patients may lack knowledge about healthy bowel habits and factors contributing to constipation. This diagnosis addresses the educational needs of the patient.
Transcript
Hey, you guys, in this care plan, we're going to be discussing constipation and encopresis. What we're going to cover in this care plan is a description of the diagnoses, the subjective and objective data related to them, and then your nursing interventions and rationales.
Alright, so constipation is actually a really common problem for children and this is especially true for our toddlers and preschoolers. So, you're looking at kids from the age of one up to probably around five years of age. And this is because during this age range, they are toilet training. They're learning how to not be picky eaters and all these things combined, make them at increased risk for constipation. By definition, constipation is when a child has less than two or three bowel movements per week and typically, the stools are going to be very hard and dry and difficult to pass. Sometimes, they can actually be so large that they block the toilet. I know that's difficult to imagine for these tiny people, but it is true. Now, if it becomes really, really bad, the child may experience something called encopresis. Encopresis is when the child involuntarily passes stool into their underwear and you can read a little bit more about how these things happen in our etiology section here.
So, our number one goal for a patient who has constipation or encopresis is for them to experience a normal bowel pattern. We want them to have soft form, easy-to-pass stools. A second goal that we would have here is to have decreased anxiety. These children can really get worked up and have a lot of difficulties with this and that just creates a really bad cycle for them where they continue to get constipated because they keep having anxiety, so we really want to work to break that cycle.
Alright, let's get started by looking at the specifics of our care plan. We'll start with the subjective data here. So, one of the major things that you're going to see in children with constipation is abdominal pain and sometimes, that pain can be really severe and it can actually decrease their level of activity. Sometimes parents notice that the pain kind of comes and goes, and this is especially true around mealtime. You can see something that would link to that in a bit, but you'll also see that it has a loss of appetite as a consequence. So, you may see children that are eating less because of this pain around mealtime. Other subjective data is that they may experience pain. We may notice that they are avoiding bowel movements, especially in public and then for some of our girls with constipation, they may have repeat bladder infections.
The objective data that's associated with this diagnosis is first, those large dry stools that we mentioned and then again, thinking about how many bowel movements they're having per week, so it's less than three. Then sometimes if they have continual issues with this, they may develop anal fissures. If that happens, they may notice that there's blood on the surface of the stool, or they notice that when they're wiping, it's typically bright red blood. And again, in severe situations, they may experience bedwetting or even daytime wetting. Now, let's take a look at our interventions and rationales. So, the very first thing that you want to do is just really talk to the parents. You need to talk to them and obtain a medical and bowel history to sort of find out what a potential cause might be. We need to know why these children are experiencing this. So, some common causes to be on the lookout for are medications. Some common ones that you may see are like iron. Iron is going to potentially cause constipation and then, some of our anti-seizure medications as well. You also want to be aware of some really concerning neurological causes. So, thinking about things like spina bifida and then Hirschsprung's disease is another one to be aware of. That may present at birth with a delayed meconium. The most common cause of constipation in kids is something that we call functional constipation and because of that, it's really important to ask families about their bowel habits, about toilet training and diet, because that's what functional constipation is. It just means that it's caused by lifestyle things like diet and activity.
Then you want to move on to really assess the abdomen and the main things that you want to do are first, to look for abdominal distension. Secondly, you want to listen to bowel sounds and then third, you want to palpate and feel for any kind of palpable mass. Now, what you're looking for here is often that if you feel a palpable mass on the left side, that is usually indicative of constipation. Next, you want to assess the patient's vital signs. If the child is in a lot of pain, you may notice an increase in heart rate and an increase in respiratory rate as well. In more severe situations, if the constipation has led to something like a bowel perforation, you want to be on the lookout for signs of shock. So, the things you want to be looking for there are, again, increased heart rate, increased respiratory rate, and then delayed capillary refill time, and eventually, decreased blood pressure.
To continue our assessment, we want to make sure that we assess the anus and rectum for any signs of bleeding and when we're doing this, we're thinking about the possible complications like fishers and rectal bleeding. So when you take that history from the parent, we need to talk to the parent and find out if they have seen any bright red bleeding in the stool or even on the toilet paper when the child is wiping, then need to assess the anus and rectum and just look for signs of bleeding, because remember these need to be treated because we don't want them to get infected. Medications that you are going to expect to see in a child that's constipated are your stool softeners and laxatives, suppositories and enemas may be given if there is a fecal impaction and if constipation becomes a chronic problem. Stool softeners, and laxatives may be given on a daily basis to help prevent that. Oftentimes, that is a really good way to help break that cycle of anxiety that we talked about by making sure that we can relieve the pain and the child becomes comfortable with that process. Again, a really practical thing that we can do for parents is to encourage them to give their child a warm tub bath. These are very easy ways for a parent to step in and do something. It helps relax the smooth muscle in the rectum and suit the perineal area, and just makes the child more comfortable and reduces their anxiety.
Our last intervention here is super, super important. So we really want to make sure that we take time to educate parents on this. Like I said, most of the time, the issues for constipation are functional. So again, it's about bowel habits, toilet training and diet. So our last intervention here is about making sure parents know about lifestyle modifications that they can make for their child. Important things to get across to them are the importance of decreasing sugar and processed food. They need to avoid excess dairy, which can contribute to that and encouraging exercise and making sure that the child stays well hydrated are going to go a really long way to helping prevent constipation. Really getting them into a routine is going to allow them to be comfortable and not avoid this problem.
Okay, that's it for our care plan on constipation and encopresis. Remember we love you guys. Go out and be your very, very best self today and as always, happy nursing!
Alright, so constipation is actually a really common problem for children and this is especially true for our toddlers and preschoolers. So, you're looking at kids from the age of one up to probably around five years of age. And this is because during this age range, they are toilet training. They're learning how to not be picky eaters and all these things combined, make them at increased risk for constipation. By definition, constipation is when a child has less than two or three bowel movements per week and typically, the stools are going to be very hard and dry and difficult to pass. Sometimes, they can actually be so large that they block the toilet. I know that's difficult to imagine for these tiny people, but it is true. Now, if it becomes really, really bad, the child may experience something called encopresis. Encopresis is when the child involuntarily passes stool into their underwear and you can read a little bit more about how these things happen in our etiology section here.
So, our number one goal for a patient who has constipation or encopresis is for them to experience a normal bowel pattern. We want them to have soft form, easy-to-pass stools. A second goal that we would have here is to have decreased anxiety. These children can really get worked up and have a lot of difficulties with this and that just creates a really bad cycle for them where they continue to get constipated because they keep having anxiety, so we really want to work to break that cycle.
Alright, let's get started by looking at the specifics of our care plan. We'll start with the subjective data here. So, one of the major things that you're going to see in children with constipation is abdominal pain and sometimes, that pain can be really severe and it can actually decrease their level of activity. Sometimes parents notice that the pain kind of comes and goes, and this is especially true around mealtime. You can see something that would link to that in a bit, but you'll also see that it has a loss of appetite as a consequence. So, you may see children that are eating less because of this pain around mealtime. Other subjective data is that they may experience pain. We may notice that they are avoiding bowel movements, especially in public and then for some of our girls with constipation, they may have repeat bladder infections.
The objective data that's associated with this diagnosis is first, those large dry stools that we mentioned and then again, thinking about how many bowel movements they're having per week, so it's less than three. Then sometimes if they have continual issues with this, they may develop anal fissures. If that happens, they may notice that there's blood on the surface of the stool, or they notice that when they're wiping, it's typically bright red blood. And again, in severe situations, they may experience bedwetting or even daytime wetting. Now, let's take a look at our interventions and rationales. So, the very first thing that you want to do is just really talk to the parents. You need to talk to them and obtain a medical and bowel history to sort of find out what a potential cause might be. We need to know why these children are experiencing this. So, some common causes to be on the lookout for are medications. Some common ones that you may see are like iron. Iron is going to potentially cause constipation and then, some of our anti-seizure medications as well. You also want to be aware of some really concerning neurological causes. So, thinking about things like spina bifida and then Hirschsprung's disease is another one to be aware of. That may present at birth with a delayed meconium. The most common cause of constipation in kids is something that we call functional constipation and because of that, it's really important to ask families about their bowel habits, about toilet training and diet, because that's what functional constipation is. It just means that it's caused by lifestyle things like diet and activity.
Then you want to move on to really assess the abdomen and the main things that you want to do are first, to look for abdominal distension. Secondly, you want to listen to bowel sounds and then third, you want to palpate and feel for any kind of palpable mass. Now, what you're looking for here is often that if you feel a palpable mass on the left side, that is usually indicative of constipation. Next, you want to assess the patient's vital signs. If the child is in a lot of pain, you may notice an increase in heart rate and an increase in respiratory rate as well. In more severe situations, if the constipation has led to something like a bowel perforation, you want to be on the lookout for signs of shock. So, the things you want to be looking for there are, again, increased heart rate, increased respiratory rate, and then delayed capillary refill time, and eventually, decreased blood pressure.
To continue our assessment, we want to make sure that we assess the anus and rectum for any signs of bleeding and when we're doing this, we're thinking about the possible complications like fishers and rectal bleeding. So when you take that history from the parent, we need to talk to the parent and find out if they have seen any bright red bleeding in the stool or even on the toilet paper when the child is wiping, then need to assess the anus and rectum and just look for signs of bleeding, because remember these need to be treated because we don't want them to get infected. Medications that you are going to expect to see in a child that's constipated are your stool softeners and laxatives, suppositories and enemas may be given if there is a fecal impaction and if constipation becomes a chronic problem. Stool softeners, and laxatives may be given on a daily basis to help prevent that. Oftentimes, that is a really good way to help break that cycle of anxiety that we talked about by making sure that we can relieve the pain and the child becomes comfortable with that process. Again, a really practical thing that we can do for parents is to encourage them to give their child a warm tub bath. These are very easy ways for a parent to step in and do something. It helps relax the smooth muscle in the rectum and suit the perineal area, and just makes the child more comfortable and reduces their anxiety.
Our last intervention here is super, super important. So we really want to make sure that we take time to educate parents on this. Like I said, most of the time, the issues for constipation are functional. So again, it's about bowel habits, toilet training and diet. So our last intervention here is about making sure parents know about lifestyle modifications that they can make for their child. Important things to get across to them are the importance of decreasing sugar and processed food. They need to avoid excess dairy, which can contribute to that and encouraging exercise and making sure that the child stays well hydrated are going to go a really long way to helping prevent constipation. Really getting them into a routine is going to allow them to be comfortable and not avoid this problem.
Okay, that's it for our care plan on constipation and encopresis. Remember we love you guys. Go out and be your very, very best self today and as always, happy nursing!
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