Question

A nurse is taking a health history of a newly admitted patient with a diagnosis of possible fecal impaction. Which question is the priority to ask the patient or caregiver? a. Have you eaten more high-fiber foods lately? b. Have you taken antibiotics recently? c. Do you have gluten intolerance? d. Have you experienced frequent, small liquid stools recently?

Short answer

The priority question to ask is 'd. Have you experienced frequent, small liquid stools recently?'

Step-by-step solution

Understand Fecal Impaction

Fecal impaction occurs when a large, hard mass of stool gets stuck in your digestive tract and cannot be passed. It often causes symptoms like abdominal pain and constipation.

Identify the Priority Question

When dealing with fecal impaction, it is important to ask about symptoms that are directly associated with this condition. The priority question should aid in confirming the diagnosis and help determine the urgency of the situation.

Evaluate the Answer Choices

Assess each answer choice to determine which one is most relevant to the symptoms of fecal impaction. Liquid stools can leak around the impaction, which is a characteristic symptom of fecal impaction.

Select the Priority Question

The priority question to ask would be about frequent, small liquid stools because this symptom is indicative of 'overflow' diarrhea, which can occur with fecal impaction.

Key concepts

Health History Taking

Health history taking is a systematic method used by nurses and healthcare professionals to gather comprehensive information about a patient's overall health, medical history, and current symptoms. The process is particularly important in identifying conditions like fecal impaction. For a patient with suspected fecal impaction, the nurse's inquiry would delve into their bowel habits, diet, activity level, medication usage, and present symptoms. During this process, questions are aimed to uncover patterns or changes that might have contributed to the condition. For instance, asking about diet can reveal if a patient's fiber intake has recently changed, which could affect bowel movements.

When assessing a patient's health history, consider:

• The frequency and nature of bowel movements to identify deviations from normal patterns.
• Dietary habits, particularly related to fiber and fluid intake.
• Use of medications that could affect bowel motility, such as narcotics or anticholinergics.
• Previous abdominal surgeries or conditions that might impact bowel function.

Effective health history taking is the foundation for formulating a robust nursing diagnosis and tailoring patient-centered care.

Nursing Diagnosis

The nursing diagnosis for fecal impaction involves evaluating data collected during the health history taking and physical assessment to identify probable causes and complications related to the patient's condition. It is a clinical judgment about the patient's response to health conditions or life processes.

A nursing diagnosis for fecal impaction may include:

• Constipation related to decreased bowel motility secondary to opioid use.
• Risk for electrolyte imbalance related to chronic laxative use.
• Improper diet or fluid intake as evidenced by dry, hard stools.
• Ineffective health maintenance related to lack of knowledge about constipation prevention strategies.

Each potential diagnosis helps nurses focus on specific patient needs and drives interventions aimed at restoring normal bowel function and preventing future episodes of impaction.

Patient Symptoms Interrogation

Patient symptoms interrogation is a key aspect of the assessment process. It involves asking targeted questions to gather detailed information about the patient's current experience of symptoms and signs of fecal impaction.

Detailed interrogation might include questions such as:

• How long has the patient been experiencing symptoms?
• What is the nature of any abdominal pain or discomfort?
• Are there any accompanying symptoms such as nausea, vomiting, or bloating?
• Has the patient noticed any changes in the size, shape, or consistency of stools?

The goal is to identify specific symptoms that correlate with fecal impaction, such as frequent, small liquid stools which may suggest 'overflow' diarrhea—a condition that arises when liquid stool leaks around an impacted mass. This thorough interrogation assists healthcare professionals in prioritizing interventions and further diagnostic procedures.

Constipation Management

Constipation management is crucial for patients with fecal impaction. It involves both immediate interventions to alleviate the current impaction and long-term strategies to prevent recurrence. Initial treatments may include manual disimpaction, enemas, or oral medications to soften the stool and promote movement through the colon.

Long-term management focuses on:

• Diet modification to include more high-fiber foods and fluids to ensure proper stool consistency and bowel motility.
• Encouraging regular exercise, which can help stimulate intestinal activity.
• Reviewing and potentially altering medications that may cause constipation as a side effect.
• Education on bowel habits, such as responding to the urge to defecate and allocating ample time for bowel movements.

Effective constipation management is essential to alleviate the discomfort associated with fecal impaction and to enhance the overall quality of life for the patient.