An older adult is admitted through the emergency department with ...

[tingc95]

An older adult is admitted through the emergency department with complaints of nausea, abdominal tenderness, and continual stooling.
 
  On assessment, the nurse notes abdominal distention, smearing of stool on undergarments, and hypoactive bowel sounds LUQ and LLQ. The patient is unable to determine when the last bowel movement was. What is the nurse's priority assessment?
  a. Signs and symptoms of an infection
  b. An impaction
  c. A pattern of laxative abuse
  d. History of GI disease

Question 2

A patient is receiving morphine for pain control. What will the nurse emphasize about preventing constipation?
 
  a. Adequate hydration consists of four full glasses of water every day.
  b. Laxatives should be given on a daily basis.
  c. Stool softeners are taken on a regular basis during opioid use.
  d. Enemas should be given on a weekly basis.

[tmlewis4706]

Answer to Question 1

ANS: B
A nursing priority is to determine basic needs such as last bowel movement, constipation, and pain control. The symptoms presented do not indicate an infection as a priority. Frequent stooling indicated by the history and smearing on the undergarments are signs of an impaction, or an area of hardened stool. Laxative abuse or a history of GI disease may be contributing factors that the health care provider will review. Although the patient may have an infection or history of GI disease, checking for an impaction is a higher priority because it is done more quickly and is more likely to yield results. These symptoms are not characteristic of laxative abuse.

Answer to Question 2

ANS: C
When codeine or morphine is used regularly for pain control in cancer patients, it is imperative that the individual know that stool softeners should be initiated and continued as long as constipating medicines are being taken. Although adequate hydration is important in the prevention of constipation, individual needs vary, and hydration alone cannot prevent constipation related to opioid use. Laxatives are too harsh to be given regularly unless specifically ordered by the health care provider. Enemas are not a preventive measure but an intervention intended to produce a more positive outcome.