module 4

Constipation in Children

Constipation in children can vary based on whether they are fed with breast milk or formula, which affects the consistency of their stool. Voluntary control of defecation is typically possible at later stages. Constipation is generally not a persistent issue but can be exacerbated by stress. Ex. A child might withhold bowel movements due to stress or discomfort.

Constipation Children Diet

For children, a high-fiber diet, hydration, and probiotics are important in managing constipation. A focus on fluid intake, especially water, and fiber-rich foods will aid bowel function. Ex. Foods like whole grains, fruits, and vegetables will help prevent constipation in children.

Constipation Children S/sx (Symptoms)

Common symptoms of constipation in children include hard, dry stools, straining or pain during bowel movements, abdominal pain or bloating, irritability, withholding behaviors, and decreased appetite. Ex. A child may become fussy and refuse to eat or avoid using the bathroom due to discomfort.

Constipation Children Risk Factors

Children may experience constipation due to diet (e.g., formula feeding or poor nutrition), lack of bowel training, insufficient fluid intake, stress, and embarrassment. Ex. A child who is reluctant to go to the bathroom at daycare may develop constipation due to stress or embarrassment.

Constipation Children Nursing Interventions

The most important interventions for children with constipation include increasing fiber and fluid intake, encouraging probiotics, establishing a regular toilet routine, and offering abdominal massage. Ex. Nurses should help children understand the importance of regular bowel movements and assist in building a comfortable bathroom routine.

Adults Constipation

In adults, constipation is commonly linked to conditions like irritable bowel syndrome (IBS), impaction, and pregnancy. It can be caused by a combination of lifestyle factors and medical conditions. Ex. An adult pregnant woman may experience constipation due to hormonal changes affecting gastrointestinal motility.

Constipation Adults Diet

High-fiber foods (such as whole grains, beans, fruits, and vegetables) and adequate fluid intake are vital in managing constipation in adults. Ex. Encouraging adults to include foods like bran, dried peas, and beans in their diet can prevent constipation.

Constipation Adults S/sx (Symptoms)

Adults with constipation often experience fewer than three bowel movements per week, hard or dry stools, straining, abdominal bloating, discomfort, and rectal pressure. Ex. An adult patient may feel uncomfortable and have difficulty passing stools due to the hardened consistency.

Constipation Adults Risk Factors

Risk factors for constipation in adults include medications (e.g., opioids), lack of fluid intake, stress (both physiological and psychological), irritable bowel syndrome, poor diet, and the use of over-the-counter laxatives. Ex. An adult using opioid pain relievers may develop constipation as a side effect.

Constipation Adults Nursing Interventions

Key nursing interventions for adults include promoting a high-fiber diet, encouraging fluid intake, recommending physical activity, and managing medication use, especially opioids. Ex. Nurses should support adults in choosing fiber-rich foods and ensure they maintain adequate hydration levels.

Elderly Constipation

Constipation is a chronic problem in the elderly, often caused by slowed peristalsis, medications, immobility, poor eating habits, or cognitive impairment. Ex. Older adults may experience constipation due to side effects from multiple medications or difficulty responding to the urge to defecate due to cognitive issues.

Constipation Elderly Diet

For elderly patients, it is essential to encourage a high-fiber, low-fat diet along with adequate fluid intake. Ex. Elderly patients should be encouraged to consume vegetables, fruits, and whole grains while drinking plenty of water to help manage constipation.

Constipation Elderly S/sx (Symptoms)

Symptoms of constipation in elderly individuals include infrequent or difficult bowel movements, hard stools, straining, abdominal discomfort or bloating, decreased appetite, and confusion or delirium in severe cases. Ex. An elderly person may exhibit signs of weakness or confusion due to chronic constipation or fecal impaction.

Constipation Elderly Risk Factors

slowed peristalsis, medications, immobility, inadequate fluid and food intake, cognitive impairment, and a decreased response to the urge to defecate. Ex. An elderly patient with dementia may fail to recognize the need to use the bathroom, contributing to constipation.

Constipation Elderly Nursing Interventions

Encouraging a high-fiber, low-fat diet, ensuring sufficient fluid intake, promoting regular physical activity, and assisting with toileting or toilet training are key interventions for elderly patients with constipation. Ex. Nurses should monitor for signs of fecal impaction and encourage elderly patients to follow a consistent toileting schedule.

Pharmacology - Laxatives/Stool Softeners

Laxatives and stool softeners are commonly used to treat constipation. Examples include osmotic laxatives like Milk of Magnesia, bulk-forming agents like Metamucil, and stimulant laxatives like Bisacodyl and Senna. Ex. These medications are usually taken in the morning to encourage bowel movement after breakfast and a regular poo routine

Osmotic laxatives

such as Milk of Magnesia, pull water into the colon to soften stools.

Bulk-forming agents

like Metamucil increase peristalsis by absorbing water into the intestines.

Stimulant laxatives

like Bisacodyl irritate the intestinal wall to promote movement

Emollient stool softeners

like Colace help soften the stool

Constipation Non-Pharmacological Interventions

increasing fiber intake, drinking more fluids, physical activity, abdominal massage, and regular toilet training. Ex. Encouraging an elderly patient to engage in regular walking and offering warm baths can assist in easing constipation symptoms.

Risk for all ages when having Diarrhea

High risk of dehydration and electrolyte imbalance.

Diarrhea Children Causes

Viruses, bacteria, food intolerance, teething, antibiotics, allergies. Ex. Antibiotics can disrupt gut bacteria and cause diarrhea.

Diarrhea Children Signs

Loose stools, dry mouth, sunken eyes, fewer wet diapers. Ex. Dehydration signs in children include fewer wet diapers.

Diarrhea Children Interventions

Give oral rehydration (Pedialyte), monitor for dehydration, teach handwashing and food safety. Ex. Ensure hand hygiene to prevent infections.

Diarrhea Adults Causes

Food poisoning, allergies, stress, infections, medications. Ex. Food poisoning can cause diarrhea as the body expels toxins.

Diarrhea Adults Signs

Cramping, urgency, weakness, dizziness, loose stools. Ex. Abdominal bloating and cramps are common in adults.

Diarrhea Adults Interventions

Encourage fluids, bland diet (BRAT), rest, monitor for bloody stools. Ex. Avoid caffeine and dairy to reduce irritation.

Diarrhea Elderly Causes

Infections, medications, chronic illnesses, food poisoning. Ex. Diuretics can lead to dehydration and diarrhea in the elderly.

Diarrhea Elderly Signs

Weakness, confusion, dizziness, dry skin, loose stools. Ex. Confusion and weakness may signal dehydration.

Diarrhea Elderly Interventions

Small sips of fluids, nutrient-rich foods (soup, toast), monitor for falls. Ex. Encourage hydration to prevent confusion and falls.

Antidiarrheal Medications

Lomotil, Immodium (anti-motility), Kaopectate (absorbent), Probiotics. Ex. Lomotil slows intestinal movement for relief.

Diarrhea Non-Pharmacological Treatment

Hydration, BRAT diet, avoid irritants (dairy, spicy foods). Teach handwashing and food safety.

Children with UTIs are at risk for

At risk for kidney damage, sepsis, dehydration, and electrolyte abnormalities. Ex. An untreated UTI in children can lead to kidney damage.

UTI Children Causes

Low fluid intake, excessive sugary foods and drinks, low fiber, high caffeine. Ex. A diet high in sugary drinks can contribute to UTIs in children.

UTI Children Signs

Dysuria, frequent urination, cloudy urine, hematuria, foul-smelling urine, lower abdominal pain, unexplained fever. Ex. Cloudy urine and fever in children may indicate a UTI.

UTI Children Risk Factors

Diabetes, uncircumcised, female genitalia, bubble baths, improper wiping, holding bladder, catheterization, cystoscopy. Ex. Bubble baths can increase the risk of UTIs in girls.

UTI Children Interventions

Ensure hydration with water, fruit juices, cranberry juice, yogurt. Ex. Encourage water intake to flush out bacteria.

Adults with UTI are at risk for

Risk of kidney damage, scarring, recurrent UTIs, and urethral narrowing in men. Ex. Recurrent UTIs may lead to kidney scarring in adults.

UTI Adults Causes

Low fluid intake, excessive sugary foods and drinks, low fiber, high caffeine, alcohol, high-protein diet. Ex. A high-protein diet can irritate the urinary tract and increase UTI risk.

UTI Adults Signs

Dysuria, hesitation to urinate, urgency, hematuria, frequency, low back pain, cloudy urine. Ex. Cloudy urine and urgency to urinate are common UTI symptoms in adults.

UTI Adults Risk Factors

Sexual intercourse, menopause, pregnancy, diabetes, diaphragm use, urine flow obstructions, improper hygiene, catheterization, cystoscopy. Ex. Menopause increases UTI risk due to reduced estrogen levels and dryness

UTI Adults Interventions

Encourage hydration with water, herbal teas, unsweetened cranberry juice, probiotic-rich foods. Ex. Drinking cranberry juice can help prevent UTIs.

Elderly with UTIs are at risk for

Risk of kidney damage, sepsis, confusion, delirium, increased hospitalization, and general decline in function. Ex. UTIs in elderly can lead to confusion or delirium.

UTI Elderly Causes

Medications, high dairy intake, low fiber, excessive sugar intake, inadequate fluid intake. Ex. Dehydration due to low fluid intake increases UTI risk in the elderly.

UTI Elderly Signs

Dysuria, cloudy urine, frequency, low abdominal pressure, confusion, agitation, lethargy, hypotension, tachycardia, dizziness. Ex. Confusion and low blood pressure are red flags for UTIs in elderly patients.

UTI Elderly Risk Factors

Increased bacteriuria, cognitive impairment, chronic conditions, immobility, immunocompromised, incomplete bladder emptying, obstructed urine flow, post-menopausal, diabetes, catheterization. Ex. Diabetes and catheterization increase the risk of UTIs in elderly patients.

UTI Elderly Interventions

Encourage coconut water, cranberry supplements, probiotic supplements. Ex. Probiotics can help restore normal flora and prevent UTIs.

UTI meds Pharmacology

Azo (analgesic, turns urine orange), Macrodantin, Bactrim (urinary antiseptic/antibiotic). Ex. Bactrim is often prescribed to treat UTIs.

UTI Non-Pharmacological treatment

Catheter Care- Assess indwelling catheters each shift and request removal if not needed. Ex. Minimize catheter use to reduce infection risk. Hygiene Education- Instruct on proper hygiene and voiding immediately after sexual intercourse. Ex. Proper wiping techniques can prevent UTIs. Hydration- Ensure adequate fluid intake, especially cranberry juice. Ex. Hydration helps flush bacteria from the urinary tract.

Urge Incontinence Definition

Involuntary loss of urine associated with a strong urge to urinate that cannot be suppressed. Ex. An individual feels an overwhelming need to urinate but cannot reach the toilet in time.

Urge Incontinence Causes

Can be caused by neurologic conditions. Ex. Neurological disorders like stroke may lead to urge incontinence.

Urge Incontinence S/S

Inability to reach the toilet despite knowing the need to urinate. Ex. A person may wet themselves due to an intense urge they can't control.

Urge Incontinence Nursing Concept

Elimination, skin integrity, pain, fluid and electrolytes, absorbent pads, possible catheterization. Ex. Ensure skin integrity when absorbent pads are used for incontinence.

Urge Incontinence Interventions

Transvaginal or transrectal electrical stimulation, pelvic floor therapy, Kegel exercises, bladder training, anticholinergic or antispasmodic medications. Ex. Pelvic floor therapy helps improve muscle control.

Stress Incontinence Definition

Involuntary urination during activities that increase intra-abdominal pressure. Ex. Coughing or sneezing can trigger stress incontinence.

Stress Incontinence Causes

Weak pelvic floor muscles or weak structural support of the pelvis, enlarged prostate in men, obesity, childbirth. Ex. Childbirth can weaken pelvic muscles and cause stress incontinence.

Stress Incontinence S/S

Urination during laughing, coughing, or sneezing, bladder distension, pain. Ex. A person may experience leakage when sneezing due to weak pelvic floor muscles.

Stress Incontinence Nursing Concept

Elimination, skin integrity, pain, fluid and electrolytes. Ex. Address skin integrity issues due to frequent leakage and irritation.

Stress Incontinence Interventions

Pelvic floor physical therapy, Kegel exercises to strengthen muscles. Ex. Kegel exercises help strengthen pelvic muscles to reduce leakage.

Urinary Retention Definition

Difficulty or inability to empty the bladder fully. Ex. A person cannot urinate completely, even when feeling the need.

Urinary Retention Causes

Obstruction of the urinary tract, blockage (e.g., enlarged prostate), nerve damage, weakened muscles, medications, surgery, anesthesia, childbirth. Ex. An enlarged prostate in men can obstruct the urinary tract and cause retention.

Urinary Retention S/S

Difficulty urinating, weak or interrupted urine stream, pressure in the bladder, lower abdominal pain, frequent urination in small amounts. Ex. A person may experience pain due to a full bladder and the inability to urinate fully.

Urinary Retention Nursing Concept

PRV measurement, bladder scan, physical exam, assess for pain, inquire about medical history, urinary patterns, medications, potential causes. Ex. A bladder scan can measure urine retention and guide treatment.

Urinary Retention Interventions

Bladder training, medications, catheters, educate the patient on fluid intake and urinary retention signs. Ex. Bladder training and catheterization may be necessary for managing retention.

Musculoskeletal

Bone pain, bow legs, muscle wasting due to vitamin D, calcium, protein, carbohydrate, and fat deficiencies. Ex. A child with vitamin D deficiency may develop bow legs and muscle wasting.

Neurologic

Can lead to cognitive decline, fatigue, memory issues, mood disorders, and nerve problems (tingling or numbness) due to malnutrition and B12 deficiency. Ex. Malnutrition can result in impaired motor skills and cognitive decline.

Cardiopulmonary

Cardiac enlargement, tachycardia, abnormal blood pressure due to poor nutrition. Ex. Malnutrition can lead to an increased heart rate and irregular blood pressure.

Digestive System

Delayed intestinal development, gastric emptying, absorption decrease, and enlarged liver or spleen from poor nutrition. Ex. Malnutrition may cause delayed digestion and organ enlargement.

Metabolic Alterations

Reduced energy, fat accumulation, muscle wasting, impaired thyroid function, and insulin resistance due to malnutrition. Ex. A lack of protein can lead to muscle wasting and low energy.

Psychological

Nutritional deficiencies hinder brain development, leading to depression, anxiety, and cognitive issues. Ex. A child with malnutrition may show signs of depression and difficulty learning.

Clear Liquid Diet

A diet consisting of clear, transparent liquids intended to hydrate, prevent dehydration, or allow the GI system to heal post-surgery. Ex. Jello, coffee (no creamer), tea, popsicles, clear broth, sprite, ginger-ale.

Full Liquid Diet

A diet consisting of any liquid or foods that can be consumed without chewing at room temperature. This includes creamed soups, broths, jelly, pudding, milk, and nutritional supplements. Typically for patients with difficulty swallowing or post-surgical recovery.

Pureed Diet

A diet consisting of liquid and/or pureed foods. Includes all food types in liquid or pureed form. This diet is used for patients with dysphagia (from stroke or head injury) or those recovering from oral or facial surgery. Ex. Mashed potatoes, applesauce, smoothies.

Mechanical Soft Diet

A diet consisting of soft foods that require minimal chewing, often used for patients with difficulty chewing. Can involve pureeing or offering soft foods like potatoes, oatmeal, pudding, or ground meat. Ex. Soft foods for dysphagia, mouth sores, or oral/facial surgery recovery.

Thickened Liquids

Liquids that have been thickened to make swallowing easier and to prevent aspiration or choking. Used for patients with swallowing issues. Ex. Applesauce, mashed potatoes, thickened milk, rice, custard, pudding, gelatin.

Diabetic Diet (ADA)

A diet focused on whole, unprocessed foods and avoiding sugary foods and drinks. It includes limiting saturated/trans fats while prioritizing healthy fats and high-protein foods. Ex. Lean meats, vegetables, whole grains. Aims to prevent diabetic episodes.

Cardiac Diet

A diet designed to reduce the risk of heart disease by managing atherosclerosis, hypertension, and other related conditions. Includes the DASH diet, which emphasizes fruits, vegetables, whole grains, low-fat dairy, nuts, and limited red meat, sodium, and unhealthy fats. Plant-based diets can also help lower CVD risk.

Renal Diet

A diet aimed at slowing kidney damage, especially for those with acute kidney injury or chronic kidney disease. The diet restricts sodium, protein, potassium, and phosphorus. Fluid intake is monitored. Ex. Cabbage, apples, cranberries, seasoning oils, lean meats, eggs, and fish. No bananas, and care with protein intake.

DASH Diet

A diet aimed at stopping hypertension, focusing on low-sodium, low-processed foods, and high intake of fruits, vegetables, whole grains, and lean proteins.

Simple Carbs

Carbohydrates that provide quick energy and cause rapid spikes in blood sugar. These include sugars and are found in foods like fruit and milk. Ex. Sugar, fruit, milk.

Complex Carbs

Carbohydrates that are digested more slowly and provide sustained energy. These are often higher in fiber and nutrients. Ex. Whole grains, brown rice, starchy vegetables. Diabetics should focus on complex carbs to manage blood sugar.

Colonoscopy

A procedure using a fiber optic-light scope to examine the large intestines from the anus to the ileocecal valve. Purpose- To detect changes, polyps, or swelling in the large intestine and rectum. Typically done every 5 years starting at age 40. Nursing Interventions- Low-residue diet followed by clear liquid diet 48 to 72 hours before, avoid red, purple, or orange foods, take laxatives 24 hours before, check vital signs, observe for signs of abdominal pain, rectal bleeding, fever, and dehydration. Teaching- Before - Special diet, laxatives, procedure, sedation. After - Rest, have someone drive home, small blood in the first bowel movement, movement to reduce bloating or gas, and rehydrate.

Occult Blood

Small amounts of blood in the stool that are not visible to the naked eye and are detected through testing. Nursing Interventions- Monitor stool for blood, assess risk factors like ulcers, administer medications if necessary, monitor vital signs for bleeding, prepare for further diagnostic tests. Teaching- Explain the test, advise on dietary restrictions, watch for black stools or vomiting blood, follow-up care is essential.

Guaiac/Hemoccult Test

A test used to detect hidden blood in the stool using a special card that reacts with blood. Nursing Interventions- Collect stool sample properly, ensure correct technique to avoid contamination, interpret results, communicate with healthcare provider, monitor for symptoms of active bleeding if test is positive. Teaching- Explain the procedure, follow dietary restrictions, follow-up may be needed for further testing if positive, recognize signs of bleeding.

G-Tube (Gastrostomy Tube)

A tube inserted through the abdominal wall directly into the stomach. Uses- Long-term nutritional support for patients who cannot swallow, have neurological disorders, or have esophageal obstructions. Medications- Liquid medications are preferred, or crushed tablets (only if approved) mixed with water.

J-Tube (Jejunostomy Tube)

A feeding tube inserted into the jejunum, a part of the small intestine. Uses- For patients with swallowing difficulty, chronic aspiration risk, pancreatitis, or gastric dysfunction. Medications- Only liquid, finely crushed, or well-dissolved medications are allowed to prevent clogging. Time-release medications should not be given. Always flush the tube before and after administering medication.

PEG Tube (Percutaneous Endoscopic Gastrostomy Tube)

A flexible feeding tube inserted through the abdominal wall into the stomach, typically placed using an endoscope. Uses- Long-term nutrition, hydration, and medication delivery for individuals unable to swallow. Medications- Liquid form or properly crushed and dissolved, avoiding extended-release or coated pills.

Bladder Scan

A non-invasive procedure to assess bladder volume and determine urinary retention without catheterization. Purpose- To assess bladder volume and check for urinary retention. How it's performed- Patient lies supine, apply ultrasound gel to lower abdomen, place probe above the pubic symphysis, adjust scanner for male or female mode, obtain bladder volume reading. Nursing Interventions & Patient Teaching- Before - Explain that it's non-invasive and painless, ask patient to void if possible before the scan. After - Discuss results, educate on signs of urinary retention (dribbling, frequency, incomplete emptying).

Bladder Ultrasound

A non-invasive test used to measure urine volume and identify conditions like bladder stones, masses, or UTIs. Purpose-To measure urine volume and identify bladder issues such as stones or tumors. Interventions- Ensure patient has a full bladder (unless contraindicated), have them lie supine, and monitor pain levels. Pt Education- Drink fluids before the procedure, educate on the painless nature of the procedure, and explain the need to lie supine during the scan.

Urine for C & S (Culture and Sensitivity)

A test to detect pathogenic microorganisms in the urine that could indicate a UTI. Purpose- To detect and identify microorganisms indicating a UTI. Before- Instruct on clean-catch method to avoid contamination, educate on cleaning genital area, and inform patient to avoid urinating immediately before the test. Collection- Patient cleans genital area, begins to urinate, then collects a midstream sample in a sterile container. Nursing Interventions- Ensure proper clean-catch collection. After- Discuss possible further tests or treatments, emphasize completing prescribed antibiotics, and tell patients to report worsening symptoms.

Normal BUN and creatinine levels

BUN - 7 to 20 mg/dL and Creatinine - 0.6 to 1.2 mg/dL

Increased BUN

20+ may indicate impaired renal function(shock, heart failure, salt and water depletion), diabetic ketoacidosis, burns.

Increased Creatinine

1.2+ may indicate impaired renal function, heart failure, shock, fluid volume deficit.

BUN high and Creatinine normal

Dehydration

Creatine high and BUN normal

Kidney dysfunction or damage

Creatine and BUN high

kidney damage or disease

24-hour Urine

Purpose - To measure the amount of certain substances in urine over 24 hours to help diagnose kidney disease. Before Collection- Explain test purpose, discard first urine, drink water throughout the day, collect all urine over 24 hours, start over if urine is missed. Nursing Interventions- Provide clear instructions, ensure understanding of collecting all urine, assist with difficulties, ensure proper labeling/storage. After Collection- Inform patient on how long it takes to get results.

Indwelling Catheter

Purpose - A closed sterile system catheter inserted through the urethra to drain urine into an external bag. Ex. Used for urinary incontinence, retention, or surgery. Pre-care- Place patient in supine position, use aseptic technique, inflate balloon (10 mL sterile water). Ex: Inflate balloon to hold catheter in bladder. Post-care- Ensure drainage bag is below bladder, clean perineal area and catheter daily, check for infection, empty bag regularly. Removal- Deflate balloon, withdraw catheter, monitor for retention, encourage fluid intake.

Condom Catheter

Purpose - External urinary collection system shaped like a condom, used for urine collection. Applied 1-2 inches above penis, urine drains into connected bag. Pre-care- Remove daily for cleaning, check for irritation. Removal- Roll down sheath to remove.