Nursing Constipation Essay Essay

For the purpose of this assignment I have changed the elect patients name to Scott to support patient confidentiality (Nursing & Midwifery Council 2004). Scott is a young male child that is 7 prospicient time of age who hang ins at home, in the suburbs of Aberdeen, with his find out down and father and has no siblings. His m otherwise is unemployed and father works inshore so is ofttimes not at home for long periods of time. Scott was admitted to infirmary after having not had whatsoever arena movements for a week and the preceding week having only passed two draws. He reported pain whilst he passed these stools along with anal bleeding.This was not the prime(prenominal) time he had been admitted to hospital with these symptoms in the past year. These symptoms lead to his diagnoses of suffering from chronic unregularity. It was found that in that location were no underlying organic causes for his harm. The modern diet of children, with a overleap of fibre, basis be t he cause of disablement (SULLIVAN, P. B. et al, 2006). This could be true in Scotts case as he is fussy with what foods he grub which may be a contri exactlying gene to his constipation.Constipation is in truth common throughout childhood and constipation is internationally reported to feign 0. % to 36% of children (Smith and Derrett 2006). Many factors privy influence constipation in children much(prenominal) as pain, dehydration, issues with cloaca training, dietary and fluid intake and history of constipation within their families (NICE GUIDELINES). There are many symptoms for constipation and these can transfigure slightly in infants and children. When assessing constipation it is principal(prenominal) that any more unsafe underlying causes are ruled out such as Hirschprungss disease, Cystic fibrosis, metabolic causes, heavy-metal poisoning or sexual abuse.This is because normal give-and-take for constipation in these cases go away not always be the first course of a ction. Constipation that has no organic cause or cannot be explained by any physiological abnormalities is described as idiopathic constipation. This is nearly always the diagnosis in children over the age of one (Biggs and Dery 2006). When assessing a child with constipation a discussion with the parents or guardians and child will help collect information. give away patterns should be discussed (NICE 2010).Less than 3 proper(ip) stools per week, overflow soiling, odour more unpleasant that normal, rabbit dropping fibre stools or large infrequent stools are symptoms which should be noted. The Bristol Stool chart can be used to help assess stool patterns as it classifies stool into 7 types with types 4 and 5 be normal and types 1 3 suggesting constipation. Distress, pain and straining whilst passing stools are also important in assessing constipation. The NICE guide nisuss state that if two or more of the former symptoms are found then the child is to be diagnosed with cons tipation.Any prior medical history should also be addressed, like in Scotts case, as his most recent stay in hospital was the endorse time in the past year that he had been admitted to hospital for constipation. in like manner diet should be discussed as a diet low in fiber can have a major impact and be a cause of constipation. Any family history in relation to constipation should be discussed. A physical examination can also be used to help assess the business and would help in discovering any red flags that could indicate that the constipation would require further investigation.The NICE guidelines also outline methods of assessing the problem that shouldnt be carried out. Scott was assessed exploitation the aforementioned methods. commencement his preceding medical history was discussed. This uncovered 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 passin g stools over the previous weeks and he found it very painful which lead to him turn ining to exclude using the toilet. This avoidance of passing stools because of fear of the pain can enkindle 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 apparent that he was quite fussy more or less what he ate so this could perhaps have lead to a low fiber intake, which can cause constipation. However 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 enured for constipation. Treatment for constipation in children involves having a clear understanding of the factors affecting the individual.In most cases more than one approach may be taken. In managing constipation the steps taken are to get rid of any impaction, to put regular bowl movements that cause no pain for the child and to try to prevent any further episodes of constipation. Firstly disimpaction of the build up faecal matter should be dealt with. There are different methods to manage this but usually medication will have a positive core without the need for surgical intervention. (NICE 2010). Laxatives are important as first line treatment and should commence as soon as possible (Rogers 2011).Movicol paediatric Plain (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 tump over the child having a negative effect in trying to get them to pass stools. These would only be used in cases when all other oral medication has failed to clear the retained stool. After the retained stool has been cleared Movicol PP is often used for month after to help principal(prenominal )tain 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 education is important in the maintenance of hygienic 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 wherefore the child has had a problem with passing stools. dietetical changes such as increasing fiber intake and generally maintaining a healthy diet is often advised.This as headspring as boost drinking water regularly is usually advised to prevent dehydration, which can be a cause of constipation. (Rogers 2011). Another important issue to be addressed is toileting habits. Toileting after meals should be encouraged and the childs comfort on the toilet should also be addressed to reduce straining. Regular exercise can also have a positive affect in maintaining healthy bowels. Poor follow up on patients progress is a main reason for failure in treatment which is why think abouts 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 sticker chart as a visual encouragement. also the nurses would play games with him surrounding drinking his Movicol to give him a positive meet of drinking it to try to stop him thinking about the unpleasant taste.This worked successfully and Scott 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 happenin g in the future. When his stools became less painful to pass he became less frightened to use the toilet, his fear being a main reason of his fecal impaction. Scott although living with both his parents he was normally cared for by his mother as his father worked offshore so was away for long periods of time. Scott was confident near 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 experienced overflow soiling which was something, which was out of his control. This would be a disagreeable environment for Scott, which could have go downed the situation as thoroughly as affect his 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 kinda than proper meals.This issue was addressed with his mother. S cott was kept in hospital durable due to child protection issues that were raised by a nurse regarding his mother. These issues were resolved 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 saw his father as a region model so he would have a great pick to play in Scotts health. His father could support 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. The se could be related to early life when he was toilet trained and be a contributing factor to his constipation.