Chapter 2: Patient Assessment
2.9 Head-to-Toe Assessment: Gastrointestinal Assessment
Critical Thinking Exercises: Questions, Answers, and Sources / References
Critical thinking questions are in bold type, and the answers are italicized. Additional resources or references are provided below.
- A patient who experiences intermittent constipation asks what they might do to promote bowel regularity. Describe three nursing interventions that the nurse might discuss.
Complete an assessment including a history to determine the nature of the constipation and possible causes. Primary causes include things like lack of fibre, inadequate fluid intake, inactivity, and environmental and psychological reasons. Secondary causes include neurological (stroke, Parkinsons), endocrine (hypothyroidism, irritable bowel), psychiatric (dementia, depression, anxiety), and pharmacological (opioids, diuretics). Consult the interdisciplinary team.
The easiest recommendations include:
- Increasing activity: Increased activity increases peristalsis.
- Increasing water intake: More water available in the body can result in softer (less hard) stools. Note: alcohol, tea, and coffee are diuretics.
- Dietary alterations to include more fibre: Increasing fibre in one’s diet increases the bulk of the stool, thus allowing it to pass easier. Note: A high fibre diet can be a contraindication to some, thus a complete history and assessment is important.
Source:
Richardson, J. (2002). Assessment and treatment of constipation. Nursing in Practice. https://www.nursinginpractice.com/article/assessment-and-treatment-constipation
2. Describe the character of stool expected from an ileostomy.
Stool from an ileostomy should be loose and perhaps very soft formed. This is because stool exits the body before it reaches the large bowel where most of the water reabsorption occurs.
Source:
Ostomy Canada Society. (2019). Ostomy. https://www.ostomycanada.ca/ostomy-information/
Sample Learning Activities
- Ask learners to complete a GI assessment on a partner, and document narratively.
Example: abdomen soft, distended. Bowel sounds x4. LBM yesterday. Describes as ‘normal’ firm formed. States tolerating regular diet. No recent weight loss or gain. Denies nausea and/or abd pain.
2. Ask learners to complete a personal food diary for 48 hours including all food and fluid intake. Then evaluate their dietary consumption in relation to Canada’s Food Guide (CFG) recommendations. Specifically:
- How does one’s dietary intake compare to the snapshot provided by the CFG?
- Create a personal plan for dietary change, if change is necessary.
Resource:
Government of Canada. (2019). Canada’s food guide. https://food-guide.canada.ca/en/food-guide-snapshot/
- Encourage small group discussions about what is the rationale behind the CFG recommendations to:
- Be mindful of your eating habits.
- Enjoy your food.
- Cook more often.
- Eat meals with others.
- Use food labels.
- Limit foods high in salt, sugar, and saturated fats.
- Be aware of food marketing.
Resource:
Government of Canada. (2019). Canada’s food guide. https://food-guide.canada.ca/en/food-guide-snapshot/