Note: This guideline is currently under review. Show
Aim Definition of Terms Assessment Management Special Considerations Education Companion Documents Evidence Table IntroductionConstipation is one of the most frequent, adverse reactions that can occur post-operatively secondary to a reduction in fluid intake, immobility and medications such as opioids. Faecal impaction may occur causing pain and discomfort for patients as well as increasing the length of hospital stay. AimThe aim of this guideline is to assist nurses' who work within the paediatric field around the prevention and management of constipation in the post-operative patient. Definition of terms
AssessmentAll post-operative patients are at risk of developing constipation as a result of a variety of factors. Constipation can be an adverse drug effect from opioid use due to the action upon opioid receptors in the gastrointestinal tract. This leads to a reduction in gastrointestinal propulsion and an increase in fluid absorption. If the patient reports difficulty in passing stools, have not had their bowels opened post op or are currently on opioids the following must be considered:
Physical Assessment
Management
Special considerations
Education
Companion documentsKids Health Info – Constipation Table 1
Note: please refer to RCH policies and procedures for medications that can be nurse initiated https://www.rch.org.au/policy/policies/Medication_Management/ Evidence tableClick here to view the evidence table. Please remember to read the disclaimer. What is true bowel sounds?Abdominal sounds (bowel sounds) are made by the movement of the intestines as they push food through. The intestines are hollow, so bowel sounds echo through the abdomen much like the sounds heard from water pipes. Most bowel sounds are normal. They simply mean that the gastrointestinal tract is working.
How does the nurse accurately assess bowel sounds?Place the diaphragm of your stethoscope lightly over the right lower quadrant and listen for bowel sounds. If you don't hear any, continue listening for 5 minutes within that quadrant. Then, listen to the right upper quadrant, the left upper quadrant, and the left lower quadrant.
How long should the nurse listen before reporting absent bowel sounds?Auscultation should begin in the right lower quadrant. If bowel sounds are not heard, in order to determine if bowel sounds are truly absent, listen for a total of five minutes (Jarvis, 2011). Bowel sounds echo the underlying movements of the intestines.
When Auscultating the abdomen for bowel sounds How long should you listen before concluding that bowel sounds are absent?In order to conclude that bowel sounds are absent, one must listen for three to five minutes (and hear nothing). Be sure to pick up the stethoscope as you move from quadrant to quadrant (do not drag it across the abdomen).
Which sound should the nurse expect to hear when Percussing a distended bladder?Tympany is high-pitched and sounds like a drum in terms of quality with longer duration than resonance and hyperresonance. When performing percussion, tympany is normally heard over fluid-filled organs such as the stomach, bladder, and bowels.
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