Background
A nursing care plan is a written document that specifies the nursing care that a patient will receive. Nurses use it to plan and describe the care that will be provided to the patient. The nursing care plan includes a detailed assessment of the patient, identification of nursing diagnoses or issues, goals for the patient’s care, remedies that will be implemented to achieve the goals, and evaluation of the clinical efficacy of the treatments (The Royal College of Nursing, 2022; Masson and Stephenson, pp. 685-690).
It is a live record that is updated regularly to reflect changes in the patient’s health and progress toward goals (Nursing & Midwifery Council, 2018). The nursing care plan ensures that the patient receives adequate and tailored care while also encouraging continuity of care among multiple healthcare providers. The patient in this example has bowel incontinence, and doctors are working to determine the underlying cause and design an effective treatment strategy (Wolf, pp. 57-59). In this scenario, the Dorothea Orem nursing model is used to oversee patient recovery since it emphasizes the need for self-care.
Nursing Care Plan
The nursing care plan for the patient is presented below. It presents the nursing diagnosis, planning, goal, implementation, or relevant intervention, and the corresponding evaluation of the stated diagnosis of Bowel incontinence.
Subjective Data
- The patient has been experiencing frequent bowel motions with blood present.
Objective Data
- Respiration rate: 16 breaths per minute.
- Oxygen saturation levels: 97%.
- Pulse rate: 98 beats per minute.
- Blood pressure: 158/90.
- Temperature: 36.2 °C.
- GCS: 15/15.
- Body mass index: 34.59kg/m2.
- Opens bowels 5-8 a day with blood present—type 6 on the Bristol stool chart.
Planning and Goal
- The patient will gain more control over his bowel movements and re-establish a pattern.
- Becomes continent or has decreased bowel movements per day.
- The patient forms a soft stool.
- Preventing loss of skin integrity.
- Assess fluid and fiber intake.
Implementation/Intervention
- Monitor and record incontinent output and frequency. This will educate the patient on the severity of each bowel movement.
- Reintroduce fluids to avoid dehydration (3000mls).
- Provide a high-fiber diet under the supervision of a dietician to improve nutritional status.
- Provide a bedside commode as the patient needs to open bowels urgently, and can reduce ‘accidents.’
- The patient may need to wear adult pads for extra protection.
- Anti-diarrheal drugs such as loperamide.
- Encourage the patient to mobilize or perform light physical activities.
- Pelvis floor exercises.
- Apply a moisture barrier ointment after the perineal area has been cleaned after each bowel movement.
Evaluation
- Collect data and evaluate the usefulness of chosen interventions.
- Modify and update the patient’s care plan if there are no improvements within 14 days.
Dorothea Orem’s Nursing Model
The Dorothea Orem Nursing Model is also known as the Self-Care Deficit Nursing Theory. It is founded on the premise that people can care for themselves and that caring ought to concentrate on aiding people to maintain or regain their capacity to do so (Warner, 2014). The paradigm is built around three key ideas: self-care, self-care deficiency, and nursing systems (Ribeiro et al., 2021). This model is based on the premise that humans need self-care to sustain their physical and mental well-being (Zhizhpon-Quinde et al., 2021). Individuals encounter a self-care deficit when they are unable to undertake self-care chores such as getting dressed or showering due to an injury or illness.
Nursing systems, in accordance with Orem’s paradigm, are intended to assist individuals in overcoming self-care inadequacies. These kinds of programs may range from simple interventions like teaching patients self-care methods to more complicated initiatives, including helping with daily chores (Zhizhpon-Quinde et al., 2021). By assisting patients with their self-care needs, nursing can encourage autonomy and enhance the quality of life (Gutenbrunner et al., pp. 13-19).
In a nutshell, the Dorothea Orem Nursing Model stresses the significance of patient-centered care and nursing’s role in assisting patients in achieving and maintaining their optimum state of health and wellness (Lohani, pp. 10-15). It has been widely used in nursing practice, teaching, and research, and it remains an important and useful paradigm for comprehending and enhancing patient care.
SMART Goals
In this study, the goals are focused on key areas of the patient’s life: fiber intake, physical exercises on the floor, reduction of bladder irritants, and establishing a bowel routine. SMART goals are a framework for setting specific, measurable, achievable, relevant, and time-bound objectives (NHS England, 2021). A detailed expansion of the goals is as follows:
- Specific. Increase my daily fiber intake.
- Measurable. Consume 25 grams of fiber each day. Depending on the patient’s or caregiver’s preference, the fiber may be distributed throughout the day or consumed in one meal.
- Achievable. Purchase high-fiber foods and gradually increase fiber intake for a week. The foods can be accessed at the nearest grocery or food stores within the patient’s reach or vicinity.
- Relevant. Fiber helps promote bowel regularity and prevents constipation. As a result, the patient stands to benefit from the advantages of fiber in their diet within the shortest time possible.
- Time-bound. Consume 25 grams of fiber each day for the next 30 days. The dietary discipline within the stipulated timeframe will ensure the patient’s health is geared towards recovery without necessarily involving the attention of caregivers.
Interventions
Reintroduce Fluids to Avoid Dehydration
In nursing, fluid reintroduction is the procedure of delivering fluids to a patient who has been deprived of them for an extended length of time. This can happen for a variety of causes, including surgery, illness, or dehydration. Reintroducing fluids necessitates careful monitoring and assessment to ensure that the patient receives the proper volume and type of fluids (Bapen, 2011).
Fluids are usually reintroduced gradually in nursing to avoid overwhelming the patient’s system. To determine the right pace and volume of fluids to deliver, the nurse will evaluate the patient’s vital signs, urine output, and other markers of fluid status. Fluids will be supplied based on the patient’s unique needs and may include oral rehydration solutions, intravenous fluids, or other specialist solutions.
Throughout the reintroduction process, nurses must interact with the patient and their healthcare team to ensure that any concerns or issues are handled swiftly. Patients and caregivers should be educated on the need to maintain enough fluid intake and identify the indications of dehydration to assist in preventing future episodes of fluid deprivation (Bapen, 2011). According to Nazarko (pp. 432-438), reintroducing fluids in nursing can provide considerable benefits for patients by improving their hydration state, organ function, wound healing, and overall health. As a result, it is a suggested nursing technique that must be carefully monitored and delivered based on the patient’s health and progress.
Anti-Diarrheal Drugs
Drugs are useful in killing disease-causing bacteria that trigger or worsen medical conditions or thrive under specific conditions. Other medications assist the body in rehabilitating the effects of physical manifestations such as bowel incontinence (Bapen, 2011; The Royal College of Nursing, 2022). The medications aid in muscle and nervous control, allowing patients to resume regular and productive lives. The drug administration should be carried out in a professional and controlled manner as prescribed by doctors to avoid potential cases of abuse or poisoning.
The nurse should analyze the patient’s symptoms before delivering an anti-diarrheal medication to decide on the proper medication and dosage. Inquire about the frequency and consistency of bowel motions and any related symptoms such as stomach pain, cramps, or fever. The nurse should also review the patient’s medical history to determine whether any underlying illnesses or medications might interact with the anti-diarrheal medication (Zhizhpon-Quinde et al., 2021). Anti-diarrheal medications can cause constipation, dizziness, and drowsiness. The nurse should monitor the patient for any adverse effects and, if necessary, communicate them to the healthcare practitioner.
If the patient has diarrhea, dehydration is a danger. The nurse should examine for indicators of dehydration, such as dry mucous membranes, decreased urine production, or lethargy, and monitor the patient’s fluid intake and output (National Institute for Health and Care Excellence, 2020). The nurse should also assess the patient’s response to measure the effectiveness of the anti-diarrheal medication (Warner, 2014).
This could include evaluating the frequency and consistency of bowel movements and any related symptoms. The nurse should educate the patient on how to use the drug correctly, including dosage, administration, and any side effects (Warner, 2014). The nurse should also advise on how to avoid dehydration, such as increasing fluid intake.
Use of Moisture Barrier Ointment
Moisture barrier ointment protects the rectum from friction or any other physical impact of standing, whether dry or loose (NHS England, 2021). The ointments contain substances such as zinc oxide and petrolatum, which build a protective barrier on the skin and prevent inflammation and irritation. These ointments can help moisturize and soothe the skin, aiding healing and preventing further damage (O’Flynn, pp. 12-15). As a result, the patient’s situation is pushed toward healing and normalcy.
To use a moisture barrier ointment for bowel incontinence, clean and dry the affected area well before applying a thin layer of the ointment. Moisture barrier ointments can also prevent and treat skin breakdown. Studies have shown that ointments help prevent and treat skin breakdown caused by moisture, abrasion, or pressure (Nazarko, pp. 432-438). According to NHS England (2021), ointments form a protective barrier between the skin and irritants, aiding in the prevention of harm and the promotion of healing.
Skin irritation and disintegration can cause pain and discomfort. According to O’Flynn, incontinence-associated dermatitis (IAD) is a prevalent condition among incontinent individuals and can cause pain, discomfort, and even infection. Moisture barrier ointments, which protect the skin from moisture and irritants, can aid in the management of IAD. Patients with wounds or incisions are in danger of infection from external pollutants, according to nursing (pp. 12-15).
Moisture barrier ointments can assist in keeping these regions clean, reduce the risk of infection, and promote healing. Moisture barrier ointments can help alleviate these symptoms while also increasing patient comfort and quality of life (NHS England, 2021). Nurses play a crucial role in identifying patients who may benefit from these therapies, as well as training patients and caregivers on how to use moisture barrier ointments properly.
Reference List
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Zhizhpon-Quinde, T.C., Mesa-Cano, I.C., and Ramírez-Coronel, A.A. (2021) Prevention of COVID-19 through Dorothea Orem’s Self-Care Theory. International Journal of Innovative Science and Research Technology, 6. Web.