Question

Nursing care plan evaluation for elderly patient with constipation and doesnt eat much food? need two evaluations for the interventions below?

1st intervention/rational: implementing more fibre rich foods/encouraging fluids. (Need an evaluation for this)

2nd intervention/rational is: assessing patients activity level and encourage them to participate in physical exercise. (what would be an evaluation for this?)

Answer 1

1) 1st intervention/rational: implementing more fibre rich foods/encouraging fluids.

People who get plenty of fluid and a variety of fruits, vegetables, and whole grains during the day tend not to suffer from constipation: Fiber and fluid keep stools from becoming hard and dry, and promote motility of the gastrointestinal tract.

Reasons for constipation in accordance to diet

• Diet is low in fiber
• Don't get enough fluids (6 to 8 glasses a day)
• Get less than 30 minutes of exercise a day
• Are immobile or bedridden due to illness or disability
• Often ignore the urge to move your bowels
• Overuse laxatives or enemas
• Have irritable bowel syndrome, also known as spastic colon, an annoying but usually harmless condition that can cause alternating bouts of diarrhea and constipation
• Have scarring, tumors or another condition in your digestive tract that prevents it from functioning properly
• Have a disease such as multiple sclerosis, lupus, scleroderma, underactive or overactive thyroid, or diabetes, all of which can affect a broad range of body functions
• Take certain medications such as antihistamines, iron supplements, diuretics, certain high blood pressure medicines, and antacids that contain aluminum and calcium

The causes of primary, or idiopathic, chronic constipation, including the subtypes of normal transit, slow transit and dyssynergic defecation (i.e., related to neuromuscular dysfunction), remain unknown. Despite the aging colon displaying smaller and more tightly packed collagen fibres as well as a reduced number of myenteric plexus neurons, age-related changes in colonic anatomy and physiology are not considered to be major contributors to the development of constipation.¹³ Decreased mobility, low fibre intake and limited fluid intake have also been implied as causes of constipation, but there is little evidence from the literature to support these claims.

Additionally, patients tend to underestimate their frequency of bowel movements.

1. Prunes

Dried plums, known as prunes, are widely used as a natural remedy for constipation.

They contain high amounts of fiber, with 2 grams of fiber per 1-ounce (28-gram) serving, or about three prunes. This is 8% of the American Heart Association's recommended daily intake of fiber.

2. Apples

Apples are rich in fiber. In fact, one medium-sized apple with the skin on (about 182 grams) contains 4.4 grams of fiber, which is 17% of the recommended daily intake.

Approximately 2.8 grams of that fiber is insoluble, while 1.2 grams is soluble fiber, mostly in the form of the dietary fiber called pectin.

3. Pears

Pears are another fruit rich in fiber, with about 5.5 grams of fiber in a medium-sized fruit (about 178 grams). That is 22% of the recommended daily fiber intake.

Alongside the fiber benefits, pears are particularly high in fructose and sorbitol, compared to other fruits.

4. Kiwifruit

You can get about 2.3 grams of fiber per kiwifruit (about 76 grams), which is 9% of the recommended daily intake.

In one study, 38 people over age 60 were given one kiwifruit per 66 pounds (30 kg) of body weight per day. This resulted in an increased frequency and ease of defecation. It also softened and increased the bulk of stools.

5. Figs

Figs are a great way to boost your fiber intake and promote healthy bowel habits.

One medium-sized raw fig (about 50 grams) contains 1.6 grams of fiber. Moreover, just half a cup (75 grams) of dried figs contains 7.3 grams of fiber, which is almost 30% of your daily requirements.

6. Citrus Fruits

Citrus fruits like oranges, grapefruits and mandarins are a refreshing snack and a good source of fiber.

For example, one orange (about 131 grams) contains 3.1 grams of fiber, which is 13% of the recommended daily fiber intake. Meanwhile, one grapefruit (about 236 grams) contains 2.6 grams of fiber, meeting 10% of your daily needs.

7. Spinach and Other Greens

Greens such as spinach, Brussels sprouts and broccoli are not only rich in fiber but also great sources of vitamin C, vitamin K and folate.

These greens help add bulk and weight to stools, which makes them easier to pass through the gut.

8. Jerusalem Artichoke and Chicory

Jerusalem artichoke and chicory belong to the sunflower family and are important sources of a type of soluble fiber known as inulin.

Inulin is a prebiotic, which means it helps stimulate the growth of bacteria in the gut, promoting digestive health. It’s particularly beneficial for Bifidobacteria.

9. Artichoke

Scientific research shows that artichokes have a prebiotic effect, promoting good gut health and regularity.

Prebiotics are indigestible carbohydrates like inulin that feed the beneficial bacteria in the gut, increasing their numbers and protecting against the growth of harmful bacteria.

10. Rhubarb

Rhubarb is a leafy plant that is well known for its bowel-stimulating properties.

It contains a compound known as sennoside A, more commonly known as Senna, a popular herbal laxative.

2) 2nd intervention/rational is: assessing patients activity level and encourage them to participate in physical exercise.

Recommend that within 1 hour of waking patients engage in mild physical activity (eg, walking, swimming, yoga, tai chi).

REGULAR EXERCISE

The National Health and Nutrition Examination Survey found that a low physical activity level is associated with a twofold increased risk of constipation. Another epidemiologic study showed that patients who are sedentary are more likely to complain of constipation. Prolonged bed rest and immobility are often associated with constipation. Although patients should be encouraged to be as physically active as possible, there is no consistent evidence that regular exercise relieves constipation. However, the Nurses’ Health Study, which followed a cohort of 62,036 women, found that physical activity two to six times per week was associated with a 35 percent lower risk of constipation.