The 78-year-old resident of a nursing home is brought to the emergency department for abdominal pain that is not responsive to oxycodone. She takes captopril, atenolol, lovastatin, and glyburide in addition to the oxycodone. Upon assessment, her abdomen is full and mildly tender. She has positive bowel sounds and reports passing gas but no stools for 96 hours. She denies anorexia or vomiting. A digital rectal examination is performed and stool is found in the rectum. The nurse anticipates being ordered to perform which intervention for this patient?  

Incorrect

  • Manual disimpaction
  • X-ray of the abdomen
  • Bowel preparation followed by a colonoscopy
  • Gastric decompression via nasogastric tube to suction

Rationale

The patient has opioid-induced constipation. A manual disimpaction will break up the hard stool in the rectum and allow for easier evacuation as well as stimulate motility. The patient should also be placed on a bowel regimen to accompany the oxycodone. With stool in the rectum and no vomiting, obstruction is unlikely. Therefore, gastric decompression and x-ray of the abdomen are unnecessary. Bowel preparation and colonoscopy are not the most appropriate interventions for the patient with fecal impaction related to opioid use.  

  • Category: Basic Care and Comfort
  • Difficulty: 9
  • Tags: Elimination Gastrointestinal Nursing Interventions

Question 64 of 75

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