A nurse is caring for a patient who recently had abdominal surgery and is experiencing severe pain. The patient’s blood pressure is 110/60 mmHg, and heart rate is 60 beats/min. Additionally, the patient does not appear to be in any distress. Which response by the nurse is most therapeutic?

Choice A reason: Choosing a time based on the patient’s defecation pattern leverages the gastrocolic reflex, promoting regular bowel movements. Scheduled toileting aligns with natural rhythms, enhancing bowel training success and reducing incontinence episodes.

Choice B reason: Leaning backward on the toilet is not recommended, as it misaligns the anorectal angle, hindering defecation. A forward-leaning or squatting position facilitates easier stool passage, making this action incorrect for bowel training.

Choice C reason: Normal exercise stimulates peristalsis through abdominal muscle movement and increased blood flow to the gut. Within the patient’s ability, it supports regular bowel function, making it an essential component of a bowel training program.

Choice D reason: Recording incontinence times identifies patterns and triggers, allowing tailored interventions. This data informs adjustments to the toileting schedule or dietary changes, improving the effectiveness of the bowel training program.

Choice E reason: Helping the patient to the toilet at designated times ensures adherence to the scheduled toileting plan, especially for those with mobility or cognitive issues. It promotes continence and reinforces the bowel training routine.

Choice F reason: Applying abdominal pressure and straining (Valsalva maneuver) risks pelvic floor strain, hemorrhoids, or cardiovascular stress. Gentle defecation with proper positioning is safer and more effective, making this action inappropriate for bowel training.

Choice A reason: Replacing a PCA syringe ensures continued pain control but is less urgent than acute severe pain. PCA systems often have residual medication, allowing a brief delay without compromising pain management, so this is not the priority.

Choice B reason: Pre-medicating before walking prevents pain exacerbation but is less critical than addressing existing severe pain. Scheduled mobility can be delayed slightly to prioritize acute needs, making this a lower priority intervention.

Choice C reason: A patient with 8/10 pain and an immediate order indicates acute, severe distress requiring urgent intervention. Severe pain can elevate stress hormones, heart rate, and blood pressure, necessitating prompt medication to stabilize the patient and alleviate suffering.

Choice D reason: Scheduled maintenance medication maintains baseline pain control but is not urgent compared to acute 8/10 pain. Delaying a scheduled dose briefly is less likely to cause harm than untreated severe pain, making this a lower priority.