Constipation Nursing Care Plan Notes

 

Definition

Constipation, costiveness, or irregularity, is a condition of the digestive system in which a person experiences hard feces that are difficult to expel.Constipation

  • This usually happens because the colon absorbs too much water from the food. If the food moves through the gastro-intestinal tract too slowly, the colon may absorb too much water, resulting in feces that are dry and hard.
  • Defecation may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction.
Causes of constipation:
  • may be dietary
  • hormonal
  • anatomical a side effect of medications (e.g. some opiates)
  • or an illness or disorder.
Clinical Manifestations
  • Fewer than three bowel movements per week, abdominal distention, and pain and pressure
  • Decreased appetite, headache, fatigue, indigestion, sensation of incomplete emptying
  • Straining at stool; elimination of small volume of hard, dry stool
  • Complications such as hypertension, hemorrhoids and fissures, fecal impaction, and megacolon
Assessment and Diagnostic Methods
  • Diagnosis is based on history, physical examination, possibly a barium enema or sigmoidoscopy, stool for occult blood, anorectal manometry (pressure studies), defecography, and colonic transit studies.
  • Newer tests such as pelvic floor MRI may identify occult pelvic floor defects.

stoolclassification

Medical Management
  • Treatment should target the underlying cause of constipation and aim to prevent recurrence, including education, bowel habit training, increased fiber and fluid intake, and judicious use of laxatives.
  • Discontinue laxative abuse; increase fluid intake; include fiber in diet; try biofeedback, exercise routine to strengthen abdominal muscles.
  • If laxative is necessary, use bulk-forming agents, saline and osmotic agents, lubricants, stimulants, or fecal softeners.
  • Specific medication therapy to increase intrinsic motor function (eg, cholinergics, cholinesterase inhibitors, or prokinetic agents).
Nursing Management
Assessment
Use tact and respect with patient when talking about bowel habits and obtaining health history.

Note the following:

  • Onset and duration of constipation, current and past elimination patterns, patient’s expectation of normal bowel elimination, and lifestyle information (eg, exercise and activity level, occupation, food and fluid intake, and stress level).
  • Past medical and surgical history, current medications, history of laxative or enema use.
  • Report of any of the following: rectal pressure or fullness, abdominal pain, straining at defecation, and flatulence.
  • Sets specific goals for teaching; goals for the patient include restoring or maintaining a regular pattern of elimination by responding to the urge to defecate, ensuring adequate intake of fluids and high fiber foods, learning about methods to avoid constipation, relieving anxiety about bowel elimination patterns, and avoiding complications.