Nursing diagnosis – RISK FOR CONSTIPATION

RISK  FOR  CONSTIPATION

DEFINITION

At risk for a decrease in normal frequency of defecation accompa-

nied by difficult or incomplete passage of stool and/or passage of

excessively hard, dry stool

RISK FACTORS

• Functional: Habitual denial

anti-inflammatory agents,

and ignoring urge to defecate,
recent environmental changes,
inadequate toileting, irregular
defecation habits, insufficient
physical activity, and abdomi-
nal muscle weakness

sedatives, aluminum-containing
antacids, laxative overuse, iron
salts, anticholinergics, antide-
pressants, anticonvulsants,
antilipemic agents, calcium
channel blockers, calcium

• Mechanical: Rectal abscess or

carbonate, diuretics, sympath-

ulcer, pregnancy, rectal anal
stricture, postsurgical obstruc-
tion, rectal anal fissures, mega-
colon (Hirschsprung’s disease),
electrolyte imbalance, tumors,
prostate enlargement,
rectocele, rectal prolapse, neu-
rologic impairment,
hemorrhoids, and obesity

omimetics, opiates, and
bismuth salts
• Physiological: Insufficient fiber
intake, dehydration, inadequate
dentition/oral hygiene, poor
eating habits, insufficient fluid
intake, change in usual
foods/eating patterns, and
decreased motility of GI tract

• Pharmacological:

• Psychological: Emotional stress,

Phenothiazines, nonsteroidal

mental confusion, depression

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Activity/rest

• Fluid and electrolytes

• Behavior

• Nutrition

• Elimination

• Risk management

EXPECTED OUTCOMES

The patient will

• Experience no signs or symptoms of constipation.

• Maintain bowel movement every ______ day(s).

• Consume a high-fiber or high-bulk diet, unless contraindicated.

• Maintain fluid intake of ______ ml daily (specify).

• Express understanding of the relationship between constipation

and dietary intake, bulk, and activity.

• Express understanding of preventive measures, such as eating fruit

and whole grain breads and cereals and engaging in mild activity,
if appropriate.

SUGGESTED NOC OUTCOMES

Bowel Elimination; Self-Care: Toileting

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INTERVENTIONS AND RATIONALES

Determine: Assess bowel sounds and check patient for abdominal

distention. Monitor and record frequency and characteristics of

stools to develop an effective treatment plan for preventing constipa-

tion and fecal impaction.

Record intake and output accurately to ensure accurate fluid

replacement therapy.

Perform: Initiate bowel program. Place patient on a bedpan or com-

mode at specific times daily, as close to usual evacuation time (if

known) as possible, to aid adaptation to routine physiological func-

tion.

Administer a laxative, an enema, or suppositories, as prescribed,

to promote elimination of solids and gases from GI tract. Monitor

effectiveness.

Inform: Teach patient to gently massage along the transverse and

descending colon to stimulate the bowel’s spastic reflex and aid in

stools passage.

Instruct patient, family member, or caregiver in the relationship

between diet, activity and exercise, and fluid intake and constipation

to discourage departure from prescribed diet and assist in promoting

elimination.

Review care plan with patient, family member, or caregiver,

emphasizing the relationship between the risk factors for

constipation and preventive measures to foster understanding.

Attend: Encourage fluid intake of 21⁄2 qt (2.5 L) daily, unless

contraindicated, to promote fluid replacement therapy and hydration.

Manage: Consult with a dietitian about how to increase fiber and

bulk in patient’s diet to the maximum amount prescribed by the

physician to improve intestinal muscle tone and promote

comfortable elimination.

Include a program of mild exercise in your care plan to promote

muscle tone and circulation.

SUGGESTED NIC INTERVENTIONS

Bowel Management; Constipation/Impaction Management; Exercise

Promotion; Fluid Management; Fluid Monitoring; Nutrition

Management

Reference

Norton, C. (2006, February–March). Constipation in older patients: Effects on

quality of life. British Journal of Nursing, 15(4), 188–192.

Nursing diagnosis – PERCEIVED CONSTIPATION

PERCEIVED  CONSTIPATION

DEFINITION

Self-diagnosis of constipation and abuse of laxatives, enemas, and

suppositories to ensure a daily bowel movement

DEFINING CHARACTERISTICS

• Expectation of passage of stools at the same time each day

• Overuse of laxatives, enemas, and/or suppositories

RELATED FACTORS

• Cultural health beliefs

• Faulty appraisal

• Family health beliefs

• Impaired thought processes

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Activity/exercise

• Elimination

• Coping

• Fluid and electrolytes

• Behavior

• Nutrition

• Emotional

EXPECTED OUTCOMES

The patient will

• Decrease use of laxatives, enemas, or suppositories.

• State understanding of normal bowel function.

• Discuss feelings about elimination pattern.

• Have a return-to-normal elimination pattern.

• Experience bowel movement every _____ day(s) without laxatives,

enemas, or suppositories.

• State understanding of factors causing constipation.

• Get regular exercise.

• Describe changes in personal habits to maintain normal

elimination pattern.

• State intent to use appropriate resources to help resolve emotional

or psychological problems.

SUGGESTED NOC OUTCOMES

Adherence Behavior; Bowel Elimination; Health Beliefs; Health

Beliefs: Perceived Threat; Knowledge: Health Behavior

INTERVENTIONS AND RATIONALES

Determine: Assess patient’s dietary habits and encourage modification

to include adequate fluids, fresh fruits and vegetables, and whole grain

cereals and breads, which supply necessary bulk for normal elimination.

Perform: If not contraindicated, increase patient’s fluid intake to about

3 qt (3 L) daily to increase functional capacity of bowel elimination.

Establish and implement an individualized bowel elimination regi-

men based on the patient’s needs. Knowledge of normal body func-

tions will improve patient’s understanding of problem.

Inform: Explain normal bowel elimination habits so patient can bet-

ter understand normal and abnormal body functions.

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Instruct patient to avoid straining during elimination to avoid tis-

sue damage, bleeding, and pain.

Instruct patient that abdominal massage may help relieve discom-

fort and promote defecation because it triggers bowel’s spastic

reflex.

Inform patient not to expect a bowel movement every day or even

every other day to avoid the use of poor health practices to stimu-

late elimination.

Attend: Encourage patient to engage in daily exercise, such as brisk

walking, to strengthen muscle tone and stimulate circulation.

Encourage patient to evacuate at regular times to aid adaptation

and routine physiological function.

Urge patient to avoid taking laxatives, if possible, or to gradually

decrease their use to avoid further trauma to intestinal mucosa.

Reassure patient that normal bowel function is possible without lax-

atives, enemas, or suppositories to give patient the necessary confi-

dence for compliance.

Manage: Give information about self-help groups, as appropriate, to

provide additional resources for patient and family.

SUGGESTED NIC INTERVENTIONS

Anxiety Reduction; Bowel Management; Counseling; Health Educa-

tion; Nutrition Management; Teaching: Individual

Reference

Hernando-Harder, A. C., et al. (2007, March). Intestinal gas retention in

patients with idiopathic slow-transit constipation. Digestive Diseases and
Sciences. [Epub ahead of print.]

Nursing diagnosis – CONSTIPATION

CONSTIPATION

DEFINITION

Decrease in normal frequency of defecation accompanied by difficult

or incomplete passage of stool and/or passage of excessively hard,

dry stool

DEFINING CHARACTERISTICS

• Palpable rectal or abdominal mass

• Borborygmi, hypoactive or hyperactive bowel sounds, or abdomi-

nal dullness on percussion

• Bright red blood with stools; bark-colored or black, tarry stools;

hard, dry stools; or oozing liquid stools

• Change in bowel pattern; decreased frequency and volume of stool

• Changes in mental status, urinary incontinence, unexplained falls,

or elevated body temperature in older adults

• Distended or tender abdomen and feeling of fullness or pressure

• General fatigue, anorexia, headache, indigestion, nausea, or vomiting

• Severe flatus; straining and possible pain during defecation

RELATED FACTORS

• Functional: habitual denial or

• Mechanical: electrolyte imbal-

ignoring urge to defecate,
irregular defecation patterns,
insufficient physical activity

ance, hemorrhoids, prostate
enlargement, rectal abscess,
anal fissure, or stricture

• Psychological: depression,

• Physiological: change in eating

emotional stress, mental
confusion

patterns or usual foods, dehy-
dration, inadequate dentition

• Pharmacological: aluminum-

or oral hygiene, insufficient

containing antacids, and drugs
that affect bowels

fiber or fluid intake

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Elimination

• Pharmacological function

• Nutrition

• Tissue integrity

EXPECTED OUTCOMES

The patient will

• Participate in development of bowel program.

• Report urge to defecate, as appropriate.

• Increase fluid and fiber intake.

• Report easy and complete evacuation of stools.

• Have elimination pattern within normal limits.

• Adopt personal habits that maintain normal elimination.

SUGGESTED NOC OUTCOMES

Bowel Elimination; Hydration; Nutritional Status: Food & Fluid

Intake

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INTERVENTIONS AND RATIONALES

Determine: Monitor frequency and characteristics of patient’s stool

daily. Careful monitoring forms the basis of an effective treatment plan.

Monitor and record patient’s fluid intake and output. Inadequate

fluid intake contributes to dry feces and constipation.

Perform: Provide privacy for elimination to promote physiological

functioning.

Plan and implement an individualized bowel regimen to establish

a regular elimination schedule; and exercise routine to promote

abdominal and pelvic muscle tone.

Inform: Emphasize importance of responding to urge to defecate. A

timely response to the urge to defecate is necessary to maintain nor-

mal physiological functioning.

Teach patient to locate public restrooms and to wear easily remov-

able clothing on outings to promote normal bowel functioning.

Teach patient to massage abdomen once per day and how to locate

and gently massage along the transverse and descending colon. In the

older patient, the neural centers in the lower intestinal wall may be

impaired, making it more difficult for the body to evacuate feces.

Massage may help stimulate peristalsis and the urge to defecate.

Teach patient sensible use of laxatives and enemas to avoid laxa-

tive dependency. Overuse of laxatives and enemas may cause fluid

and electrolyte loss and damage to intestinal mucosa.

Attend: Encourage patient to use a bedside commode or walk to toi-

let facilities to encourage normal position for evacuation. Encourage

intake of high-fiber foods to supply bulk for normal elimination and

improve muscle tone. Unless contraindicated, encourage fluid intake

of 6–8 glasses (1,420–1,900 ml) daily to maintain normal metabolic

processes.

Manage: Help patient understand diet modification plan along with

dietitian, if appropriate, to encourage compliance with prescribed

diet.

SUGGESTED NIC INTERVENTIONS

Bowel Management; Constipation/Impaction Management; Exercise

Promotion; Fluid Management; Nutrition Management

Reference

Wilson, L. A. (2005, November). Understanding bowel problems in older peo-

ple: Part 1. Nursing Older People, 17(8), 25–29.