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.

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