Constipation

5 Constipation Nursing Care Plans Diagnosis and Interventions

Constipation NCLEX Review Care Plans

Nursing Study Guide on Constipation

Constipation is a medical condition characterized by infrequent bowel movement, difficult passage of stool, or both.

It is often defined as less than three bowel movements a week. It is a common complaint with an estimated prevalence of 12-19% of population in America and about 27% in Canada.

Constipation has several causes, which may include gastrointestinal disorders, neurological problems, post-surgical status, ongoing chemotherapy treatment, or even pregnancy.

Its treatment process is often directed not only in addressing constipation but on tackling the underlying cause.

Signs and Symptoms of Constipation

  • Passing fewer than three stools a week
  • Having lumpy or hard stools
  • Straining to have bowel movements or needing help to empty the rectum
  • Feeling of a rectal blockage
  • Feeling of incomplete emptying of the stool

Causes of Constipation

Normally, the stool passes through the intestinal tract and rectum through peristalsis.

Constipation occurs when there is disruption in this normal movement causing stool or waste to become hard and dry; therefore, making it more difficult to excrete out of the body.

The causes for constipation are classified into primary and secondary causes.

  1. Primary constipation. Primary causes are problems directly affecting the colon and the anorectal function.
  2. Normal transit constipation – this form of constipation is also known as functional constipation. It is the most common cause of constipation and it is often treated with dietary changes. When high fiber diet does not help to improve the condition, doctors often do additional tests to identify the exact cause.
  3. Slow-transit constipation – involves prolonged colonic transit time. It is believed to be associated to a neuromuscular disorder in the colon. This form of constipation is most common in young women.
  4. Defecation disorders – may include anatomical malformation of the colon or anorectal area leading to constipation.
  5. Secondary constipation. This refers to other reasons that indirectly affect the normal process of defecation and stool formation.
  6. Drug-causing constipation – several drugs are known to cause constipation. It is a known side effect for most prescribed and over-the-counter drugs.
  7. Neurological disorders – some conditions are known to cause constipation such as autonomic neuropathy, diabetes mellitus, and other endocrine disorders.
  8. Neurogenic bowel dysfunction – this condition is quite common in patients with spinal cord injury, multiple sclerosis, and Parkinson’s disease.

Treatment for Constipation

  1. Diet and lifestyle changes. These important steps belong to the first line of treatment for constipation.
    • Dietary changes including high-fiber diet is highly recommended to improve elimination.
    • Proper hydration helps in the process as well by preventing the stool from forming dry.
    • Exercises and keeping active also improve the transit of wastes.
    • Not delaying bowel movement when it arises – passage of stool may take time. It is important that patients are given enough time to use the toilet and open their bowels.
  2. Laxatives. Laxatives are medications used to promote smooth transit of stool.
    • Fiber supplements – improve the bulk of stool to make them easier to pass.
    • Stimulants – drugs that trigger the intestines to contract.
    • Osmotics – drugs used to promote water movement in the intestines therefore improving the transit of stools.
    • Lubricants – lubricants such as mineral oil allows the stool to pass through the intestines easily.
    • Stool softeners – draw water to the colon to moisten the stool.
    • Enemas and suppositories – lubricate the passageway and stimulates bowel movement.
  3. Pelvic muscles exercises. Strengthening the pelvic floor is believed to help pass stools.
  4. Surgery. In some cases, surgery may be required when the cause of constipation is occlusion or stricture.

5 Nursing Care Plans for Constipation

Nursing Care Plan 1

Post-Surgical Care

Nursing Diagnosis: Constipation related to immobility secondary to hip fracture surgery as evidenced by difficulty to pass stool and no bowel movement for 4 days post-surgery.

Desired outcome: The patient will manage to pass stool in 1-2 days.

InterventionsRationales
Commence stool chart.To monitor the pattern of elimination including amount and type of stool passed.
Start a fluid balance chart.To monitor the patient’s hydration status and identify dehydration as possible cause of constipation.
Commence food chart.Diet post-surgery may be different from the patient’s normal eating pattern. Assessing the food intake of the patient may help improve elimination.
Assess mobility and level of physical activity.Reduced physical activity can affect peristalsis and promote constipation. Mobility may be difficult in the first few days after surgery.
Encourage high fiber diet and oral fluid intake.Bowel movements may change post-surgery due to the medications given during procedures and immobility.
Encouraging the patient to include fiber in diet when able, and to drink plenty of fluids will help ease constipation.
Provide time to use the toiletOpening of the bowel may be painful in the first few days post-surgery. It is important for patients to be supported and be given adequate time to use the toilet as needed.  
Refer the patient to physiotherapy.Patients post-surgery may find it hard to mobilize due to the surgical wound and pain. Physiotherapists can help improve the patient’s mobility and provide tips on how to move around better with ease.
Administer laxatives as prescribed.Laxatives are effective in promoting bowel movements.
Offer mobility assistive device like zimmer frame, wheelchair and/or use of commode.Mobility may be difficult for patients post-surgery. Providing them with assistive equipment may ease their burden when mobilizing around, which may include trips to the toilet.
Administer pain killers as needed.Patient may require additional pain management following surgery when planning to do activities like a trip to the toilet to open their bowels.

Nursing Care Plan 2

Neurological Disorders such as Multiple sclerosis, Parkinson’s Disease and Muscular dystrophy

Nursing Diagnosis: Constipation related to reduced muscle control secondary to Parkinson’s Disease, as evidenced by reduced bowel movement, hard and lumpy stool, verbalization of having to strain when on the toilet, restlessness

Desired Outcome: return of normal elimination pattern following managed PD symptoms.

InterventionsRationales
Commence stool chart.To monitor the pattern of elimination including amount and type of stool passed.
Commence fluid balance chart.Patients with PD may find it difficult to hydrate themselves due to reduced muscle control.  
Commence food chart.Patients with PD may have reduced appetite due to reduced ability to feed themselves secondary to reduced muscle control.
Assess mobility and level of physical activity.Reduced physical activity can affect peristalsis and promote constipation. Assessing the physical activities of patients with PD may help identify additional care needs such as the need of assistive device when going to the toilet.
Assess medications list.Patients with PD may be on some medications that can cause constipation. Reviewing the medication list can help identify and plan for alternatives to these medications.  
Encourage high fiber diet and oral fluid intake.PD can affect the patient’s ability to feed him/herself and reduce appetite. Ensuring that the patient has proper nutrition with adequate fiber in diet can improve the bulk of stool for easier passage. Also, adequate hydration will help provide lubrication and prevent stool from becoming hard and dry.   
Assess what helps patient open his/her bowels easier.Patients with PD may need additional support when completing activities of daily living. Assessing what helps the patient may improve his/her experience and make elimination more of an ease.
Provide time to use the toilet.Due to changes in muscle control and mobility issues, patients with PD may need more time in the toilet than others.  
Provide privacy.PD patients may find it embarrassing to open their bowels in ward areas. Providing privacy can help them focus in opening their bowels.
Administer laxatives as prescribed.Laxatives are effective in promoting bowel movement.
Administer PD drugs on time.Administration of PD drugs on time will improve management of symptoms, reduce involuntary muscle movements, and improve muscle control. 

Nursing Care Plan 3

Dementia

Nursing Diagnosis: Constipation related to ignoring the urge to defecate secondary to dementia as evidenced by straining and passage of hard stools, restlessness, and refusal to go to the toilet.

Desired outcome: The patient will be able to re-establish return of normal elimination pattern and being free from pain while passing stools.

InterventionsRationales
Start stool chart.To monitor the pattern of elimination including amount and type of stool passed.
Commence fluid balance and food chart.Patients with dementia may have an altered eating and drinking pattern. Assessing how well they are hydrated and fed can help assess the need for supplementary hydration and nutrition provision.  
Assess mobility and level of physical activity.Dementia can have varying effects on patient’s activity levels.
Assess medications list.Some medications given to patients with dementia can cause constipation. A review of their medications list can help plan for alternatives.  
Encourage high fiber diet and oral fluid intake.Patients with dementia may not be aware of what they eat and how much they drink. Encouraging them to eat the proper food and to drink plenty will help improve their eating routine and promote regular elimination.
Provide time to use the toilet.Allowing them to have more time in the toilet will give them enough time to figure out how things work.
Encourage regular time for elimination.Providing time to defecate will help the patient develop a routine and promote regular bowel movement.
Assess the patient’s ability to use toilet facility.Patient’s with dementia may need to be reoriented about the toilet facility.
Provide privacy.Privacy will help patient to focus on opening their bowels and will limit distractions to patients with dementia.
Make a clear path to the toilet.Patients with dementia may easily lose their way. Making sure that the toilet is easily found and is free from clutter will help patients with dementia find their way to the toilet.
Administer laxatives as prescribed.Laxatives are effective in promoting bowel movement as needed.

Nursing Care Plan 4

Gastrointestinal Disorders (e.g. Diverticulitis)
Nursing Diagnosis: Constipation related to inflammatory process of diverticulitis as evidenced by type 1-2 stools on Bristol stool chart, inability to open bowels in the last 3 days.

Desired Outcome: The patient will be able to re-establish normal bowel elimination.

InterventionsRationales
Commence a stool chart. Use a standardized stool assessment tool such as Bristol stool chart.To monitor the patient’s bowel pattern.
Administer laxatives as prescribed.To help evacuate stools, the following laxatives can be used as prescribed:
•Stimulant laxatives •Stool softeners, especially for the elderly patients •Bulk laxatives
Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Check if the patient is in any fluid restriction before doing so.To help soften the stool and make it easier to pass.
Encourage physical mobility and exercise as tolerated.To increase bowel peristaltic movement.
Encourage fiber intake of at least 25 grams per day for women and 38 grams per day for men, as recommended by the dietitian.To help the food move through the intestines. Examples of good dietary fiber include artichokes, carrots, and spinach.

Nursing Care Plan 5

Cancer and Ongoing Chemotherapy Treatment

Nursing Diagnosis: Constipation related to side effect of systemic anti-cancer therapy (SACT) as evidenced by type 1-2 stools on Bristol stool chart 2 days post-chemotherapy session, feeling of difficulty in emptying stools, irritability

Desired Outcome: The patient will be able to re-establish normal bowel elimination.

Coordinate with the oncology pharmacist on reviewing the patient’s medications list.Some medications given to patients with cancer patients can cause constipation. A review of their medications list can help plan for alternatives. 
Consider changing laxative regimen.Laxatives are effective in promoting bowel movement. However, chemotherapeutic agents may cause the patient to be increasingly constipated, thus the need of regular reviewing of bowel elimination status and trying a different laxative regimen.
Encourage fiber intake of at least 25 grams per day for women and 38 grams per day for men, as recommended by the dietitian. Educate on increasing fluids like water and juices.To help the food move through the intestines. Examples of good dietary fiber include artichokes, carrots, and spinach.
Refer the patient to the oncology dietitian.Oncology dietitian are specialists in dealing with constipation and other bowel movement problems related to cancer and anti-cancer treatments.
Refer the patient to physiotherapy.Physiotherapists can help improve the patient’s mobility and provide pelvic floor exercises for constipation.
Encourage exercises as tolerated.Physical activity promotes peristalsis and elimination.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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