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Nursing Care Plan for Constipation

Sample of nursing care plan for constipation

Nursing diagnosis: Constipation


Definition of constipation

  • Decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool

Related Factors of constipation | Nursing Care Plan for Constipation

FUNCTIONALS

  • Irregular defecation habits; inadequate toileting (e.g., timeliness, positioning for defecation, privacy)

  • Insufficient physical activity; abdominal muscle weakness

  • Recent environmental changes

  • Habitual denial/ignoring of urge to defecate

PSYCHOLOGICAL

PHARMACOLOGICAL

  • Antilipemic agents; laxative overdose; calcium carbonate; aluminum containing antacids; nonsteroidal anti-inflammatory agents; opiates; anticholinergics; diuretics; iron salts; phenothiazides; sedatives; sympathomimetics; bismuth salts; antidepressants; calcium channel blockers

MECHANICAL

  • Hemorrhoids; pregnancy; obesity

  • Rectal abscess or ulcer, anal fissures, prolapse; anal strictures; rectocele

  • Prostate enlargement; postsurgical obstruction

  • Neurological impairment; megacolon (Hirschsprung’s disease); tumors

  • Electrolyte imbalance

PHYSIOLOGICAL

  • Poor eating habits; change in usual foods and eating patterns; insufficient fiber intake; insufficient fluid intake, dehydration

  • Inadequate dentition or oral hygiene

  • Decreased motility of gastrointestinal tract


Defining Characteristics| Nursing Care Plan for Constipation


SUBJECTIVE

  • Change in bowel pattern; unable to pass stool; decreased frequency; decreased volume of stool

  • Change in usual foods and eating patterns; increased abdominal pressure; feeling of rectal fullness or pressure

  • Abdominal pain; pain with defecation; nausea and/or vomiting; headache; indigestion; generalized fatigue

OBJECTIVE

  • Dry, hard, formed stool

  • Straining with defecation

  • Hypoactive or hyperactive bowel sounds; change in abdominal growling (borborygmi)

  • Distended abdomen; abdominal tenderness with or without palpable muscle resistance

  • Percussed abdominal dullness

  • Presence of soft pastelike stool in rectum; oozing liquid stool; bright red blood with stool; dark or black or tarry stool

  • Severe flatus; anorexia

  • Atypical presentations in older adults (e.g., change in mental status, urinary incontinence, unexplained falls, elevated body temperature)



Desired Outcomes/Evaluation Criteria—Client Will:

  • Establish/regain normal pattern of bowel functioning.

  • Verbalize understanding of etiology and appropriate interventions/solutions for individual situation.

  • Demonstrate behaviors or lifestyle changes to prevent recurrence of problem.

  • Participate in bowel program as indicated.


Nursing Interventions for Constipation | Nursing Care Plan for Constipation


NURSING PRIORITY NO. 1. To identify causative/contributing factors:

  • Review daily dietary regimen.Note oral/dental health that can impact intake.

  • Determine fluid intake, to note deficits.

  • Evaluate medication/drug usage and note interactions or side effects (e.g., narcotics, antacids, chemotherapy, iron, contrast media such as barium, steroids).

  • Note energy/activity level and exercise pattern.

  • Identify areas of stress (e.g., personal relationships, occupational factors, financial problems).

  • Determine access to bathroom, privacy, and ability to perform self-care activities.

  • Investigate reports of pain with defecation. Inspect perianal area for hemorrhoids, fissures, skin breakdown, or other abnormal findings.

  • Discuss laxative/enema use. Note signs/reports of laxative abuse.

  • Review medical/surgical history (e.g., metabolic or endocrine disorders, pregnancy, prior surgery, megacolon).

  • Palpate abdomen for presence of distention, masses.

  • Check for presence of fecal impaction as indicated.

  • Assist with medical workup for identification of other possible causative factors.



Nursing Interventions for Constipation | Nursing Care Plan for Constipation

NURSING PRIORITY NO. 2. To determine usual pattern of elimination:

  • Discuss usual elimination pattern and problem.

  • Note factors that usually stimulate bowel activity and any interferences present.



NURSING PRIORITY NO. 3. To assess current pattern of elimination:

  • Note color, odor, consistency, amount, and frequency of stool. Provides a baseline for comparison, promotes recognition of changes.

  • Ascertain duration of current problem and degree of concern (e.g., long-standing condition that client has “lived with” or a postsurgical event that causes great distress) as client’s response may be inappropriate in relation to severity of condition.

  • Auscultate abdomen for presence, location, and characteristics of bowel sounds reflecting bowel activity.

  • Note laxative/enema use.

  • Review current fluid/dietary intake.



Nursing Interventions for Constipation | Nursing Care Plan for Constipation

NURSING PRIORITY NO. 4. To facilitate return to usual/acceptable pattern of elimination:

  • Instruct in/encourage balanced fiber and bulk in diet to improve consistency of stool and facilitate passage through colon.

  • Promote adequate fluid intake, including high-fiber fruit juices; suggest drinking warm, stimulating fluids (e.g., decaffeinated coffee, hot water, tea) to promote moist/soft stool.

  • Encourage activity/exercise within limits of individual ability to stimulate contractions of the intestines.

  • Provide privacy and routinely scheduled time for defecation (bathroom or commode preferable to bedpan).

  • Encourage/support treatment of underlying medical cause where appropriate (e.g., thyroid treatment) to improve body function, including the bowel.

  • Administer stool softeners, mild stimulants, or bulk-forming agents as ordered, and/or routinely when appropriate (e.g., client receiving opiates, decreased level of activity/immobility).

  • Apply lubricant/anesthetic ointment to anus if needed.

  • Administer enemas; digitally remove impacted stool.

  • Provide sitz bath after stools for soothing effect to rectal area.

  • Establish bowel program to include glycerin suppositories and digital stimulation as appropriate when long-term or permanent bowel dysfunction is present.



NURSING PRIORITY NO. 5. To promote wellness (Teaching/Discharge Considerations):

  • Discuss physiology and acceptable variations in elimination.

  • Provide information about relationship of diet, exercise, fluid, and appropriate use of laxatives as indicated.

  • Discuss rationale for and encourage continuation of successful interventions.

  • Encourage client to maintain elimination diary if appropriate to facilitate monitoring of long-term problem.

  • Identify specific actions to be taken if problem recurs to promote timely intervention, enhancing client’s independence.



Documentation Focus | Nursing Care Plan for Constipation

ASSESSMENT/REASSESSMENT| Nursing Care Plan for Constipation

  • Usual and current bowel pattern, duration of the problem, and individual contributing factors.

  • Characteristics of stool.

  • Underlying dynamics.



PLANNING| Nursing Care Plan for Constipation

  • Plan of care/interventions and changes in lifestyle that are necessary to correct individual situation, and who is involved in planning.

  • Teaching plan.



IMPLEMENTATION/EVALUATION| Nursing Care Plan for Constipation

  • Responses to interventions/teaching and actions performed.

  • Change in bowel pattern, character of stool.

  • Attainment/progress toward desired outcomes.

  • Modifications to plan of care.



DISCHARGE PLANNING| Nursing Care Plan for Constipation

  • Individual long-term needs, noting who is responsible for actions to be taken.

  • Recommendations for follow-up care.

  • Specific referrals made.

This is a sample of Nursing Care Plan for Constipation.