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Constipation Nursing Care Plan & Management

Notes

Definition
Constipation, costiveness, or irregularity, is a plight of the digestive method in which a individual experiences flinty feces that are arduous to thrust-out.Constipation
  • This commsingly happens consequently the colon restrains too fur inspire from the aid. If the aid moves through the gastro-intestinal entrust too sloth, the colon may restrain too fur inspire, upshoting in feces that are dry and flinty.
  • Defecation may be exceedingly afflictive, and in exact cases (fecal impaction) bring to symptoms of bowel impediment.
Causes of constipation:
  • may be fareary
  • hormonal
  • anatomical a face property of medications (e.g. some opiates)
  • or an experimentation or experimentation.
Clinical Manifestations
  • Fewer than three bowel movements per week, abdominal distention, and disinclination and constraining
  • Decreased inclination, muddiness, jade, indigestion, sensation of peccconducive emptying
  • Sinoculation at stool; exportation of paltry work of flinty, dry stool
  • Complications such as hypertension, hemorrhoids and fissures, fecal impaction, and megacolon
Assessment and Diagnostic Methods
  • Diagnosis is based on truth, visible probation, possibly a barium enema or sigmoidoscopy, stool for mysterious rank, anorectal manometry (consinoculation studies), defecography, and colonic transit studies.
  • Newer tests such as pelvic floor MRI may identify mysterious pelvic floor defects.
stoolclassification
Medical Management
  • Treatment should target the belowlying origin of constipation and aim to forefend perching, including education, bowel practice inoculation, acceptiond fiber and fluid intake, and judicious use of balsamics.
  • Discontinue balsamic abuse; acception fluid intake; include fiber in fare; try biofeedback, application round to strengthen abdominal muscles.
  • If balsamic is requisite, use dimension-forming agents, extraordinary and osmotic agents, lubricants, stimulants, or fecal gentleeners.
  • Specific medication therapy to acception inward motor duty (eg, cholinergics, cholinesterase inhibitors, or prokinetic agents).
Nursing Management
Assessment
Use taste and regard behind a conjuncture enduring when talking about bowel manners and procureing soundness truth.
Note the following:
  • Onset and continuance of constipation, exoteric and gone-by exportation plans, enduring’s confluence of ordinary bowel elimination, and lifestyle notice (eg, application and essence smooth, tenure, aid and fluid intake, and stress level).
  • Past medical and surgical truth, exoteric medications, truth of balsamic or enema use.
  • Report of any of the following: rectal consinoculation or repletion, abdominal disinclination, sinoculation at clarification, and flatulence.
  • Sets sundericular goals for training; goals for the enduring include restoring or maintaining a systematic plan of exportation by responding to the press to defecate, ensuring unlimited intake of gentles and proud fiber aids, learning about methods to abandon constipation, relieving diffidence about bowel exportation plans, and abandoning complications.

Nursing Economy Plan

Nursing Diagnosis
  • Constipation
May be allied to
  • Functional Recent environintellectual alters; practiceual discardment or ignoring of press to defecate; scant visible essence; irsystematic clarification practices; not-alike toileting, abdominal muscle inadhesiveness
  • Psychological Depression; melting stress; intellectual confusion
  • Pharmacological Antilipemic agents; balsamic aggravatedose; calcium carbonate; aluminum-containing antacids; nonsteroidal antiinflammatory agents; opiates; anticholinergics; diuretics; sturdy salts; phenothiazides; sedatives; sympathomimetics; bismuth salts; antidepressants; calcium implement blockers
  • Mechanical Rectal abscess or ulcer; pregnancy; rectal anal fissures; tumors; megacolon (Hirschsprung’s sickness); electrolyte imbalance; rectal prolapse; prostate enlargement; neurological impairment; rectal anal stricture; rectocele; postsurgical impediment; hemorrhoids; obesity
  • Physiological Poor eating practices; decreased motility of gastrointestinal entrust; not-alike dentition or vocal hygiene; scant fiber intake; scant gentle intake; alter in common aids and eating plans; dehydration
Desired Outcomes
  • Maintains journey of gentle, formed stool exhaustive 1 to 3 days behind a conjunctureout tenuity
  • States deliverance from disagreeableness of constipation
  • Identifies measures that forefend or discourse constipation
Nursing Interventions
  • Observe common plan of clarification including spell of day, equality and abundance of stool, analogy of stool, truth of bowel practices or balsamic use; fare including gentle intake; application plans; individualal remedies for constipation; obstetrical/gynecological truth; surgeries; alterations in perianal sensation; offer bowel cheer.
    • Rationale: There regularly are multiple deduces for constipation; the chief step is rate of common plans of bowel exportation.
  • Have the client or source maintain a diary of bowel practices including spell of day; common excitation; analogy, equality, and abundance of stool; gentle consumption; and use of any aids to clarification.
    • Rationale: A diary of bowel practices is costly in discoursement of constipation.
  • Review client’s exoteric medications.
    • Rationale: Divers medications concern ordinary bowel duty, including opiates, antidepressants, antihypertensives, anticholinergics, diuretics, anticonvulsants, antacids containing aluminum, sturdy supplements, and muscle relaxants.
  • Palpate for abdominal distention, percuss for indiscriminateness, and auscultate bowel sounds.
    • Rationale: In clients behind a conjuncture constipation the abdomen is regularly inflated behind a conjuncture a distinct colon.
  • Check for impaction; effect digital dissolution per physician’s regulate. If impaction is offer, use lustration cheer until you procure a very gentle stool. If using an enema, the client must be conducive to corporeal restrain the gentle. If the client has scanty sphincter temper, use a cone tip irrigating bag to co-operate-behind a conjuncture the client in restraining the gentles.
    • Rationale: This to-boot decreases the equality of gentle requisite for lustration.
  • Provide retreat for clarification. Co-operate-behind a conjuncture the client to the bathroom and terminate the door if likely.
    • Rationale: Bowel exportation is a very peculiar act, and a noncommunication of retreat can co-operate to constipation.
  • Encourage fiber intake of 25 g/day for adults. Emphasize aids such as novel return, beans, vegetables, and bran cereals. Add fiber to fare spiritual.
    • Rationale: Fiber succors forefend constipation by giving stool dimension. Add fiber to fare spiritual consequently a hasty acception can origin bloating, gas, and diarrhea. A daily fiber intake of 25 g can acception abundance of stools in clients behind a conjuncture constipation. Dietary supplements of fiber in the form of bran or wheat fiber are beneficial for women experiencing constipation behind a conjuncture pregnancy.
  • Encourage a gentle intake of 1.5 to 2 L/day (6 to 8 glasses of liquids per day). If vocal intake is low, spiritual acception gentle intake. Gentle intake must be behind a conjuncturein the cardiac and renal secretiveness.
    • Rationale: Unlimited gentle intake is requisite to forefend flinty, dry stools. Increasing gentle intake to 1.5 to 2 L/day concurrently behind a conjuncture fiber intake of 25 g can emblemificantly acception abundance of stools in clients behind a conjuncture constipation.
  • Encourage client to be out of bed as shortly as likely, and to own activities of daily succor (ADLs) as conducive. Suffer applications such as turning and changing positions in bed, lifting their hips off the bed, doing concatenate of motion applications, alternating lifting each knee to the chest, doing wheelchair lifts, doing waist twists, stretching engagement separate from matter, and pulling in the abdomen conjuncture preface sagacious breaths.
    • Rationale: Activity, plain minimal, acceptions peristalsis, which is requisite to forefend constipation.
  • At each frugality, sprinkle bran aggravate client’s aid as known by client and prescribed fare. Ensure that client receives unlimited gentle (1500 ml/day) concurrently behind a conjuncture bran.
    • Rationale: The estimate of bowel movements is acceptiond and the use of balsamics is decreased in a client who eats wheat bran. A opine performed on institutionalized old hardy clients behind a conjuncture continuous constipation demonstrated that behind a conjuncture bran use, clients were conducive to eradicate use of vocal balsamics.
  • Initiate a systematic catalogue for clarification, using the client’s ordinary colliquation spell whenever likely. Offer hot coffee, hot lemon inspire, or drees juice precedently breakfast, or conjuncture sitting on the toilet if requisite. An optimal spell for divers people is 30 minutes behind breakfast consequently of the gastrocolic reflex.
    • Rationale: A catalogue gives the client a sentiment of restrain, but further importantly it prefers colliquation precedently drying of stool and constipation take-place. Hot liquids can exasperate peristasis and upshot in clarification.
  • Emphasize to the client the requisite ingredients for a ordinary bowel cheer (e.g., gentle, fiber, essence, and systematic catalogue for clarification). Succor client onto bedface commode or toilet behind a conjuncture client’s hips flexed and feet downright. Have client sagacious murmur through mouth to suffer recreation of the pelvic foot muscle and use the abdominal muscles to succor colliquation.
  • Provide balsamics, suppositories, and enemas as scarcityed and as regulateed singly; organize a client goal of eliminating their use. Abandon soapsuds enemas, or use a low force of castile soap singly. Use of balsamics should be abandoned.
    • Rationale: Soapsuds enemas can origin mischief to the colonic mucosa. The use of a soapsuds enema was shown to acception stool output as compared behind a conjuncture tap inspire enemas in preoperative liver remand endurings; equality of mucosal effeminacy was mysterious.
  • For the stconducive neurological client, opine use of a bowel round of Therevac enema or suppositories exhaustive other day, or effecting digital stimulation behind a conjuncture physician’s liberty. For perpetual constipation, associate to physician for evaluation.
    • Rationale: Use of the Therevac SB mini-enema was institute to cut spell scarcityed for bowel economy by as fur as one hour or further as compared behind a conjuncture use of suppositories.
Geriatric
  • Explain the consequence of fiber intake, gentle intake, and essence for gentle, formed stool.
    • Rationale: Fiber intake, gentle intake, and essence are regularly decreased in old clients. Increasing fiber and gentles can propertyively forefend constipation in the old.
  • Determine client’s belowstanding of ordinary bowel exportation; prefer superabundance to a systematic catalogue.
    • Rationale: Misconceptions respecting the abundance of bowel movements can bring to diffidence and aggravateuse of balsamics.
  • Explain Valsalva’s maneuver and the deduce it should be abandoned.
    • Rationale: Valsalva’s maneuver can origin bradycardia and plain expiration in cardiac endurings.
  • Respond instantly to client’s flatter for succor behind a conjuncture toileting.
  • Avoid systematic use of enemas in the old.
    • Rationale: Enemas can origin gentle and electrolyte imbalances ( and mischief to the colonic mucosa.
  • Use opioids cautiously.
    • Rationale: If regulateed, use stool gentleeners and bran mixtures to forefend constipation. Use of opioids can origin constipation.
  • Position client on toilet or commode and situate a paltry footstool below the feet.
    • Rationale: Placing a paltry footstool below the feet acceptions intraabdominal consinoculation and makes clarification easier for an old client behind a conjuncture inadhesive abdominal muscles.
Home Economy Interventions
  • Put client in bathroom to toilet when likely.
    • Rationale: Bowel exportation is a very peculiar act, and a noncommunication of retreat can co-operate to constipation.
  • Carefully warner bowel plans of clients below disinclination skill behind a conjuncture opioids. Introduce a bowel skill program at chief emblem of constipation.
    • Rationale: Constipation is a important collection for terminally ill or hospice clients who may scarcity very proud doses of opioids for disinclination skill.
  • When using a bowel program, organize a plan that is very systematic and allows client to be sunder of source item.
    • Rationale: Regularity of program prefers metaphysical and/or physiological “readiness” to abandon. Families of settlement economy clients regularly cannot income behind a conjuncture ordinary daily activities until bowel programs are exhaustive.
Client/Family Teaching Nursing economy plans For Constipation
  • Instruct client on ordinary bowel duty and the requirement of gentle, fiber, and essence in a bowel program.
  • Encourage client to heed clarification premonition emblems and enunciate a systematic catalogue of clarification by using a excitation such as a irascible imbibe or drees juice.
    • Rationale: Most cases of constipation are effortless and upshot from practiceual slight of impulses that emblemal alienate spell for clarification. This upshots in supply of a catholic, dry fecal body.
  • Encourage client to abandon long-term use of balsamics and enemas and to spiritual behind a conjuncturedraw from their use if used systematicly.
  • If not contraindicated, train client how to do bent-leg sit-ups to acception abdominal temper; to-boot suffer client to conentrust abdominal muscles regularly throughout the day.
    • Rationale: Succor client enunciate a daily application program to acception peristalsis.

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