Understanding Constipation
Constipation is a common issue, but how do treat it?
Constipation is a common issue in nursing practice, and understanding its fundamentals is essential for NCLEX's success. This guide will provide you with the critical information needed to master constipation-related questions on the NCLEX.
What is Constipation?
Definition: Constipation is characterized by infrequent bowel movements, typically fewer than three times a week, and difficulty passing stools.
Constipation happens for a lot of reasons
Causes of Constipation:
1. Dietary Factors:
- Low fiber intake: Not taking in enough fiber in diet. A client who constantly eats fast food will not get enough fiber. One who does not eat fruits and vegetables in their diet will lack in fiber. Provide teaching and recipes to encourage good eating habits.
- Inadequate fluid consumption: fluids not containing caffeine will hydrate the body and bowels. Caffeine will pull liquid off and dry the stool up. So coke, pepsi and other soft drinks will pull fluid off and can constipate the client further.
2. Lifestyle Factors:
- Sedentary lifestyle: A client who does not get up and move during the day or is ill and can not move needs help with movement. Even the use of range of motion of the lower extremities can help.
- Changes in routine or environment: Give reasons why the client needs to move their legs if in a wheelchair or works from a chair. Chair exercises will increase the movement of lower extremities.
3. Medications: can take fluids off the bowels like in the case of diuretics or opioids. Monitor the medication list for meds that might need to be modified or changed by the doctor to help with constipation.
- Opioids
- Antacids containing calcium or aluminum
- Antidepressants
- Iron supplements
4. Medical Conditions: Some conditions can increase the chances of constipation such as diabetes. When the patient’s blood sugar is high, the client’s body will respond with increased urinatation to bring the sugar levels down - and lose fluids. Check out the other conditions listed below and figure out why they increase the likelihood of constipation.
- Hypothyroidism
- Diabetes
- Irritable bowel syndrome (IBS)
- Neurological disorders (e.g., Parkinson’s disease, multiple sclerosis)
Constipation symptoms
Symptoms of Constipation: Diarreha can be a sign that the body is not completely emptying itself and is dumping the soft stool first. This is more likely to happen with a bowel obstruction, but can happen with constipation. Below is a list of constipation symptoms
- Infrequent bowel movements
- Hard or lumpy stools
- Straining during bowel movements
- Feeling of incomplete evacuation
- Abdominal bloating or pain
What do you assess for constipation?
Assessment:
When assessing a patient for constipation these are all things a nurse must take into account when looking at a client. These things add up to constipation, so consider the following:
- History: Dietary habits, fluid intake, activity level, medication use, and medical history.
- Physical Examination: Abdominal palpation to detect masses or tenderness, and rectal examination to check for stool impaction.
Nursing Interventions
Nursing Interventions:
1. Dietary Changes:
- Increase fiber intake (e.g., fruits, vegetables, whole grains)
- Ensure adequate hydration (8-10 glasses of water daily)
2. Lifestyle Modifications:
- Encourage regular physical activity
- Establish a regular bowel routine
3. Medications:
- Bulk-forming agents (e.g., psyllium)
- Stool softeners (e.g., docusate sodium)
- Stimulant laxatives (e.g., bisacodyl, senna) - used cautiously
4. Education:
- Educate patients on the importance of not ignoring the urge to defecate
- Discuss the effects of medications and conditions that contribute to constipation
NextGen NCLEX Case Study!
Practice NGN NCLEX questions by way of an evolving case study!
NGN Evolving Case Study: Managing Constipation:
Scenario 1: Initial Assessment
Patient Profile:
Name: Mr. John Smith
Age: 55
Admitting Diagnosis: Chronic constipation
Medical History: Hypertension, Type 2 Diabetes, Osteoarthritis
His current medications are:
- Metformin 500 mg BID
- Lisinopril 10 mg daily
- Ibuprofen 400 mg TID PRN for pain
- Iron supplements 325 mg daily
Chief complaint upon admission: Mr. Smith reports having fewer than three bowel movements per week, with hard stools and straining during defecation. He also mentions feeling bloated and uncomfortable.
Nursing Assessment:
- Vital Signs: BP 130/85, HR 78, RR 16, Temp 98.6°F
- Abdominal Assessment: Abdomen distended, tender to palpation in the lower quadrants
- Bowel Sounds: Hypoactive
NGN Question 1: Identify Potential Causes
Highlight the factors in Mr. Smith's history and medications that might contribute to his constipation.
Scenario 2: Dietary and Lifestyle Recommendations
Patient Education:
The nurse discusses dietary and lifestyle changes with Mr. Smith to help manage his constipation.
Educational Points:
- Increase dietary fiber: fruits, vegetables, whole grains - Ensure adequate hydration: at least 8 glasses of water per day
- Regular physical activity: walking, stretching
- Establish a regular bowel routine: try to have a bowel movement at the same time each day
NGN Question 2: Plan of Care
Based on the patient education provided, list three specific recommendations the nurse should give to Mr. Smith to manage his constipation.
Scenario 3: Prioritize Hypothesis
Which of the following topics would be a priority for Mr. Smith to apply for his constipation each day?
- Four 16 oz bottles of water
- Bedrest with bathroom privileges
- Walking around the block after meals
- Eating whole grain breads and cereals, along with vegetables
- Cheeseburger and french fries with diet coke
NGN Question 3: Plan of Care
List the topics for Mr. Smith to apply to his daily routine
Scenario 4: Medication Review and Interventions
Mr. Smith takes the following medications:
A. Metformin
B. Lisinopril
C. Ibuprofen
D. Iron supplements
NGN Question 4: Medication Review
Which of Mr. Smith’s medications should be reviewed or adjusted to help alleviate his constipation? Explain why. Select all that apply
A. Metformin
B. Lisinopril
C. Ibuprofen
D. Iron supplements
Scenario 5: Follow-Up and Evaluation
Follow-Up Visit: Two weeks later, Mr. Smith returns for a follow-up visit. He reports some improvement in his symptoms but still experiences occasional difficulty with bowel movements.
Nursing Assessment:
- Vital Signs: BP 128/80, HR 76, RR 16, Temp 98.4°F
- Abdominal Assessment: Mild distention, no tenderness
- Bowel Sounds: Normoactive
- Bowel Movements: 3-4 times per week, softer stools
NGN Question 5: Evaluation of Interventions
Evaluate the effectiveness of the interventions implemented for Mr. Smith’s constipation. Identify any additional steps that could be taken to further improve his bowel regularity.
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This evolving case study helps nursing students apply their knowledge of constipation management through realistic scenarios. It emphasizes the importance of comprehensive assessment, patient education, medication review, and continuous evaluation in providing effective care. Use this case study to sharpen your critical thinking and decision-making skills for the NCLEX and in your future nursing practice.
Constipation is a frequent concern in patients and requires a comprehensive approach to management. Understanding its causes, symptoms, and interventions is crucial for effective nursing care. Remember, regular assessment and patient education are key components in preventing and managing constipation. Use this knowledge to tackle NCLEX questions confidently and provide high-quality care in your nursing practice.
Review your answers to the NGN questions.
NCLEX Practice Questions Based on the Evolving Case Study Answers to questions:
Question 1: Potential Causes
Highlight the factors in Mr. Smith's history and medications that might contribute to his constipation.
Correct Answer: Iron supplements, ibuprofen, low fluid intake, low dietary fiber.
Question 2: Plan of Care
Based on the patient education provided, list three recommendations the nurse should give Mr. Smith to manage his constipation.
Correct Answers:
1. Increase high-fiber foods such as fruits, vegetables, and whole grains intake.
2. Drink at least 8 glasses of water per day.
3. Engage in regular physical activity, such as walking for 30 minutes daily.
Scenario 3: Prioritize Hypothesis
Which of the following topics would be a priority for Mr. Smith to apply for his constipation each day?
- Four 16 oz bottles of water
- Bedrest with bathroom privileges
- Walking around the block after meals
- Eating whole grain breads and cereals, along with vegetables
- Cheeseburger and french fries with diet coke
Correct priority actions:
Four 16 oz bottles of water
Walking around the block after meals
Eating whole grain breads and cereals, along with vegetables
Question 4: Medication Review
Which of Mr. Smith’s medications should be reviewed or adjusted to help alleviate his constipation? Explain why.
Correct Answers:
D. Iron supplements—Iron supplements can cause constipation, so they may need to be adjusted or an alternative treatment considered.
C. Ibuprofen - While not as common as iron supplements, NSAIDs like ibuprofen can sometimes contribute to gastrointestinal discomfort, including constipation.
Question 5: Evaluation of Interventions
Evaluate the effectiveness of the interventions implemented for Mr. Smith’s constipation. Identify any additional steps that could be taken to improve his bowel regularity further.
Correct Answers:
- The interventions have shown some effectiveness as Mr. Smith reports more frequent and softer bowel movements.
- Additional steps include: adding a bulk-forming laxative like psyllium, monitoring and possibly adjusting his diet further, and ensuring adherence to physical activity recommendations.
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