Constipation Nursing Diagnosis and Care Plans

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Constipation is characterized by infrequent bowel movements, difficulty passing stools, or the sensation of incomplete evacuation.

According to the Rome IV criteria, functional constipation is diagnosed when a patient experiences at least two of the following symptoms for at least three months:

  • Straining during more than 25% of defecations
  • Lumpy or hard stools in more than 25% of defecations
  • Sensation of incomplete evacuation in more than 25% of defecations
  • Sensation of anorectal obstruction/blockage in more than 25% of defecations
  • Manual maneuvers to facilitate more than 25% of defecations
  • Fewer than three spontaneous bowel movements per week

Causes of Constipation

Understanding the underlying causes of constipation is essential for developing an effective nursing care plan. Common causes include:

Dietary Factors

  • Low fiber intake
  • Inadequate fluid consumption
  • Excessive consumption of dairy products
  • High intake of processed foods

Lifestyle Factors

  • Lack of physical activity
  • Ignoring the urge to defecate
  • Changes in routine
  • Stress

Medications

  • Opioid pain medications
  • Antidepressants
  • Antacids containing calcium or aluminum
  • Iron supplements
  • Certain blood pressure medications

Medical Conditions

  • Irritable Bowel Syndrome (IBS)
  • Hypothyroidism
  • Diabetes
  • Parkinson’s disease
  • Multiple sclerosis
  • Spinal cord injuries
  • Colorectal cancer

Nursing Assessment for Constipation

A thorough nursing assessment is crucial for diagnosing constipation and developing an appropriate care plan. The assessment should include:

Patient History

  • Usual bowel habits
  • Dietary habits
  • Fluid intake
  • Physical activity level
  • Medication use
  • Medical history

Physical Examination

  • Abdominal assessment (inspection, auscultation, percussion, and palpation)
  • Digital rectal examination (if indicated)

Stool Assessment

  • Frequency
  • Consistency (using the Bristol Stool Scale)
  • Color
  • Presence of blood or mucus

Pain Assessment

  • Location
  • Severity
  • Duration
  • Aggravating and alleviating factors

Psychosocial Assessment

  • Stress levels
  • Emotional state
  • Impact on quality of life

Diagnostic Tests (if ordered by the healthcare provider)

  • Abdominal X-ray
  • Colonoscopy
  • Transit time studies

Nursing Interventions for Constipation

Based on the assessment findings, nurses can implement various interventions to alleviate constipation:

Dietary Modifications

  • Increase fiber intake (25-30 grams per day)
  • Encourage adequate fluid intake (8-10 glasses per day)
  • Recommend probiotic-rich foods

Physical Activity

  • Encourage regular exercise (30 minutes daily)
  • Assist with mobility for bedbound patients

Toileting Habits

  • Establish a regular toileting schedule
  • Ensure privacy and comfort during defecation
  • Teach proper positioning (use of a footstool for squatting position)

Pharmacological Interventions (as prescribed)

  • Administer stool softeners (e.g., docusate sodium)
  • Use osmotic laxatives (e.g., polyethylene glycol)
  • Apply stimulant laxatives (e.g., bisacodyl) as a last resort

Non-pharmacological Interventions

  • Perform abdominal massage
  • Apply warm compresses to the abdomen
  • Teach relaxation techniques

Education

  • Provide information on the importance of regular bowel movements
  • Teach patients to recognize early signs of constipation
  • Instruct on proper use of laxatives and potential side effects

Nursing Care Plans for Constipation

Here are five detailed nursing care plans for patients with constipation:

Nursing Care Plan 1: Constipation related to inadequate fiber and fluid intake

Nursing Diagnosis Statement:
Constipation related to inadequate fiber and fluid intake as evidenced by hard, dry stools and fewer than three bowel movements per week.

Related factors/causes:

  • Low fiber diet
  • Insufficient fluid intake
  • Lack of knowledge about proper nutrition

Nursing Interventions and Rationales:

  1. Assess the patient’s current dietary habits and fluid intake.
    Rationale: Provides baseline data for developing an individualized nutrition plan.
  2. Educate the patient on high-fiber foods and recommend a gradual increase to 25-30 grams of fiber daily.
    Rationale: Fiber adds bulk to stool, promoting regular bowel movements.
  3. Encourage the patient to drink 8-10 glasses of water daily.
    Rationale: Adequate hydration softens stool and facilitates easier passage.
  4. Provide a food and fluid intake diary for the patient to track their consumption.
    Rationale: Increases patient awareness and accountability for dietary changes.
  5. Teach the patient about the importance of regular meals and not skipping breakfast.
    Rationale: Regular meals stimulate the gastrocolic reflex, promoting bowel movements.

Desired Outcomes:

  • Patient will verbalize understanding of the importance of fiber and fluid intake in preventing constipation.
  • Patient will demonstrate increased consumption of high-fiber foods and fluids as evidenced by food diary entries.
  • Patient will report softer stools and more frequent bowel movements (at least 3 per week) within 7 days.

Nursing Care Plan 2: Constipation related to decreased physical activity

Nursing Diagnosis Statement:
Constipation related to decreased physical activity as evidenced by infrequent bowel movements and abdominal discomfort.

Related factors/causes:

  • Prolonged bed rest
  • Sedentary lifestyle
  • Physical limitations due to medical conditions

Nursing Interventions and Rationales:

  1. Assess the patient’s current activity level and any physical limitations.
    Rationale: Provides baseline data for developing an appropriate exercise plan.
  2. Collaborate with physical therapy to develop a safe exercise regimen tailored to the patient’s abilities.
    Rationale: Ensures exercises are appropriate and safe for the patient’s condition.
  3. Encourage the patient to engage in 30 minutes of physical activity daily, as tolerated.
    Rationale: Regular physical activity stimulates peristalsis and promotes bowel movements.
  4. Assist the patient with range of motion exercises and position changes every 2 hours if bedbound.
    Rationale: Movement, even passive, can help stimulate bowel function.
  5. Educate the patient on the connection between physical activity and bowel regularity.
    Rationale: Increases patient motivation to maintain an active lifestyle.

Desired Outcomes:

  • Patient will demonstrate increased physical activity as appropriate for their condition.
  • Patient will report more frequent bowel movements (at least 3 per week) within 7 days.
  • Patient will express understanding of the relationship between physical activity and bowel function.

Nursing Care Plan 3: Constipation related to medication side effects

Nursing Diagnosis Statement:
Constipation related to medication side effects (e.g., opioid analgesics) as evidenced by hard stools and straining during defecation.

Related factors/causes:

  • Use of constipation-inducing medications
  • Inadequate patient education on medication side effects
  • Insufficient preventive measures

Nursing Interventions and Rationales:

  1. Review the patient’s medication list and identify drugs that may cause constipation.
    Rationale: Allows for targeted interventions and potential medication adjustments.
  2. Collaborate with the healthcare provider to consider alternative medications or adjust dosages if possible.
    Rationale: Minimizes the constipating effects of medications while maintaining therapeutic benefits.
  3. Implement a bowel regimen, including stool softeners or laxatives as prescribed.
    Rationale: Proactively manages constipation in patients taking constipation-inducing medications.
  4. Educate the patient on the potential side effects of their medications and the importance of reporting constipation.
    Rationale: Empowers the patient to monitor for side effects and seek help promptly.
  5. Teach non-pharmacological methods to promote bowel regularity (e.g., increased fluid intake, dietary changes).
    Rationale: Provides additional strategies to combat medication-induced constipation.

Desired Outcomes:

  • Patient will verbalize understanding of medication side effects and the importance of reporting constipation.
  • Patient will demonstrate adherence to the prescribed bowel regimen.
  • Patient will report improved bowel movements (softer stools, less straining) within 5 days.

Nursing Care Plan 4: Constipation related to ignoring the urge to defecate

Nursing Diagnosis Statement:
Constipation related to ignoring the urge to defecate as evidenced by infrequent bowel movements and feelings of incomplete evacuation.

Related factors/causes:

  • Busy lifestyle
  • Lack of privacy or comfortable toileting facilities
  • Anxiety about public restrooms

Nursing Interventions and Rationales:

  1. Assess the patient’s toileting habits and identify factors that lead to ignoring the urge to defecate.
    Rationale: Provides insight into behavioral patterns that contribute to constipation.
  2. Educate the patient on the importance of responding promptly to the urge to defecate.
    Rationale: Helps establish healthy bowel habits and prevents constipation.
  3. Teach the patient about the gastrocolic reflex and suggest toileting after meals.
    Rationale: Leverages natural digestive processes to promote regular bowel movements.
  4. Implement a scheduled toileting routine, allowing sufficient time and privacy.
    Rationale: Establishes a regular pattern for bowel movements and reduces anxiety.
  5. Provide strategies for managing bowel habits in various settings (e.g., work, travel).
    Rationale: Equips the patient with tools to maintain regularity despite lifestyle challenges.

Desired Outcomes:

  • Patient will verbalize understanding of the importance of responding to defecation urges.
  • Patient will demonstrate adherence to a regular toileting schedule.
  • Patient will report more frequent and complete bowel movements within 7 days.

Nursing Care Plan 5: Constipation related to psychological factors

Nursing Diagnosis Statement:
Constipation related to psychological factors (i.e., stress, anxiety) as evidenced by irregular bowel movements and abdominal discomfort.

Related factors/causes:

  • High levels of stress or anxiety
  • Depression
  • Eating disorders

Nursing Interventions and Rationales:

  1. Assess the patient’s psychological state and identify stressors that may contribute to constipation.
    Rationale: Provides a basis for addressing underlying psychological factors.
  2. Teach relaxation techniques such as deep breathing, progressive muscle relaxation, or guided imagery.
    Rationale: Reduces stress and promotes overall gastrointestinal function.
  3. Encourage the patient to engage in stress-reducing activities (e.g., yoga, meditation, hobbies).
    Rationale: Helps manage stress levels, which can positively impact bowel function.
  4. Provide education on the gut-brain connection and how psychological factors can affect digestion.
    Rationale: Increases patient understanding of the mind-body relationship in bowel health.
  5. Refer the patient to a mental health professional if psychological issues are severe or persistent.
    Rationale: Ensures comprehensive care for both psychological and physical well-being.

Desired Outcomes:

  • Patient will demonstrate the use of at least one stress-reduction technique daily.
  • Patient will report decreased stress levels within 14 days.
  • Patient will experience more regular bowel movements (at least 3 per week) within 14 days.

Conclusion

Constipation is a common but manageable condition that requires a comprehensive nursing approach. Nurses can significantly improve patient outcomes and quality of life by understanding the causes, performing thorough assessments, and implementing targeted interventions.

References

  1. American Gastroenterological Association, Bharucha, A. E., Dorn, S. D., Lembo, A., & Pressman, A. (2013). American Gastroenterological Association medical position statement on constipation. Gastroenterology, 144(1), 211-217.
  2. Dougherty, L., & Lister, S. (Eds.). (2015). The Royal Marsden Manual of Clinical Nursing Procedures (9th ed.). Wiley-Blackwell.
  3. Forootan, M., Bagheri, N., & Darvishi, M. (2018). Chronic constipation: A review of literature. Medicine, 97(20), e10631.
  4. Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). NANDA International Nursing Diagnoses: Definitions & Classification 2018-2020. Thieme.
  5. Leung, L., Riutta, T., Kotecha, J., & Rosser, W. (2011). Chronic constipation: an evidence-based review. The Journal of the American Board of Family Medicine, 24(4), 436-451.
  6. Mearin, F., Lacy, B. E., Chang, L., Chey, W. D., Lembo, A. J., Simren, M., & Spiller, R. (2016). Bowel disorders. Gastroenterology, 150(6), 1393-1407.
  7. Rao, S. S., & Go, J. T. (2010). Update on the management of constipation in the elderly: new treatment options. Clinical interventions in aging, 5, 163-171.
  8. Sharma, A., & Rao, S. (2017). Constipation: Pathophysiology and current therapeutic approaches. Handbook of experimental pharmacology, 239, 59-74.
  9. Tack, J., Müller‐Lissner, S., Stanghellini, V., Boeckxstaens, G., Kamm, M. A., Simren, M., … & Fried, M. (2011). Diagnosis and treatment of chronic constipation–a European perspective. Neurogastroenterology & Motility, 23(8), 697-710.
  10. Wald, A. (2016). Constipation: Advances in diagnosis and treatment. JAMA, 315(2), 185-191.

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