Nursing Care Plan for Constipation

Constipation Pathophysiology

Many factors can contribute to constipation. The problem could have an external cause or come from the colon or the rectum.

Usually, the problem is delayed intestinal motility, which appears after years of excessive laxative use. However, a few patients may have an outlet obstruction as the underlying cause, such as rectal prolapse or a rectocele.

External factors contributing to constipation include poor eating habits, a lack of fluid intake, the abuse of certain medicines, endocrine conditions including hypothyroidism, and psychological disorders.

Causes

• Irregular eating patterns
• Insufficient fluids
• Diet low in fiber and/or high in fats and sugars
• Increased intake of caffeine and alcohol
• Delaying the urge to have a bowel movement
• Life changes (pregnancy, travel, aging)
• Inactivity
• Medications (including pain killers, antidepressants, and blood pressure drugs) 
• Supplements (iron & calcium)
• Irritable bowel syndrome (IBS)
• Intestinal blockage

Symptoms

• Hard stools that are difficult to pass
• Pain with bowel movements
• Abdominal bloating
• Low back pain
• Hemorrhoids and/or fissures
• Less than three bowel movements a week
• Rectal bleeding with bowel movements

Subjective (Patient May Report)

• Complaints of straining at stooling, incomplete evacuation, abdominal bloating, or pain
• Abdominal pain
• Loss of appetite
• Avoidance of bowel movements (withholding, especially in public)
• A feeling of being blocked (or not having fully emptied the bowel)
• Repeat bladder infections (female)

Objective

• Large, dry stools that are difficult to pass
• Less than three bowel movements per week
• Bright red blood on surface of stool

Risk Factors

• Dehydration
• Eating a diet that’s low in fiber
• Getting little or no physical activity
• Taking certain medications (sedatives, opioid pain medications, some antidepressants, blood pressure drugs)
• Having a mental health condition (such as depression or an eating disorder)

Constipation Nursing Intervention

Assessment

Focus on the patient’s regularity and frequency of bowel movements, along with symptoms of nausea and vomiting. Ask the patient whether stools are difficult to pass or whether bowel movements are occurring at all.

Examine medical history in relation to suspected constipation (constipation history, level of activity, drugs frequently used for constipation).

Cardiac Function

• Increased blood pressure (from strain)

Respiratory function

• Shortness of breath

Neurologic and Sensory Functions

• Possible neurogenic bowel dysfunction

Visual Appearance & Labs

• Blood tests
• MRI defecography
• Evaluation of how well food moves through the colon

Constipation Nursing Diagnosis

Assessment 

Further assessment should focus on changes in regularity and frequency of bowel movements, as well as medication side effects.

Rationale

Dietary adjustments help the colon process feces and make it easier for feces to travel through the body. Despite being convenient, processed foods and sugar lead to constipation. Peristalsis and stoma transit are supported by activity and exercise.

Care Plan/Planning

• A Nursing Care Plan (NCP) for Constipation starts at patient admission.
• The goal of an NCP is to create a treatment plan that’s specific to the patient. Plans should be anchored in evidence-based practices, accurately record existing data, and identify potential needs or risks.

Nursing Actions & Care Note for Constipation

Perform

• Abdominal assessment (percussion, palpation, and auscultation)
• Abdominal massage

Provide

• Adequate privacy
• Assistive equipment for mobility

Avoid

• Patient pain
• Caffeine and alcohol
• Intolerant foods (i.e. dairy, oils, etc.)

Administer

• Stool softeners and laxatives as ordered
• Suppositories

Monitor

• Patient hydration status
• Start a stool chart to keep track of the frequency and kind of bowel motions, establish a baseline, and spot irregularities

Encourage

• Client to watch defecation warning signs and develop a regular schedule by using a stimulus (such as a warm drink or prune juice).
• Avoidance of long-term use of laxatives and enemas and gradually withdrawing from their use (if used regularly).
• Decrease of opioids (if that’s the underlying concern)

Goals and Outcomes

• Experiencing a normal bowel pattern
• Experiencing relief from discomfort of constipation
• Identifying measures that prevent or treat constipation

Constipation Post Intervention Evaluation & Monitoring

Monitor

• Pattern of elimination
• Intake and output

Future goals 

• Patient identifying measures that prevent or treat constipation such as activity, fluid intake, fiber, medication, etc.
• Patient adhering to a daily schedule to avoid constipation.

Prevention

• Patient maintaining a regular bowel schedule by eating a well-balanced diet high in fiber, drinking more water, and being active regularly.

Supplemental Material for Constipation

Client Case (Example)

Patient is a 39-year-old female who presents with complaints of constipation. The patient has been experiencing symptoms of constipation for the past week and has been to the hospital once before. 

The patient reports that she does not have any pain or discomfort, but she wants to find out what is causing her constipation so that it can be treated properly. The plan of care for this client will include administering medication daily until all symptoms are gone. 

This includes teaching the client how to eat healthy foods that help with digestion and bowel movements, encouraging her to exercise regularly, and encouraging her to drink plenty of water throughout the day.

Constipation NCLEX Questions

Correct answers are highlighted in green.

Which of the following are treatments for constipation?

1. Ambulation
2. High fiber diet
3. Increased fluid intake
4. Whole wheat foods 
5. High carbohydrate diet

Which of the following is a complication of constipation?

1. Encopresis
2. Impaction
3. Hemorrhoids
4. Rectal prolapse
5. Colorectal cancer

Which of these clients are struggling with constipation?

1. The client who eats a high-fiber diet, exercises, and has a bowel movement every 2 days.
2. The client who eats a high-fat diet, is sedentary, and has a bowel movement every 5-7 days.
3. The client who eats fruits and vegetables, drinks 8 glasses of water a day, and exercises daily.
4. The client who uses the Valsalva maneuver for bowel movements, has hemorrhoids, and takes laxatives every other week.
5. The client who has lumpy, hard stools every 2 days, drinks 8 oz. of water daily, drinks colas, and eats snacks throughout the day.

Find our other nursing care plans here

References

The Pathophysiology, Diagnosis, and Treatment of Constipation Dtsch Arztebl Int. 2009

Palliative Care for Constipation Pace University

University of California Davis

University of Rochester Medical Center