Constipation
Jessica Miller
University of Michigan
School of Nursing
Constipation Constipation is a symptom-based disorder defined as unsatisfactory defecation and characterized by the passage of dry, hard stool, difficulty passing stool, no stool, or a sense of incomplete emptying after a bowel movement (Woodward, 2012). Often, constipation occurs when the movement of feces through the large intestine is slow, thus allowing time for additional reabsorption (Berman, Kozier, Snyder, Erb 2008). Constipation is defined specific to the patient’s usual bowel movements; some people defecate only a couple times a week versus everyday. Opioid-induced constipation is specifically defined as an adverse effect of opiods caused by increased anal sphincter tone, reduced peristalsis of the small intestine, and impaired defecation response (“Patients receiving opioids”, 2013). Diagnosis of constipation requires assessment and completion of nursing history pertaining the patient’s fecal elimination patterns. Examples include obtaining information about their last bowel movement and the consistency of the stool. The physical examination includes auscultation followed by percussion of the abdomen. If the abdomen is found firm or distended it is suffice evidence of constipation. During the nurse history assessment any findings of bowel irregularity or discomforts are indications of constipation (Berman et. al 2008). Treatment of constipation includes lifestyle modification and pharmacological agents. Usually lifestyle modification precedes pharmacological remedies, however laxatives are frequently given as a first-line treatment in all patients receiving opioids to avoid opioid-induced constipation. Lifestyle changes include exercise and altering patient’s diets by adding bulk to stimulate peristalsis of the GI tract (Woodward, 2012). A number of various laxatives are prescribed to relieve constipation including stimulant laxatives, bulking agents, osmotic agents and stool softeners. W.H. was administered to the hospital for spinal surgery to correct the damage from his degenerative disc disease. W.H was transferred to 4A for postoperative care where he was administered various analgesics, including opioids, to control his pain. Postoperative day two W.H. complained of abdominal discomfort and verbalized having no bowel movement since being administered in the hospital. After performing an abdominal assessment, the findings of slightly distended abdomen and information obtained from the nursing history led to the diagnosis of opioid-induced constipation. Nursing implications and treatments for W.H included receiving various laxatives to stimulate the production of a successful bowel movement and decrease his discomfort level. W.H. received regulatory laxatives Docusate 100 mg to soften his stool, Polyethylene Glycol 17 g to incorporate water into his GI tract, and 2 tablets of Docusate Sodium to
