Clinical Findings

GI/GU: Complaints of constipation; infrequent stools accompanied by discomfort, bloating, flatulence.

Possible Causes: Diuretics, loperamide, opioids, antidepressants, and medications containing iron, calcium, or aluminum; insufficient intake of dietary fiber; dehydration; hypothyroidism; hypokalemia; injury to anal sphincter; diminished or absent peristalsis related to surgery, cancer, diverticula, IBS, or functional incapacity.

Collaborative Management

• Assess bowel sounds, which may be infrequent; listen for a full 5 min before concluding that bowel sounds are absent.
• If no bowel sounds are heard, do not administer laxatives or prn enemas; notify HCP.
• Assess for abdominal distention and pain.
• Ask about last bowel movement and recent dietary intake.
• Assess Pt’s dietary intake, especially for consumption of high-fiber foods.
• Check MAR for medication that can cause constipation and for prn laxatives or daily stool softener order.
• If Pt has bowel sounds, is on a solid diet, and has a prn order for a laxative, check how soon laxative is designed to work, and administer it at appropriate time (e.g., some magnesium-containing laxatives work quickly; some are designed to work over 8 hr).
• If there is an order for a small-volume enema that can be self-administered or an oral laxative, ask Pt which they prefer. Explain how to use enema as needed.
• Monitor effectiveness of laxative and return of usual bowel function.
• Check for impaction; administer saline enema.