Introduction: Constipation is an unpleasant and often distressing symptom that can happen to anyone at any time. Regularity of bowel movement is different for every person. “The diagnosis of constipation is based on the patient’s history, physical examination, possibly results of a barium enema and stool testing for occult blood”. (Day et al, 2010). Symptoms include frequency of defecation; hardness of stools; abdominal fullness or bloatedness, and abdominal pain. (Prynn,P. , 2011). It is non-life-threatening; it causes distress that leads to patient discomfort and diminished quality of life.
Constipation is considered a major health concern for providers of care, especially for patients in high-risk groups such as the elderly; less mobile individuals, and the neurologically impaired. The causes of constipation can be influenced by physical, psychological, physiological, emotional and environmental factors. I picked constipation to discuss because I am a Personal Support Worker, I provide care for the elderly; most of them have health conditions which are likely contributory factors.
Older adults are more prone to constipation than younger adults because peristalsis of the intestine usually weakened as we age; ingestion of certain medications; also due to reduced activity levels; muscle weakness and inadequate amounts of fluids and fibre intake. (Kozeir et al, 2010). As a primary caregiver to my Clients, I have to make sure they are meeting the quality of life by simply monitoring signs and symptoms of constipation. Prevention is better than to treat, every precaution must be made to prevent a recurrence.
Also, it is my responsibility to teach the family how to care for their love ones whom they suspect to be constipated. I have a Client who is paraplegic due to Spinal Cord Injury, she is also diabetic. Since March of 2010 she is on opioids for long term pain management. Recently an MRI has been done to her to see why her pain scale is always 10 out of 10, 10 as the worst pain she ever experienced. The Neurosurgeon said she has a syrinx on her spinal cord. He won’t do any surgery because it will only make her condition worst.
This means, she has to learn how to live with the pain since no further medical procedure will help her to be pain free from the syrinx. Knowing that constipation is a major problem for her since she is taking opioids for pain, I took up some in-service training conducted by my agency. I am trained to do digital stimulation and use of suppository for the management of chronic constipation. In her care, I often incorporate these procedures to prevent fecal impaction, as well as to prevent any complications that might be associated with constipation.
Educating the patient and health promotion are important functions of a nurse. First, it is vital for the adult Client and to her family to know how to manage constipation because opioid-induced constipation is a significant problem that requires attention and should be monitored frequently. Secondly, a stool softener is often employed and bulk-forming laxatives should be avoided because of the risk of obstruction. A member of the oncology team should be approached for advice if needed. (Prynn, P. , 2011).
Since my Client is using a power wheelchair, exercise is recommended, it tailored her physical ability and may benefit from daily activities such as moving her head, lifting her arms and hands while cooking, etc. Lifestyle modification such as providing privacy and strictly following the Client’s daily routine. Having a regular time for defecation (e. g. best time is after breakfast or after other meals or at bedtime). Lastly, provide dietary information. Suggest eating high-residue, high-fibre foods; adding bran and/or flaxseed daily (must be introduced gradually); and increasing fluid intake (unless contraindicated). Day et al. , 2010). To support nursing practice at the point of care, whether at the bedside, in a patient’s home, or in a community setting, Physicians, Nurses, Physiotherapist, Occupational Therapist, Pharmacist, Personal support worker to name a few interprofessional team members works hand in hand to promote quality of life to older adults. Each member of the interprofessional team plays an important role to the clients care but I want to discuss the role of the Dietician. Dieticians are experts in food and nutrition. Adapting what you eat may help to ease constipation.
Dieticians advise people on what food to eat which leads to a healthy lifestyle or achieve a specific health-related goal. Adjusting the diet, usually the elderly should eat more food containing cellulose, such as crude flour, brown rice, corn, celery, leek, spinach, and fruits to increase dietary fiber, stimulate and promote intestinal peristalsis. “Dietary fibre intake should be from 25 to 30 grams of dietary fibre per day. Dietary intake of fibre should be gradually increased once the client has a consistent fluid intake of 1500 ml per 24hours”. (Rnao,2005). Consultation with a dietician is highly recommended.
Another interprofessional team memeber that plays an important role in caring for older adults is the Dentist. The Dentist assesses the Client’s mouth for infection and bone loss on gums. Aging affects muscles of the gums to shrink, Clients are asked to see the dentist every 2-3 years for dentures refitting. ” People who have loose-fitting dentures or those who lost their teeth have difficulty chewing. Most of the time they prefer soft, processed meals that are low in fibre’. (Day et all. ,2010). Client’s with dentures are also educated to avoid eating hard foods to chew such as nuts, etc.
Denture sealers are also used to keep the dentures I place and to avoid irritating the gums by keeping the food out. Patient education and health promotion are important functions of the nurse. After health history is reviewed, the nurse sets specific teaching goals. These goals are for the patient to restore and maintain defecation, methods to avoid constipation, relieving anxiety about bowel movement elimination patterns and to avoid complications. (Day et al. , 2010). Nurses need to be aware of the condition and knowledge of its management.
If fecal impaction is suspected, depending on the agency policies the client is often given an oil retention enema, after 2-4 hrs cleansing enema is given, suppositories , or stool softeners which are ordered by a physician. A Digital Rectal Examination is done which means manual removal is feces should be performed if other measures fail. (Woodward, S. ,2012).
References: Day, R. , Paul, P. , Williams, B. , Smeltzer, S. , & Bare, B. (2010). Brunner & Suddarth’s Texbook of Canadian Medical-Surgical Nursing. (2nd Canadian ed. ). Wolters Kluwer Health; Lippincott Williams & Wilkins. Kozier, B. , Erb, G. , Berman, A. , Synder, S. , Bouchal D. , Hirst, S. , Yiu, L. , Stamler, L. , & Buck M. (2010). Fundamentals of Canadian Nursing Concepts, Process, and Practive. (2nd Canadian ed. ). Toronto: Pearson Canada Kyle, G. (2007). Developing a constipation risk assessment tool. Continence. UK. 1(1): 38-45 Prynn, P. (2011). Managing adult constipation. Practice Nurse (PRACT NURSE), 41(17), 23-8. Retrieved from database CINAHL with full text Woodward, S. (2009). Assessment and management of constipation in older adult. Gastrointestinal disorders. UK. 24(5). pp. 21-26