Nurse's Pocket Guide

• Determine laxative/enema use. Note signs/reports overuse of
stimulant laxatives.
• Palpate abdomen for presence of distention, masses.
• Check rectum for presence of fecal impaction, as indicated.
• Assist with medical work-up (e.g., x-rays, abdominal imaging,
proctosigmoidoscopy, colonic transit studies, stool sample
tests) for identification of other possible causative factors.
NURSING PRIORITY NO.2.To determine usual pattern of elimination:
• Discuss usual elimination habits (e.g., normal urge time) and
problems (e.g., client unable to elimimate unless in own
home, passing hard stool after prolonged effort, anal pain).
• Identify elements that usually stimulate bowel activity (e.g.,
caffeine, walking, laxative use) and any interfering factors
(e.g., taking opioid pain medications, unable to ambulate to
bathroom, pelvic surgery, etc.).
NURSING PRIORITY NO.3.To assess current pattern of elimination:
• Note color, odor, consistency, amount, and frequency of stool.
Provides a baseline for comparison, promotes recognition
of changes.
• Ascertain duration of current problem and client’s degree of
concern (e.g., long-standing condition that client has “lived
with” may not cause undue concern, whereas an acute postsurgical
occurrence of constipation can cause great distress).
Client’s response may/may not reflect severity of condition.
• Auscultate abdomen for presence, location, and characteristics
of bowel sounds reflecting bowel activity.
• Note treatments client has tried to relieve current situation
(e.g., laxatives, suppositories, enemas) and document failure/
lack of effectiveness.
NURSING PRIORITY NO. 4.To facilitate return to usual/acceptable
pattern of elimination:
• Instruct in/encourage a diet of balanced fiber and bulk (e.g.,
fruits, vegetables, and whole grains) and fiber supplements
(e.g., wheat bran, psyllium) to improve consistency of stool
and facilitate passage through colon. Note: Improvement in
elimimation as a result of dietary changes takes time and is
not a treatment for acute constipation.
• Promote adequate fluid intake, including high-fiber fruit
juices; suggest drinking warm, stimulating fluids (e.g., coffee,
hot water, tea) to promote passage of soft stool.
• Encourage activity/exercise within limits of individual ability
to stimulate contractions of the intestines.
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
Diagnostic Studies Pediatric/Geriatric/Lifespan Medications 197
CONSTIPATION