Last updated on December 28th, 2023
Here we will formulate a sample nursing care plan for Constipation based on a hypothetical case scenario.
It will include three sample nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales.
Constipation Case Scenario
A 77-year old patient presents to the emergency room with complaints of nausea, loss of appetite, and abdominal pain. The patient has a history of osteoporosis and constipation. She had a recent admission for a fall and subsequent hip replacement 3 weeks ago, and was sent home from the hospital on oral opioids. The patient reports that she was also prescribed a stool softener, but she hasn’t been taking it because “it’s difficult to walk and I was afraid it would cause diarrhea.” She reportedly hasn’t had a bowel movement in 6 days.
Upon assessment, the temperature is 37.5 C, heart rate is 90 BPM, blood pressure is 126/83 mmHg, respiratory rate is 23 breaths per minute, and oxygen saturation is 97% on room air. Upon auscultation, the lungs are clear but no bowel sounds are heard. Palpation of the abdomen is mildly painful for the patient.
An x-ray of the abdomen and pelvis is performed and shows a dilated colon and a large fecal burden. A CT scan is performed to rule out any acute process and no obstruction or ileus is seen.
The patient is admitted to the hospital with Constipation.
#1 Sample Constipation Nursing Care Plan – Dysfunctional Gastrointestinal Motility
Nursing Assessment
Subjective Data:
- The patient reports nausea, loss of appetite, and hasn’t had a bowel movement for 6 days.
Objective Data:
- Absence of bowel sounds
- Large fecal burden confirmed on x-ray
Nursing Diagnosis
Dysfunctional gastrointestinal motility related to post-surgical opioid use and decreased mobility as evidenced by the absence of bowel sounds and a large fecal burden noted on x-ray
Goal/Desired Outcome
Short-term goal: The patient will report passing gas and bowel sounds will be auscultated by the end of the shift.
Long-term goal: The patient will defecate soft, formed bowel movements every day to every third day.
Constipation Nursing Interventions with Rationales – Dysfunctional gastrointestinal motility
| Nursing Interventions | Rationales |
| Administer oral laxatives: Bulk fiber e.g. Metamucil Stool softeners e.g. docusate (Colace) Osmotic laxatives e.g. Milk of Magnesia or Miralax Stimulant laxatives e.g. Senokot (sennosides) Lubricants e.g. mineral oil | Bulk fiber increases the amount of water in the stool, which makes it softer and easier to pass. It also increases the bulk of the stool which stimulates the movement of the intestines. Stool softeners increase the amount of water in the stool, making it softer and easier to pass Osmotic laxatives work by drawing more water into the intestines Stimulant laxatives irritate the intestines and cause them to contract, promoting a bowel movement Lubricants coat the surface of the stool making it easier to pass |
| Consider suppository administration | Suppositories have the same classifications as oral laxatives but work more quickly. If the oral medications are ineffective or working too slowly, consider a suppository. Do not administer to patients with low platelets, rectal bleeding, or rectal prolapse. |
| Consider an enema | There are many different types of enemas: fleet, mineral oil, saline, etc. An enema is quite invasive and should be used sparingly. |
| Perform a rectal exam and digitally disimpact if necessary | Stool that sits in the rectum for long periods can become hard and difficult to pass. Use of a lubricated, gloved finger can help break up the stool |
#2 Sample Constipation Nursing Care Plan – Risk for injury
Nursing Assessment
Subjective Data:
- The patient complains of nausea and abdominal pain
- The patient hasn’t had a bowel movement in 6 days
Objective Data:
- Absence of bowel sounds
- A large stool burden is noted on x-ray
Nursing Diagnosis
Risk for injury related to complications of constipation as evidenced by abdominal pain, absence of bowel sounds, and 6 days since last bowel movement
Goal/Desired Outcome
Short-term goal: By the end of the shift bowel sounds will be auscultated and the patient will report a lessening of abdominal pain
Long-term goal: The patient will have regular, soft bowel movements every day to every 3 days
Constipation Nursing Interventions with Rationales – Risk for injury
| Nursing Interventions | Rationales |
| When attempting to defecate, assist the patient to high-Fowler’s with the knees flexed | This position straightens the rectum which allows for the easiest passage of stool |
| Provide adequate privacy | Lack of privacy can cause and exacerbate constipation |
| Educate the patient about pelvic muscle exercises | These exercises can help strengthen the pelvic muscles, leading to easier bowel movements. To perform the exercise, the patient should clench their sphincter muscles as if stopping a bowel movement, hold for 5 seconds, then relax for 10 seconds. |
| Start a stool chart | A stool chart monitors the number and type of bowel movements to determine a baseline and detect irregularities |
| In severe cases, consider surgery | If lifestyle changes are ineffective and other treatment strategies fail, surgery may be recommended to relieve a stricture or blockage |
#3 Sample Constipation Nursing Care Plan – Knowledge deficit
Nursing Assessment
Subjective Data:
- The patient admits to not taking her prescribed stool softener because she was worried it would cause diarrhea
Objective Data:
- Absence of bowel sounds
- Large stool burden noted on x-ray
Nursing Diagnosis
Knowledge deficit related to factors that cause constipation as evidenced by patient admission that she didn’t take prescribed post-surgical stool softener
Goal/Desired Outcome
Short-term goal: By the end of the shift the patient will verbalize that surgery, opioid use, and immobility are factors that contribute to constipation.
Long-term goal: The patient will take stool softeners as prescribed and will maintain a regular bowel regimen.
Constipation Nursing Interventions with Rationales – Knowledge deficit
| Nursing Interventions | Rationales |
| Educate the patient about dietary changes to prevent constipation | Increasing fiber intake will help prevent constipation. Fiber can be found in fresh fruits and vegetables, beans, and whole grains. |
| Increase fluid intake | If not contraindicated, the patient should try to drink 2-3 L of water a day to keep stool soft and bowel movements regular |
| Increase activity | Increasing activity helps food move more quickly through the colon. |
| Educate the patient about medications that cause constipation | Medications such as opioids, diuretics, NSAIDs, and antidepressants can cause constipation |
| Educate the patient about laxative overuse | Laxatives should be used cautiously as overuse can cause serious, long-term issues such as dehydration, electrolyte imbalances, colonic nerve damage, and chronic constipation. |
Conclusion
To conclude, we created scenario-based three sample nursing care plans for Constipation. These nursing care plans include nursing assessment, NANDA nursing diagnosis, expected outcome, and nursing interventions with rationales.
Reference
Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). Elsevier.
Herdman, T., Kamitsuru, S. & Lopes, C. (2021). NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Thieme.
Swearingen, P. (2016). ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). Elsevier/Mosby.
