Sample Constipation Nursing Care Plan

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 InterventionsRationales 
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 administrationSuppositories 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 enemaThere 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 necessaryStool 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 InterventionsRationales 
When attempting to defecate, assist the patient to high-Fowler’s with the knees flexedThis position straightens the rectum which allows for the easiest passage of stool
Provide adequate privacyLack of privacy can cause and exacerbate constipation 
Educate the patient about pelvic muscle exercisesThese 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 chartA stool chart monitors the number and type of bowel movements to determine a baseline and detect irregularities 
In severe cases, consider surgeryIf 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 InterventionsRationales 
Educate the patient about dietary changes to prevent constipationIncreasing 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 constipationMedications such as opioids, diuretics, NSAIDs, and antidepressants can cause constipation
Educate the patient about laxative overuseLaxatives 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.

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