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Case Study Four
Amanda L. Miller
N309 Nursing of the Gerontological Client
February 12 2012

	The definition of constipation in Mauk’s(2010) Gerontological Nursing, is a lack of bowel movements for 3 or more days. Associated with constipation includes, lack of dietary fiber, lack of physical activity, and lack of fluid. 
	The probably cause of George’s constipation is the dehydration and cognitive impairment related to his medications he is taking for BPH that is impairing his cognitive ability. His cognitive impairment is leading to him thinking that decreasing his fluids will help him with incontinence. Additional causes of constipation could be from diet, fecal impairment, incontinence, and delirium. 
. Additional causes of constipation are as follows: • immobility • side effect of medications diet (insufficient fiber intake) • coexisting medical illness (Alzheimer’s, hernias, metabolic/endocrine disorder, neurologic disorders/injury, muscular dystrophy, Parkinson’s, cerebrovascular accident, surgical adhesions, and/or abdominal surgery)
• obstructive disorders (e.g., tumor)
	Medications that are known to cause constipation include pain medications diuretics and those used to treat Parkinson's disease, high blood pressure and depression (Mayo Clinic, 2010).
Medications known to cause constipation are as follows: • ACE inhibitors • aluminum containing antacids
• antiarrhythmia medications • anticholinergics/antihistamines • antidepressants • antispasmodics
• antiparkinsonian agents • antipsychotics • benzodiazepines • beta-blockers • calcium channel blockers
• calcium supplements • diuretics • iron sulfate • muscle relaxants • neuroleptics • opiates

	Complications of chronic constipation include fecal impaction, incontinence and delirium leading to curtailment of ADL’s and in some cases, hospitalization (Mauk. 2010. P 239).
Complications of chronic constipation are as follows: 1. Fecal impaction that may result in intestinal obstruction, colonic ulceration, incontinence leakage of stool around the impaction, and an over compensated shift to diarrhea 
2. Excessive straining may result in increased risk of syncope/stroke, hemorrhoids, rectal prolapse, fissures, tears, and subsequent risk of infection 3. Megacolon (abnormal dilation of the colon) 4. Generalized symptoms of abdominal discomfort, rectal pain, bloating, distension, loss of appetite, nausea, or vomiting

	Treatments for constipation include medications, therapies involving dietary changes and bowel training, and sometimes surgery. Medications that could treat constipation are antidiarrheals, laxatives, and stool softeners. As I mentioned before, some therapies like dietary changes include increasing fiber and fluids into the diet. Bowel training is a therapy sometimes when you go to the bathroom at a specific time of day. Surgery is an option to those who need to correct an underlying problem. Sphincteroplasty is a surgery to repair a damaged or weakened anal sphincter (Mayo Clinic, 2010).
	Nonmedicinal recommendations were mentioned above with the help of bowel training, and dietary changes. There are other remedies that could assist in helping with constipation which include keeping the skin around the anus clean and dry to eliminate any discomfort with the bowel movement (Mayo Clinic, 2010). 
	Something the nurse could suggest to the family is to keep the mint flavored MOM in stock in their home. It is important that George keep a night time ritual before going to bed so that he remembers to take MOM. Because of his previous falls, it is incredibly important that the family remove any barriers that could limit his ability to reach the bathroom safely. This could mean removing any rugs or furniture out of the way. It is also important to install nightlights to help George see his way to the bathroom. 
Recommendations for further management of George’s constipation with MOM
should include the following: • take the medication with 8 oz of water • establish a clear plan for fluid and dietary intake • make sure his MOM is taken at the same time every other day, results usually
occur within 3–6 hours, so stools can be predictable after initial dosing • make sure this medication is not taken within 2 hours of other medications unless recommended by his nurse practitioner, because it can interfere with
absorption of other medications

References
Mauk, K.L. (2010). Gerontological nursing: Competencies for care (2nd ed.). Boston: 
	Jones & Bartlett.
Mayo Clinic. Fecal incontinence. (2010, August 14). Retrieved from 

	http://www.mayoclinic.com/health/fecal-incontinence/DS00477/DSECTION=lifestyle-
	
	and-home-remedies