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Case Study 15.4
Brittany M. Hicks
Lakeview College of Nursing
N-309
February 02, 2012

Case Study 15.4
Constipation is typically a gastrointestinal problem. Constipation is characterized by infrequent or difficulty with the passage of stool, lasting more than 3 days (Mauk, 2010). I believe that George’s most probable cause of constipation is dehydration and cognitive impairment. A common problem that older adults have with constipation is due to are a reduction in fiber intake, being inactive, and decrease fluid intake (Mauk, 2010). Some additional causes of constipation could be: nutritional habits, water intake, exercise, and all medications that they take (Mauk, 2010). According to Mauk, many older patients don’t have a sense of being thirsty, which can lead to insufficient fluid intake (Mauk, 2010). 
Some of the medications that can cause constipation are: antihypertensive, anticholinergic, iron, pain medications and antacids (Mayo Clinic, 2012)
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

. Some of the complications that can arise with chronic constipation are: hemorrhoids, anal fissures, stool impactions, rectal prolapse, and if laxatives are often used lazy bowel syndrome can occur (Mayo Clinic, 2012).
 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 

 Some common non-pharmacological treatments could be to increase exercise regularly, eat a high fiber diet, and increase your fluid intake (Mayo Clinic, 2012). Some alternative measures are introducing medication to help aid in constipation relief are: fiber supplements, stimulants, lubricants, stool softeners, osmotic, and saline laxatives (Mayo Clinic, 2012). Stool softeners were common on the cardiac step down unit that we had clinical at last semester; it seemed that all of my patients were on Colace. Another over the counter supplement would be Metamucil, my grandmother takes this every day. It depends on the patients symptoms and situation as to which would be the correct medication for him. 
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
Mayoclinic.com. (2012). Alternative Medicine. Retrieved February 11, 2012, from 	http://www.mayoclinic.com/health/constipation/DS00063/DSECTION=alternative-	medicine
Mauk, K. L. (2010). Gerontological nursing: Competencies for care. (2nd ed.) Sudbury, MA: 	Jones and Bartlett
Mayoclinic.com. (2012). Prevention. Retrieved February 11, 2012, from 	http://www.mayoclinic.com/health/constipation/DS00063/DSECTION=prevention
Mayoclinic.com. (2012). Treatments and Drugs. Retrieved February 11, 2012, from 	http://www.mayoclinic.com/health/constipation/DS00063/DSECTION=treatments-and-	drugs