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Case Study 15.4

Gregory Cahill
N 309
Lakeview College of Nursing

Case Study 15.4
1.  Constipation is usually defined as a lack of bowel movement for 3 or more days but in most hospital settings constipation is defined as a lack of bowel movement for 2 or more days (Mark, 2010).
2.  Dehydration and cognitive impairment are common causes of constipation (Mauk, 2010) and the most probable causes of George’s constipation.
3.  Causes of constipation in the elderly include a slowing of intestinal peristalsis and a decrease in the thirst mechanism, resulting in not enough fluids being drank (Mauk, 2010).  Other causes can be laxative abuse, decreased activity, and lack of fiber in the diet, side effects of medications, and neurogenic bowel or other disease (Mauk, 2010).
4.  Opioids, beta-blockers, benzodiazepines, and diuretics are known to cause constipation (Mayo Clinic, 2011).
• 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

5.  Complications of constipation include cognitive impairment, hemorrhoids, rectal prolapse, fecal impaction and lazy bowel syndrome in the case of laxative abuse.
6.  Constipation treatment starts with interventions before medications.  Interventions include changing diet, eating more fiber, drinking more water, increasing activity, and timing bowel movements so that you are trying to defecate at the same time every day.  If the previous interventions do not work then enemas and medications are used.
7.   Interventions include changing diet, eating more fiber, drinking more water, increasing activity, and timing bowel movements so that you are trying to defecate at the same time every day.
8.  The family should know that MOM can cause rectal bleeding or electrolyte imbalances and that MOM should not be taken within 2 hours of other medications (Leek, 2009).

References
Leek, V. (2009) Pharm phlash!. Philadelphia: F.E. Davis, Company 
Mauk, K. L. (2010). Gerontological nursing: Competencies for care (2nd ed.). Boston: 
     Jones & Bartlett.
Mayo Clinic. (2011). Constipation. Retrieved February 11, 2012, from 
     http://www.mayoclinic.com/health/constipation/DS00063/DSECTION=causes