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Case Study Week 4
Jena Boen
Lakeview College of Nursing
Gerontology
N309
February 09, 2012

Case Study Week 4
1.	How is constipation defined?
Constipation is “the lack of a bowel movement for 3 or more days” (Mauk, 2010, p. 239).  “Functional impairment of the colon may occur in elderly or bedridden patients who fail to responds to the urge to defecate” (Mosby’s, 2009, p. 441).  With healthy, older adults, there are a few different reasons they may be experiencing constipation.  This can include, “lack of dietary fiber, low levels of physical activity and lack of fluid” (Mauk, 2010, p. 239).  
2.	What is the probable cause of George’s constipation?
I think the probable cause of George’s constipation is dehydration and cognitive impairment.  Like I said in the above answer, one of the major causes of constipation in elderly adults can be lack of fluid. Since George is also retired, he may have a limited level of physical activity which could also lead to constipation.  (Mauk, 2010.)
3.	 What are additional causes of constipation?
There are several additional causes of constipation to consider with the elderly client.  These causes can be brought about by the normal aging process that slow “intestinal peristalsis” and the thirst mechanism is decreased, so the patient takes in less fluid.  (Porth, 2011, p. 545)  Some other causes of constipation include, “dehydration, decreased activity, lack of fiber in the diet, side effects of medications, and neurogenic bowel or other disease” (Mauk, 2010, p. 411)
4.	Medication classes known to cause constipation.
Medication classes that are known to cause constipation should be watched in older adults.  One class, Opioid Analgesics, cause constipation because they slow down the GI tract.  Drugs that have anticholinergic effects also cause constipation.  These have this effect because they cause decrease GI motility and muscle tone.  (Abrams, Pennington, & Lammon, 2009)  Other drugs that can cause constipation are “narcotics, calcium channel blockers, diuretics, calcium, iron supplements and aluminum antacids” (Porth, 2011, p. 719).
5.	What are complications of chronic constipation?
Complications of chronic constipation can include hemorrhoids and fissures in the anus from hard stool stretching.  Fecal impaction can occur that may have to be removed manually.  Lazy bowel syndrome is also a complication that can occur if laxatives are used frequently which cause the bowel to become dependent on them to function.  (Porth, 2011)
6.	What are treatments for constipation?
Treatment for constipation must depend on the cause of the client’s constipation.  It is recommended that the client start with the most natural means first and a clean bowel.  To start the treatment, the bowel must first be cleaned of any impactions and medications administered to cleanse the bowel.  (Mauk, 2010)  The client should make sure to only change one part of their bowel program at a time and should avoid using bed pans.  Also, the client should be given “the least caustic type of suppository that is effective for the older adult” (Mauk, 2010, p. 412).
7.	What types of nonmedical recommendations can the nurse encourage for this patient?
Some nonmedical recommendations the nurse can make would be to increase the daily intake of fiber in the client’s diet.  The client can do this by consuming whole grains, beans, root vegetables and bran cereals.  The client should also increase their fluid intake, preferably water, to around 1.5 to 2 liters every day.  (Mauk, 2010)
8.	What nursing considerations should Geneva, RN, make to the family for the management of George’s constipation with MOM?
The nurse could inform George’s family to give him the MOM on an empty stomach with around 240 mL of fluid which will increase the effectiveness of the medication.  MOM is not safe for “long term or prolonged use because they may produce a fluid and electrolyte imbalance” (Abrams, Pennington, & Lammon, 2009, p. 972).  The effects of MOM will occur within ½ to 6 hours and are used for rapid bowel evacuation.  (Abrams et al., 2009)

References
Abrams, A. C., Pennington, S. S., & Lammon, C. B. (2009). Clinical drug therapy (9th ed.). City, State: Publishers name.
Mauk, K. L. (2010). Gerontological nursing  (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.
Author or editor (2009).Mosby’s Dictionary of Medicine, Nursing & Health Professions (8th ed.). (2009).  City, State: Publisher.
Porth, C. M. (2011). Essentials of Pathophysiology (3rd ed.). City, State: Name of Publisher.