13.5

Case Study #4
Kalyn Madej
Lakeview College of Nursing 
N309: Nursing of the Gerontological Client
Aline Davis / Mary Edwards
February 12, 2012 

Case Study #4
1.	Constipation is defined according to Mauk as, “… the lack of a bowel movement for 3 or more days” (Mauk, 2010, p. 239). 
2.	Out of all of the listed options the most probably cause of George’s constipation would be C. which was dehydration and cognitive impairment. Mauk states, “A lack of dietary fiber, low levels of physical activity, and lack of fluid are associated with constipation among healthy older adults” (Mauk, 2010, p. 239). Since George is limiting his fluid intake to prevent urinary urgency, it actually may be a probably cause that would contribute to the constipation issue. 
3.	Other addition causes of constipation can be the lack of fiber in the diet, the deduction in physical activity, and the adverse effects of certain medications. 
4.	Medications that have been seen to cause some cases of constipations may be anti-hypertensive, anti-cholinergics, cholestyramines, iron and antacids. (Medications&The Digestive System, 2011). Also if George was prescribed any medications to treat his benign prostatic hyperplasia (BPH) may cause constipation depending on the medication.
5.	Chronic constipation according to Mauk is, “… recent review reported that chronic constipation was associated with serious consequences including fecal impaction, incontinence, and delirium, leading to severe curtailment in ADLs and, in some cases, necessitating hospitalization” (Mauk, 2010, p.239). These are very serious complications that should not be over looked. 
6.	When it comes to the treatment of constipation there are a few different options that the patient can try. Each treatment also depends on the initial cause of the constipation. One of the first things that may be suggested would be to add fiber to your diet along with incorporating some daily exercise. The patient may also be advised to use some lubricant laxatives and stool softeners to help pass the stool that has accumulated. There are medications that can be prescribed by the physician if some of the other options do not work. Enemas and even surgery may be used to help sure the patient of their constipation. These are some of the most common ways to treat constipation in modern day practice however the measure taken depends on the patient, the cause, and how severely the patient is constipated.
7.	When discussing treatment it is important to recommend some nonmedical alternatives. Some things the patient can do would be to increase the amount of daily fiber in their diet. Making sure that the patient is fully hydrated and receiving the appropriate amount of fluid intake will help with constipation. Exercise can also help to generate movement of the bowels. 
8.	In regards to George’s constipation with MOM Geneva, RN should be sure to inform the family about the warnings and side effects that George may experience while taking the MOM. It is very important that she include George with the side effects as well. The patient and family should notify the doctor if George starts to experience any signs of stomach pain, nausea, or vomiting. It is also important to notify the doctor if there is any sudden change in his bowel movements and patterns. If George is having any rectal bleeding the use of Milk of Magnesia should be stopped. The medication should also be terminated if there are no recorded bowel movements after administration of the medication. The family and George should be informed that for the medication to work the way it is supposed to it may take over a week for results. (Phillips’ Milk of Magnesia|Phillips’ Relief, 2010)
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

Resources
Mauk, K.L. (2010). Gerontological nursing: Competencies for care (2nd ed.). Sudbury, MA: 	Jones and Bartlett.
   
Ohio State University Medical Center. (2012). Medications & the digestive system.  Retrieved 	from http://medicalcenter.osu.edu/patientcare/healthcare_services/digestive_disorers/
medication_and_digestive_system/Pages/index.aspx

Bayer Health Care LLC. (2012).| Effective stimulant free, cramp free constipation relief.	Retrievedfromhttp://phillipsrelief.com/products/phillips-milk- 	magnesia?WT.mc_id=PHS120666& 	WT.srch=1