15/15 but see comments

Case Study 4 (15.4)
Nina Fainter
Lakeview College of Nursing
N309
February 12, 2012

Case Study 4 (15.4)
1.	Constipation is a concern for the elderly. Mauk defines it as “the lack of a bowel movement for three of more days” (Mauk, 2010). Little activity, poor fluid intake, and diets low in fiber all contribute to constipation in the elderly. Also, peristalsis is slowed in the elderly causing slower GI motility. Serious consequences can result from chronic constipation. Older adults may suffer from fecal impaction, incontinence, and delirium because of constipation. Bowel elimination is a private matter so many people may not discuss causing more problems and risk of constipation (Mauk, 2010). 

2.	George’s constipation is likely caused by dehydration and cognitive impairment. Normal aging causes a decrease in thirst in the elderly which increases dehydration which can contribute to constipation. George also has a preexisting diagnose of BPH so he has been decreasing his fluid intake to help prevent urinary urgency. This will also be a factor in dehydration therefore causing dehydration and constipation. George has cognitive impairment which may contribute to constipation. He may lack the cognitive capability to seek help when he is constipated or to realize if he is not having regular bowel movements (Mauk, 2010). 

3.	Constipation can occur from the normal aging process. Peristalsis is slowed which slows GI motility causing constipation. Thirst is decreased which causes dehydration because of poor fluid intake. The older population is less active and decreased physical activity can cause constipation. It’s common for older adults to be on more than one medication which can cause side effects or because of normal aging the medications react differently in the body and can cause side effects such as constipation. Neurogenic bowel is another cause and a lack of fiber in the diet. Another uncontrollable factor that can cause constipation may be family history and the existence of a prior bowel disease. These causes can lead to other severe consequences such as fecal impactions and bowel obstructions (Mauk, 2010). 

4.	Medications that may cause constipation include opioids, antacids containing calcium and aluminum, calcium channel blockers, Anti-Parkinson’s agents, antispasmodics, antidepressants, iron supplements, diuretics, and anticonvulsants (National). 

5.	Chronic constipation may lead to more severe issues. Some of these issues that may arise include fecal impaction, bowel obstruction, incontinence, and delirium. These issues can cause a decrease in the ability to achieve ADLs and in some cases hospitalization may even be needed (Mauk, 2010). 

6.	Oral medications that can be used to help treat constipation are bulk formers such as Metamucil and Fibermed. These require a large amount of fluid intake to be successful so this may be difficult to accomplish in George’s case. Another option is stool softeners such as Colace/Docusate. Colace is one of the most common medications used to treat constipation but for it to be successful at least one liter of fluid must be consumed. In some instances this may prevent constipation and the Colace may not even be needed. Pericolace and Senna are peristaltic stimulators which are another oral medication that may be used. Rectal medications are another way to treat constipation. Glycerin suppositories (a mild form), bisacodyl suppositories also known as Dulcolax is a strong but effective form, CEO-2 suppositories work by releasing gas and extend the rectum, and a combination of a melted glycerin suppository, Colace, and soap in a plastic dispense bottle also known as Therevac are all rectal forms of medications. The Therevac may be the quickest form because it is already in liquid form (Mauk, 2010).

7.	If the bowel is impacted the first step would be to remove the fecal impaction. George should be encouraged to drink plenty of fluid to decrease the risk of dehydration and to consume a diet high in fiber. He may eat foods such as whole grains, beans, bran cereal, pulpy fruits, and root vegetables to name a few. Positioning and timing are also suggested. Normal bowel patterns are suggested. Also sitting up allows gravity to help. He should be as activate as possible as this will stimulate peristalsis (Mauk, 2010).

8.	Geneva should make sure that George is drinking plenty of fluids and increasing activity during the day as tolerated. When taking the MOM, it should be administered with eight ounces of water and to shake it before taking it. It should not be used as a long term therapy for constipation because it may cause bowel tone to be lost. It shouldn’t be given at bedtime because this may interrupt sleep habits. Eating citrus fruit after administration may help counteract the unpleasant taste also (Mosby’s, 2011).

References
Mauk, K. L. (2010). Gerontological nursing: competencies for care. (2nd ed.) Sudbury, MA: Jones and Bartlett 
Mosby's Nursing Drug Reference (24th ed.). (2011). Philadelphia: Elsevier Mosby.
National Digestive Diseases Information Clearinghouse. (n.d.) Constipation. Retrieved from http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/