Constipation
Also Consider: Abdominal Discomfort, Diarrhea, Nausea/Vomiting, Rectal Bleeding, Vomiting Blood
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Causes
Common: Medications, inactivity, diet, dehydration, recent surgery/anesthesia, irritable bowel syndrome
Less common: Obstruction, hypothyroidism, depression, hypercalcemia, hyperglycemia
Sudden worsening of constipation can be a symptom of a significant illness.
1. Take Vital Signs
Temperature:
Blood Pressure:
Heart Rate:
Respiratory Rate:
Oxygen Saturation:
2. Evaluate Symptoms and Signs
Acute mental status change
Not eating or drinking as much as usual
Acute decline in ADL abilities
Signs of dehydration
GI: Nausea, vomiting, abdominal distention or tenderness, rebound tenderness, bowel sounds
Rectal check for impaction, appearance of stool
Fingerstick glucose (patients with diabetes)
Patient’s usual bowel habits
Patient’s preference for management of constipation
3. Take Action using SBAR Report:
Presence of other, significant symptoms or signs of illness
Refer to appropriate Situation-Specific Evaluation for the identified symptoms and signs.
Notify medical staff & resident representative within the next 16 hours.
Fecal impaction with no other symptoms or signs of illness
Notify medical staff on the next business day
No bowel movement in the last 3 days despite use of "prn" laxatives
Notify medical staff at the next regular rounds
Use of any “prn” laxatives more than three times in a week
SBAR Report
Situation: "Constipation associated with:" (fecal impaction) (no bowel movement since ___ )
Background:
Reason the patient is in the nursing home (rehab for___, long term care for __).
Bowel record for the prior week (dates, descriptions, use of prn medications).
Abnormal Vital Signs based on patient’s previous values
Recent barium study
Recent illness, surgery, medication changes
General observation of patient condition
Diet restrictions, Fluid restriction, thickened liquids
Tube feeding rate, water flush orders, residual measurements, recent changes
Assessment: I am concerned about: __________
Recommendations/Requests:
Stop a medication causing constipation: narcotics, calcium, iron, antihypertensives
Diet change
Laxative, considering patient’s preference
Adjust maintenance laxative(s) to prevent future episodes
Tap water enema
Other:
Clarify expectations for care, interventions, and illness course/prognosis. Repeat any telephone orders back to the provider to ensure that they are correct and complete
4. Implement Management Plan
Monitor fluid intake
Offer fluids frequently
Place on 24-hour report
Increase activity
Monitor meal acceptance
Dietitian / Clinical Nutrition consultation for diet adjustment
Avoid using stool softeners (such as docusate) given their limited effectiveness for constipation
Avoid using sodium phosphate enemas because of risks.
2025-04-26
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