NURSING DIAGNOSIS: Risk for constipation

related to:
  1. decreased gastrointestinal motility associated with manipulation of bowel during abdominal surgery, depressant effect of anesthesia and narcotic (opioid) analgesics, and decreased activity;
  2. decreased fluid intake;
  3. decreased intake of foods high in fiber.
Desired Outcome
The client will not experience constipation as evidenced by:
  1. usual frequency of bowel movements about two days after usual oral intake is resumed
  2. passage of soft, formed stool
  3. absence of increasing abdominal distention and pain, feeling of rectal fullness or pressure, and straining during defecation.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for signs and symptoms of constipation (e.g. decrease in frequency of bowel movements; passage of hard, formed stools; anorexia; increasing abdominal distention and pain; feeling of fullness or pressure in rectum; straining during defecation).
  2. Assess bowel sounds. Report a pattern of diminishing sounds or sounds that do not return to normal when expected.
  3. Implement measures to prevent constipation:
    1. increase activity as allowed and tolerated
    2. encourage client to defecate whenever the urge is felt
    3. assist client to the bathroom or bedside commode or place in high Fowler's position on bedpan for bowel movements unless contraindicated
    4. encourage client to relax, provide privacy, and have call signal within reach during attempts to defecate (measures to promote relaxation enable client to relax the levator ani muscle and external anal sphincter, which facilitates evacuation of stool)
    5. encourage client to establish a regular time for defecation, preferably an hour after a meal
    6. encourage use of nonnarcotic rather than narcotic (opioid) analgesics once period of severe pain has subsided
    7. when oral intake is allowed:
      1. instruct client to maintain a minimum fluid intake of 2500 ml/day unless contraindicated
      2. encourage client to drink hot liquids upon arising in the morning in order to stimulate peristalsis
      3. when diet advances, instruct client to increase intake of foods high in fiber (e.g. bran, whole-grain breads and cereals, fresh fruits and vegetables) unless contraindicated
    8. administer laxatives or cathartics and/or enemas if ordered.
  4. Consult appropriate health care provider if signs and symptoms of constipation persist.