{
  "name": "Constipation",
  "slug": "constipation",
  "url": "https://nursingplex.com/care-plans/constipation",
  "category": "Gastrointestinal",
  "summary": "Infrequent, hard stools; fiber, fluids, activity and safe laxative use.",
  "nursing_diagnoses": [
    "Constipation",
    "Acute pain",
    "Deficient knowledge"
  ],
  "overview": [
    "Constipation is infrequent or difficult passage of hard, dry stool, often with straining and a sense of incomplete evacuation. It is a symptom rather than a disease, and in hospitalized and older patients it is one of the most common and most preventable problems.",
    "Contributing factors include low fiber and fluid intake, immobility, opioids and anticholinergics, ignoring the urge, depression, hypothyroidism and mechanical obstruction. Untreated constipation leads to fecal impaction, overflow diarrhea, hemorrhoids, fissures and, rarely, perforation.",
    "Nursing care establishes a realistic baseline pattern, then combines fiber, fluids, activity and toileting routine with the least aggressive pharmacologic support that works."
  ],
  "key_facts": [
    {
      "label": "Definition",
      "text": "Fewer than three bowel movements per week, or a change from the person's own pattern with hard stool."
    },
    {
      "label": "Opioids",
      "text": "Anyone started on opioids needs a prophylactic stimulant laxative plus softener from day one."
    },
    {
      "label": "Impaction clue",
      "text": "Liquid stool leaking around a hard mass is overflow diarrhea, not true diarrhea — check with a rectal exam."
    },
    {
      "label": "Gastrocolic reflex",
      "text": "Toileting 30 minutes after a meal, especially breakfast, uses the body's natural urge."
    }
  ],
  "nursing_priorities": [
    "Establish the patient's normal bowel pattern and current deviation.",
    "Rule out obstruction and impaction.",
    "Increase fiber, fluids and mobility as tolerated.",
    "Establish a consistent toileting routine.",
    "Use laxatives appropriately and prevent dependence."
  ],
  "assessment": {
    "subjective": [
      "Reports of straining, hard stool or incomplete emptying",
      "Complaints of abdominal fullness, bloating or cramping",
      "History of usual bowel frequency and laxative use",
      "Reports of reduced appetite or nausea"
    ],
    "objective": [
      "Documented frequency and Bristol stool type",
      "Abdominal distention, hypoactive bowel sounds, palpable mass in the left lower quadrant",
      "Hard stool or empty vault on rectal examination",
      "Medication review showing opioids, anticholinergics, iron or calcium channel blockers",
      "Imaging showing stool burden if obtained"
    ],
    "related_factors": [
      "Low-fiber diet and inadequate fluids",
      "Immobility and weak abdominal musculature",
      "Opioids, anticholinergics, iron, antacids with aluminum",
      "Ignoring the urge, lack of privacy, bedpan use",
      "Hypothyroidism, hypercalcemia, neurologic disease or obstruction"
    ]
  },
  "goals": [
    "The client will pass a soft formed stool without straining within the expected interval.",
    "The client will report relief of abdominal discomfort and bloating.",
    "The client will describe fiber, fluid and activity strategies to prevent recurrence.",
    "The client will remain free from impaction."
  ],
  "interventions": [
    {
      "title": "Assess and document",
      "points": [
        "Record every bowel movement with Bristol type on a bowel chart.",
        "Auscultate and palpate the abdomen and perform a rectal exam when impaction is suspected.",
        "Review the medication list for constipating agents.",
        "Report absent bowel sounds, vomiting or severe distention that may indicate obstruction."
      ]
    },
    {
      "title": "Non-pharmacologic measures",
      "points": [
        "Increase dietary fiber toward 25–30 g daily with fruit, vegetables, whole grains and prunes.",
        "Encourage 1.5–2 liters of fluid daily unless restricted, including a warm drink in the morning.",
        "Promote ambulation and, for bedbound patients, abdominal massage and in-bed exercises.",
        "Provide privacy and an upright position with feet supported; use a commode rather than a bedpan when possible.",
        "Schedule toileting 30 minutes after breakfast."
      ]
    },
    {
      "title": "Pharmacologic support",
      "points": [
        "Use a stepwise approach: bulk former with adequate fluid, then osmotic, then stimulant as ordered.",
        "Give routine softener plus stimulant with all opioid prescriptions.",
        "Administer suppositories or enemas for impaction after digital assessment.",
        "Avoid long-term stimulant dependence and reassess the regimen regularly."
      ]
    }
  ],
  "patient_teaching": [
    "Explain that daily bowel movements are not required — the person's own pattern matters.",
    "Teach gradual fiber increases with fluids to avoid gas and bloating.",
    "Advise responding to the urge promptly and never straining.",
    "Report no stool for three days with pain, vomiting or distention."
  ]
}