The nurse is developing a plan of care for an MS client with constipation. Which interventions are appropriate? SELECT ALL THAT APPLY

Rationale: A. Adequate hydration is crucial for softening stool and promoting bowel motility, especially in MS patients who may have neurogenic bowel or decreased mobility. Insufficient fluid intake can lead to hard, dry stools, worsening constipation and increasing the risk of complications like hemorrhoids or fecal impaction. B. Medications such as docusate (stool softener) or psyllium (bulk-forming fiber) can help prevent straining and make bowel movements easier. In MS, nerve damage may reduce peristalsis and bowel coordination, so these agents support regularity and prevent complications associated with chronic constipation. C. Physical activity stimulates the gastrointestinal tract and bowel motility. In MS patients, immobility already contributes to constipation due to slower colonic transit. Limiting activity would aggravate constipation. Gentle exercise, such as walking or stretching, should be encouraged to improve bowel function. D. Fiber increases stool bulk and water retention, which helps stimulate peristalsis and improve regularity. Foods like whole grains, fruits, and vegetables are recommended. Low-fiber diets, common in some MS patients due to chewing/swallowing difficulties or diet restrictions, can worsen constipation. E. Establishing a consistent routine, often after meals to take advantage of the gastrocolic reflex, encourages predictable bowel movements. This is especially important in MS clients with neurogenic bowel, who may have decreased sensory awareness of the need to defecate. Ignoring this can lead to infrequent, difficult, or incomplete bowel movements.