Best Practices for Prevention and Assessment of Constipation in Older Adults, Lecture notes of Nursing

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Best Practices for Assessment and

Prevention of Constipation

Presenters: Shaila Aranha RN MScN LTC BPC Waterloo Wellington LHIN and Heather Woodbeck RN, HBScN, MHSA LTC BPC Northwest LHIN

February 10/11 2016

Constipation Poll

Please complete the true and false questions on constipation in the poll on the right side of your screen.

Objectives

1. Provide an overview of Constipation
2. Highlight best practice recommendations for

implementation of the RNAO Best Practice Guideline on Prevention of Constipation in the Older Adult Population.

3. Share resources to support implementation of best practices to address and prevent constipation.

Conditions that affect Bowels

• Colon cancer
• Diabetes mellitus
• Hypercalcemia/ hypokalemia
• Neurological conditions
• Parkinson’s disease
• Stroke
• Paralysis
• Damage to sacral nerve – childbirth.

Heart & Stroke Tips and Tools for Everyday Living 2010^7

Other Constipation Causes

• Habits and Patterns:
  • Ignoring the “Urge” to defecate
  • Abuse of laxatives
  • Lack of exercise
  • Dehydration,
  • Immobility
  • Low fibre diet and/or high carbohydrate diet

Prevention of Constipation Algorithm

10

Assessment: Bowel history Diet history Medication Review Functional Cognitive Physical 7 day bowel record/diary

Toilet at a consistent time of day

Tailor physical activity Increase fluid intake to between 1500-2000 ml/day

Increase dietary fibre to 21-25 gram/day

Evaluate using 7-day bowel record RNAO Prevention of Constipation BPG, 2011

Assessment Recommendations

1.0 Assess constipation by with a client history.

Bowel history includes...:

2.0 Assess fluid and fibre intake levels and Relevant medical & surgical history. 3.0 Review of Medications 3.1 Screen for risks of Polypharmacy

Medication-Associated

Risks for Constipation

3.0 Review the client’s medications to identify those associated with an increased risk for developing constipation, including chronic laxative use and history of laxative use. 3.1 Screen for risks of polypharmacy, including both prescription and over-the-counter drugs and their adverse effects.

4.0 Assess functional & cognitive abilities

True or False?

2. A resident with immobility is at risk for constipation…

True

Constipation - Interventions

Address Contributing Factors

• Insufficient fluid
• Decreased fibre in diet.
• Regular toileting
• Decreased mobility due to lack of exercise.
• Cognitive issues: ie, lack of recognition of urge to defecate.
• Medications that cause constipation

Monitor effect of interventions on BM’s

True or False?

4. Increasing fluid intake improves constipation

Generally True

True or False?

3. Adding fibre to residents’ diets

is a good way to prevent constipation…

True, most of the time…

Interventions - Fibre

8. Encourage daily fibre intake of 21-25 gms/day

• Must drink fluid to digest fibre!
• Consider using a dietary fibre supplement
• Gradually increase fibre intake as fluid intake increases
• Use caution with ‘bed-bound’ residents
• Refer to dietitian