GERIATRIC

NURSING
MA.ALICIA GRACE S. KAIMO, RN, MAN
INSTRUCTOR

Universidad de Manila, College of Health Sciences

Module Title Theoretical Foundation of Nursing

Module No. 5

Total study hours () Hrs. Lecture

Module writer: Ma. Alicia Grace S. Kaimo

Introduction Objectives and Terminologies

Module Aims This aims to impart to the learners how to properly manage older adult
problem on constipation.
Module Learning Outcomes For the learners to understand the nursing management applicable to
Constipation.

Content Constipation

Teaching/Learning Activities Online, Synchronous, Asynchronous

Assessment methods
Program Bachelor of Science in Nursing

Level/Placement 3rd year, 1st semester

Course Title Geriatric Nursing

Course code NCM 114

No. of Units () units

Pre-requisite

Course Description

Rationale This course deals with the development of proper nursing care management on older client with
constipation problem.

Focus
The nursing care plan for older adult with constipation.

Outcome At the end of the course, the learners are expected to appreciate and utilize relevant nursing
management of older adult with problem on constipation.
LEARNING OBJECTIVES
By the end of this course, the learners will be able to:
Assess the needs of older adult experiencing constipation.
Implement nursing measures to alleviate problem on constipation.
11 Nursing Care Plans (NCP) and
Nursing Diagnosis for Geriatric
Nursing
4. Constipation
Nursing Diagnosis
o Constipation

Related Factors
Here are the common related factors for Constipation that can be
used for the “related to” of the nursing diagnostic statement:

o Changes in diet, decreased activity, and psychosocial factors

Defining Characteristics
The following are the common subjective and objective data or
nursing assessment cues (signs and symptoms) that could serve as
your “as evidenced by” for this care plan:

o Changes in bowel pattern; unable to pass stool

o Atypical presentation in older adults (changes in mentation, urinary
incontinence, unexplained falls)
o Straining with defecation
Desired Outcomes
Below are the commonly used expected outcomes or patient goals
for Constipation nursing diagnosis:

The patient will state that his or her bowel habit has returned to
normal within 3 to 4 days of this diagnosis.
Patient’s stool will appear soft, and the patient will not strain in
passing tools.
Nursing Interventions and Rationale
The following are sample nursing interventions and rationale (or
scientific explanation) for Constipation that you can use for our
geriatric nursing or gerontological nursing care plans:
Nursing Intervention Rationale
Nursing Assessment
Excessive roughage taken too
Quantify the amount of roughage to
rapidly can cause gas, bloating
the severity of constipation.
and diarrhea.
 Nursing Assessment
During admission, assess and record
the patient’s normal bowel
elimination pattern (frequency, time
of day, associated habits, and This assessment sets a baseline and
previous measures to manage identifies the normal bowel elimination
constipation). Discuss with the pattern of the patient.
patient’s significant others or
caregiver if the patient cannot
provide this information.
Assess hydration status for signs
of dehydration. Maintain diet, fluid,
The use of osmotic medications can
activity, and continuation of routines.
result in dehydration. Fluid volume
If there is an absence of bowel
deficit can result in hard stools, which
movement within 3 days, start with
are more difficult to pass.
mild laxatives to attempt to reattain
the normal bowel pattern.
 Therapeutic Interventions
Inform the patient that changes
happening during hospitalization
may increase the risk of
Constipation is not difficult to handle
constipation. Allow the patient to
preventively than it is when present
use effective nonpharmacologic
or prolonged.
management practiced at home as
this problem is observed or
prophylactically as needed.
Educate the patient about the
connection between fluid intake and Increase consumption of fluids can
constipation. Encourage fluid intake make the stool soft and lessens the
(2500 ml/day) unless risk of constipation. Patients with
contraindicated. Assess and record renal, cardiac, or hepatic diseases
bowel movements (amount, date, may have a fluid restriction.
time, consistency).
 Therapeutic Interventions
Instruct the patient to include
Having a roughage (raw fruits and
roughage in every meal when
vegetables, whole grains, legumes,
possible. For patients with low
nuts, fruits with skin) in the diet adds
tolerance to raw foods, encourage
bulk in the stool, therefore,
intake of bran via cereals, bread,
minimizes episodes of constipation.
and muffin.
Educate the patient about the
connection between activity level
and constipation. Support optimal Regular exercise stimulates
activity for all patients. Institute and peristaltic movement thus it can
build an activity program to foster reduce or prevent constipation.
participation; include devices
necessary to enable independence.
 Therapeutic Interventions
Scheduling interventions that
Encourage the patient to use his or
correspond with the bowel habits of
her gastrocolic or duodenocolic
the patient are more likely to
reflex to promote colonic emptying,
increase bowel movements. Taking
if the usual bowel movement
warm liquids in the morning, for
happens in the early morning. If the
example, also promotes peristalsis.
patient’s bowel movement occurs in
Digital stimulation of the inner anal
the evening, ambulate the patient
sphincter can trigger a bowel
just before the right time.
movement.
Try to use the patient’s previously
effective measures. Follow the Aggressive measures done may
maxim “start low, go slow” (i.e., lead to rebound constipation and
apply the lowest level of nonnatural can hinder with subsequent bowel
intervention and progress gently to movements.
a more powerful intervention).
 Therapeutic Interventions
Try to use the patient’s previously
effective measures. Follow the Aggressive measures done may
maxim “start low, go slow” (i.e., lead to rebound constipation and
apply the lowest level of nonnatural can hinder with subsequent bowel
intervention and progress gently to movements.
a more powerful intervention).
When giving pharmacologic therapy
to the patient, administer the more
benign, oral methods first. The
following hierarchy of laxatives is
recommended:

oBulk-forming additives such as

bra, methylcellulose, psyllium
 Therapeutic Interventions
oMild laxatives (apple or prune
juice, Milk of Magnesia)
oStool softeners (docusate calcium, Older persons tend to focus on the
docusate sodium) loss of habit as an indicator of
oPotent laxatives or cathartics constipation rather than on the
(senna, bisacodyl, cascara number of stools. Do not intervene
sagrada) pharmacologically until the older
oMedicated suppositories (glycerin, adult has not had a stool for three
bisacodyl) days.
oEnema (tap water, saline, sodium
phosphate/biphosphate)
Administer laxatives as ordered Administer laxatives as ordered after
after diagnostic imaging of the diagnostic imaging of the
gastrointestinal tract with the aid of gastrointestinal tract with the aid of
barium. barium.
 “A smile is the light in your window that tells
others that there is a caring, sharing person inside.”
Denis Waitley.
Thank you!!