00011 Constipation

Domain 3: elimination and exchange
Class 2: gastrointestinal function
Diagnostic Code: <00011
Nanda Tag: constipation
Diagnostic focus: constipation
Approved 1975 • Revised 1998, 2017, 2020 • Level of evidence 3.1

NANDA Nursing Diagnosis Definition

Nanda’s nursing diagnosis « constipation » is defined as: evacuation of infrequent feces or with difficulty.

Definite characteristics

  • Evidence of symptoms in standardized diagnostic criteria
  • Hard feces
  • lumpy stools
  • Need for manual maneuvers to facilitate defecation
  • Elimination of less than three defecations per week
  • Sensation of anorectal obstruction
  • Incomplete evacuation sensation
  • Excessive effort in defecation

Related factors

  • Alteration of regular routine
  • Average daily physical activity is lower than recommended according to sex and age
  • Cognitive dysfunction
  • Barriers in communication
  • It usually represses the urgency to defecate
  • deterioration of physical mobility
  • Postural balance deterioration
  • Insufficient knowledge of modifiable factors
  • Inappropriate elimination habits
  • Insufficient fiber intake
  • Insufficient fluid intake
  • Insufficient intimacy
  • Stressors
  • Inappropriate use of substances

Risk population

  • Hospitalized people
  • People who experience prolonged hospitalization
  • People in geriatric residences
  • People in the immediate postoperative period
  • Older adults
  • Pregnant women
  • Women

Associated problems

  • Colon block
  • Recto’s lock
  • Depression
  • Disabilities of development
  • Digestive system diseases
  • Endocrine system diseases
  • heart disease
  • Mental disorders
  • Muscle diseases
  • Nervous system diseases
  • Neurocognitive disorder
  • Pelvic floor disorders
  • Pharmacological preparations
  • Radiation therapy
  • Uroginecological disorders

Suggestions of use

Use the diagnosis of constipation when the defining characteristics are present. Some patients mistakenly believe that they are constipated and self -medicate with laxatives, enemas or suppositories to ensure defecation up to date. For these patients, the diagnosis of subjective constipation should be used. When risk factors are present, but there are no symptoms, use constipation risk.

Suggested alternative diagnostics

  • Constipation, risk of
  • Subjective constipation

NOC Results

  • Self -care of ostomy: personal actions to keep the stoma for elimination
  • Symptom control: personal actions aimed at reducing adverse changes perceived in physical and emotional functioning
  • Intestinal elimination: Formation and evacuation of feces
  • Hydration: appropriate amount of water in the intracellular and extracellular compartments of the organism

Evaluation objectives and criteria

  • Improvement of constipation, which is manifested by intestinal elimination (specify from 1 to 5: seriously, substantially, moderately, slightly or not affected)
    • Intestinal habit
    • Soft and formed stool
    • Evacuation without help
  • Improvement of constipation, which is manifested by intestinal elimination (specify from 1 to 5: severe, substantial, moderate, mild, absent)
    • Blood in the stool
    • Pain when defecating

Other examples

The patient will be able to:

  • Prove that you know the intestinal evacuation regime necessary to counteract the side effects of medications
  • Manifest that it can evacuate with less pain and effort
  • Demonstrate appropriate hydration (for example, skin turgidity, fluid intake approximately equal to excreta)

NIC Interventions

  • Ostomy care: Maintenance of elimination through a stoma and tissue care that surrounds it
  • Sphincter training: help the patient to educate the intestine to evacuate specific intervals
  • Intestinal elimination management: establishment and maintenance of a regular habit of fecal evacuation
  • Liquid management: Promote liquid balance and prevent complications resulting from an anomalous or unwanted amount of liquids
  • Management of liquids and electrolytes: regulation and prevention of complications derived from hydroelectrolytic alterations
  • Building/impact management: prevention and improvement of constipation and impact

Nursing Activities

In general, nursing activities for this diagnosis focus on evaluating and treating the causes of constipation. Often this means promoting regular habits of evacuation, hydration, exercise or mobility and a diet rich in fiber

Valuations

  • Prepare a database on the intestinal regime, activity, medications and patient habit
  • Value and register:
    • Color and consistency of the first postoperative evacuation
    • Frequency, color and consistency of feces
    • Flatulence
    • Impact presence
    • Presence or absence of intestinal noise and abdominal distension in the four abdominal quadrants
  • (NIC) Management of constipation/impact ’.
    • Look for signs and symptoms of intestinal rupture or peritonitis
    • Identify factors (medications, bed and diet rest) that can cause or contribute to constipation

Patient and family education

  • Inform the patient of the possibility that constipation is caused by medications
  • Instruct the patient in the use of assistants for evacuation, which will facilitate an optimal intestinal habit once at home
  • Teach the patient the influence of the diet (for example, liquids and fiber) on evacuation
  • Inform the patient about the consequences of chronic use of laxatives
  • Highlight the importance of avoiding extreme effort to defecate in order to avoid changes in vital signs, dizziness or hemorrhages
  • (NIC) Management of constipation/impact: Explain to the patient the etiology of discomfort and the foundations of nursing activities

Collaboration activities

  • Consult a dietitian to increase fiber and liquids in the diet
  • Request a medical order to receive auxiliaries in the evacuation, such as dietary save, feces, enemas and laxatives
  • (NIC) management/impact:
    • Consult with a doctor if there is an increase or reduction of intestinal noise
    • Advise the patient to consult your doctor if constipation or impact persist

Others

  • Recommend the patient to request analgesics before defecating to facilitate painless evacuation
  • Encourage the patient to perform an optimal activity to stimulate intestinal evacuation
  • Ensure patient privacy and safety during defecation
  • Provide care with acceptance and without criticism
  • Give the patient the liquids you prefer, specify

At home

  • Teach the patient and the family to take a food diary
  • Teach the patient and their caregivers who should not extract the stool impacted, but to communicate it to the medical staff
  • Evaluate the accessibility and privacy of the bathroom at home

Babies and Children

  • In children, constipation is defined as the evacuation of hard stools, difficulties in evacuating, stained stained with blood and abdominal discomfort
  • For babies, add fruit to the diet (not compote or apple juice), or corn syrup to artificial milk
  • For children, mix saved with other cereals if you don’t like flavor. Offer plum juice, mix it with other juices or water if you don’t like flavor
  • Teach parents, when they start training for sphincter control, to monitor if they voluntarily retain stool, frequent cause of constipation in children
  • If constipation persists, channel it to primary care

Older people

  • Constipation is more frequent in older people than in other age groups. With aging, the rectal wall loses elasticity and the intestine secretes less mucus. Older people may also have less activity and ingest less liquids and fiber. In addition, the abuse of laxatives and the side effects of medicines can contribute to constipation
  • At the first symptom of constipation, establish a intestinal elimination management program