Constipation stool softeners

CONSTIPATION The nurse checks the bowel elimination pattern daily because constipation can occur with repeated doses of a narcotic. The nurse keeps a daily record of bowel movements and informs the primary health care provider if constipation appears to be a problem. Most patients should begin taking a stool softener or laxative with the initial dose of a narcotic analgesic. Many patients need to continue taking a laxative as long as the narcotic analgesic is taken. If the patient is constipated despite the use of a stool softener, the primary health care provider may prescribe an enema or another means of relieving constipation. 

MANAGING CONSTIPATION. Constipation caused by decreased gastric motility can be a problem widi cholinergic dm. The nurse urges the patient to increase fluid intake up to 2000 mL daily (if healdi conditions permit), eat a diet high in fiber, and obtain adequate exercise The primary healdi care provider may prescribe a stool softener, if necessary, to prevent constipation. 

If you experience constipation, drink plenty of fluids, eat a high-fiber diet, and exercise (if your condition allows). If constipation persists, the primary health care provider may prescribe a mild laxative or stool softener. 

Constipation may occur as an adverse drug reaction. When the patient has constipation as an adverse reaction to another drug, the primary care provider may prescribe a stool softener or another laxative to prevent constipation during the drug therapy. Display 48-2 lists the names of some dm and drug classifications that may cause constipation. 

Also known as surfactants and stool softeners, emollients (e.g., salts of docusate) act by increasing the surface wetting action on the stool leading to a softening effect. They reduce friction and make the stool easier to pass. These agents are not recommended for treating constipation of long duration. 

Laxatives may provide appropriate relief when constipation occurs during the postpartum period, when not breastfeeding and in immobile patients. Patients who are not constipated but who need to avoid straining (e.g., patients with hemorrhoids, hernia, or myocardial infarction) may benefit from stool softeners or mild laxatives. 

Hydration, heating pads, relaxation, and distraction Stool softener and/or stimulants for constipation Antihistamine for itching Antiemetics for nausea or vomiting... 

Continue diet increments Constipation Fiber supplement Stool softener Abdominal radiograph Laxative (if x-ray confirms constipation)... 

Docusate Calcium (Surfak)/Docusate Potassium (Dialose)/ Docusate Sodium (DOSS, Colace) [Emollient Laxative/Fecal Softener] Uses Constipation adjunct to painful anorectal conditions (hemorrhoids) Action Stool softener Dose Adults. 50-500 mg PO + daily qid Peds. Infants-3 y 10-40 mg/24 h daily qid 3-6 y 20-60 mg/24 h + daily qid 6-12 y 40-120 mg/24 h + daily qid Caution [C, ] Contra Use w/ mineral oil intestinal obst, acute abd pain, N/V Disp Caps, syrup, Liq, soln SE Rare abd cramping, D Interactions T Absorption of mineral oil EMS Monitor for Sxs of electrolyte disturbances and hypovolemia d/t D OD May cause N/V/D and abd pain symptomatic and supportive... 

Finally, gastrointestinal distress in the form of nausea and vomiting is quite common with many of the narcotic analgesics. Because of their antiperistaltic action, these drugs can also cause constipation.48 Because this constipating effect can be quite severe, laxatives and stool softeners (see Chapter 27) can be used to prevent opioid-induced constipation in certain people, such as with patients who are at risk for fecal impaction (e.g., people with spinal cord injuries), or with people who are taking opioids for an extended period of time (e.g., patients receiving opioids for treatment of cancer-related pain).36,70... 

The effects that the drug has on the gastrointestinal tract are quite severe. Fentanyl use, whether clinical or recreational, will cause constipation in the user. It is recommended that patients always take laxatives or stool softeners when using fentanyl. At least one bowel movement every two to three days is recommended. Longer periods of time between movements can result in damage to the colon, intestines, and stomach. If it has been longer than three days since the last bowel movement, patients are instmcted to contact their physician,... 

Stool softeners and cathartics can be used in children, as in adults, to relieve symptoms of constipation. Nausea and vomiting generally diminish as opioid therapy is continued, but antihistamines with antiemetic effects, such as hydroxyzine or promethazine, may be helpful as adjuvants to diminish impleasant G1 symptoms. Reducing the opioid dose to minimal analgesic levels may help to limit sedation or drowsiness. Mild respiratory depression, an uncommon side effect in children, may require only that the opioid dose be reduced. 

Opioid-induced constipation is more troublesome in older patients, and it should be anticipated by instituting laxative therapy along with the narcotic. A typical laxative regimen consists of psyllium and a stool softener. A mild stimulant laxative such as bisacodyl (Dulcolax) can be added if constipation becomes problematic. 

A 72-year-old man has started taking lactulose for chronic constipation not relieved by stool softeners. He takes 30 mL tid and over the past couple of days he has had two or three loose bowel movements a day. Which of the following would be the appropriate next step A. Discontinue the lactulose as it is not indicated for chronic use. 

Therapeutically, mineral oil has been used in the treatment of constipation, as it acts as a lubricant and stool softener when taken orally. Daily doses of up to 45 mL have been administered orally, while doses of up to 120 mL have been used as an enema. However, excessive dosage of mineral oil, either orally or rectally, can result in anal seepage and irritation and its oral use as a laxative is not considered desirable. 

Long-term use of oral opiates is not routinely recommended for several pharmacologic reasons. Some opioids such as morphine and codeine have the tendency to cause constipation by slowing down the peristaltic action of the bowels, which can also result in a functional ileus. This effect can be minimized by administering laxatives and/or stool softeners in patients who require longer-term opiate therapy. Prokinetic agents may also be helpful in treating opiate-related constipation. 

Answer B. Docusate is a stool-softening laxative that facilitates mixing of oil and water via its surfactant properties. Drugs that have muscarinic blocking effects, like scopolamine and the antihistamines diphenhydramine and promethazine, tend to cause constipation by decreasing GI motility. Loperamide is an opioid derivative, with no analgesic activity, used in the treatment of diarrheal states. 

Lactulose is a hyperosmotic agent, which produces increased osmotic pressure within colon and acidifies its contents, resulting in increased stool water content and stool softening. It causes migration of ammonia from blood into colon, where it is converted to ammonium ion and expelled through laxative action. It is indicated in the treatment of constipation and prevention and treatment of portal-systemic encephalopathy, including stages of hepatic precoma and coma. 

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