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November 2011, Volume 41 Number 11 , p 14 - 15


  • Harleah G. Buck PhD, RN, CHPN


"SNAKES. WHY'D IT have to be snakes?" In Raiders of the Lost Ark, Indiana Jones mutters this famous line as he peers down into the Well of Souls.As a nurse I've often wanted to mutter, "Bowels. Why'd it have to be bowels?" Of all of the symptoms that patients have to deal with in end of life, constipation is one of the most distressing and least discussed. Extremely common, constipation can have a strong impact on patient quality of life, yet many nurses feel alone in trying to address it.The National Digestive Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases, defines constipation as fewer than three bowel movements per week with stool generally hard, dry, small, and painful to pass.1 The patient may experience bloating or a sensation of fullness and strain to evacuate the rectum. Chronic or prolonged constipation can result in impaction and predispose the patient to perforation, sepsis, and death if left untreated.2Constipation is experienced by almost everyone at some time, but the prevalence is especially high at end of life. Advancing age, immobility, disease processes, and even treatment can increase the risk of constipation (see Constipation culprits).Constipation generally responds well to nursing intervention but often isn't routinely assessed and therefore isn't treated. Especially in the fast-paced world of 48-hour hospital stays, it's often easy to "let sleeping bowels lie." Besides being distressing for the patient, however, constipation contributes to negative patient outcomes such as prolonged hospital stays and increased readmissions. So what's the busy nurse to do?Like many symptoms, constipation is easier to prevent then treat. Prevention begins with teaching the patient and caregiver about good bowel hygiene. At every patient assessment, ask about the date of last bowel movement, diet, activity, use of laxatives and other medications, and history of constipation. Patients who are

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