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Risk for Constipation/Diarrhea | Nursing Care Plan (NCP) Total Joint Replacement

Nursing diagnosis: risk for Constipation

Risk factors may include
Insufficient physical activity; decreased mobility, weakness
Insufficient fiber or fluid intake; dehydration, poor eating habits
Decreased gastrointestinal (GI) motility, effects of medications—anesthesia, opiate analgesics
Environmental changes, inadequate toileting

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Bowel Elimination
Maintain usual pattern of bowel functioning.
Demonstrate behaviors to prevent problem.

Nursing intervention with rationale:
1. Identify individual risk factors. Determine current situation and possible impact on bowel function—surgery, new and chronic use of medications affecting intestinal functioning, age, or weakness.
Rationale: Constipation is one of the most frequent complaints following surgery and during rehabilitation. If left untreated, constipation can lead to nausea and vomiting, bowel obstruction, or even sepsis, especially in the elderly.

2. Auscultate abdomen for presence, location, and characteristics of bowel sounds.
Rationale: Reflects activity of GI tract.

3. Determine usual elimination pattern or frequency, characteristics of stool— color, consistency, amount—manner of constipation, and use of laxatives.
Rationale: Provides baseline for comparison, promotes recognition of changes, and helps to establish a preventative plan.

4. Evaluate usual dietary and fluid intake; compare with current intake.
Rationale: Client’s usual diet and fluid intake may be marginal at best in promoting healthy bowel functioning, especially when combined with current postsurgical status.

5. Promote increased fluid intake, including water and high-fiber fruit juices; offer warm stimulating fluids, such as coffee, tea, and hot water.
Rationale: Prevents dehydration and decreases reabsorption of water from the bowel, promoting softer stool and facilitating passage of stool.

6. Encourage activity and exercise within client’s limitation of activity. Assist with early mobility.
Rationale: To stimulate and optimize GI function.

7. Provide privacy and routinely scheduled time for defecation based on usual pattern, as appropriate (e.g., bedside commode or toilet with elevated seat, after breakfast).
Rationale: To facilitate return of normalcy in toileting routine.

8. Consult with dietitian or nutritionist, as indicated.
Rationale: Helpful in providing a diet with balanced fiber and bulk that client can continue after discharge to improve consistency of stool and facilitate its passage.

9. Implement bowel program: administer routine stool softeners (e.g., docusate [Colace]); stool stimulants (e.g., bisacody [Dulcolax]), polyethylene glycol (Miralax); sennosides (e.g., [Senokot, Ex-lax]); bulk-forming agents (e.g., polycarbophil [FiberCon]), psyllium (Metamucil); saline laxatives (e.g., magnesium citrate), and enemas, as indicated.
Rationale: Used to prevent or treat constipation.
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