Disorders of the Gastrointestinal System, 2nd Edition
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Secondary constipation can be caused by other disorders and may not be treat- able with lifestyle changes. Some condi- tions contributing to chronic secondary constipation were listed above, including neurological, metabolic, and connective tissue disorders. In some cases, a cause is not identified, the cause may not be able to be removed, or treatment is not achieved with dietary and lifestyle chang- es, and medications may be necessary for long-term treatment. For example, pa- tients who must take opioid medications may not be able to stop taking these med- ications and may require lubiprostone (Amitiza). Other drugs for the treatment of idiopathic chronic constipation include linaclotide (Linzess) and plecanatide (Tru- lance) (Rao, 2022). | NURSING ALERT Constipation in a patient with an ile- ostomy may rapidly progress to a full small bowel blockage and is extreme- ly dangerous. Patients can quickly be- come dehydrated, and removing the blockage is considered urgent. Pa- tients who experience no output from their ileostomy stoma for six hours or more should be instructed to call their ostomy nurse or healthcare pro- vider and will likely need to visit the emergency department for an ileos- tomy lavage (National Health Service, 2022; United Ostomy Association of America [UOAA], 2020). Patients with an ileostomy should be advised never to use laxatives without proper mon- itoring or ongoing assessment by a healthcare provider, as severe dehy- dration may occur (Memorial Sloan Kettering Cancer Center, 2022b).
| NURSING CONSIDERATION
Each individual has a different toler- ance level for exercise based on age and general health. Patients should consult their healthcare provider be- fore initiating an exercise regimen.
| NURSING ALERT
Some patients may have fluid restric - tions because of other health condi- tions. When providing patient educa- tion, be aware of overall health status and medically ordered fluid restric - tions (Drugs.com, 2022). It is important that patients be advised to avoid overusing laxatives. People who be- lieve that they must have a bowel move- ment every day may rely on laxatives to make this happen. Overuse makes the bowel dependent on laxatives to have a bowel movement (Basson, 2020). Overuse of enemas is also contraindi- cated. In particular, frequent use of sodi- um bisphosphate should be avoided be- cause it is a hypertonic solution that can absorb a significant amount of the colon’s sodium or pull intestinal fluids into the colon, thus causing dehydration (Drugs. com, 2022b). To help establish a normal pattern of bowel evacuation, a person should main- tain a regular time for bowel movements, such as in the morning after breakfast. Pri- vacy is important. Using a small footstool to enable thigh flexion while sitting on the toilet may facilitate bowel evacuation. Patients should also be told to respond as soon as possible to the urge to have a bowel movement (Marculescu, 2021).
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