Chronic functional constipation

Domain 3. Elimination and exchange
Class 2. Gastrointestinal function
Diagnostic Code: 00235
Nanda label: Chronic functional constipation
Diagnostic focus: Functional constipation

Nursing Diagnosis Chronic Functional Constipation

Nursing diagnosis chronic functional constipation is a clinical condition where an individual has hardened stools and/or infrequent bowel movements that are not relieved. This diagnosis can be very uncomfortable, cause bloating and abdominal pain, other associated symptoms, and long-term health effects if not addressed. A comprehensive care plan should incorporate the focus of symptom relief, diet and lifestyle changes, and treatment or medication in order to obtain the best possible outcome.

NANDA Nursing Diagnosis Definition

The National Association of Nurses' Diagnoses (NANDA) classified chronic functional constipation as a type of gastroenterology nursing diagnosis. This diagnosis is also defined by difficulty or infrequency in passing stools, passage of dry and hard stools, and straining at stool leading to discomfort or pain. This diagnosis has implications for chronic gastrointestinal dysfunction, and could be the body’s way of signaling the need for more dietary fiber, more physical activity, more adequate hydration, less stress, or a different form of medication.

Defining Characteristics

Subjective:

• Complaints of infrequent, incomplete evacuation of fecal stools
• Straining at stool without passage of soft, formed stools
• A feeling of incomplete evacuation after defecation

Objectives:

• Involuntary postponement of defecation
• Lengthened intervals between defecations, typically one every 3 days or fewer
• Presence of abnormal stools in the colon, such as impacted stool
• Rectal examination reveals difficulty in evacuation of rectal contents

Related Factors

There are many factors that can contribute or be associated with chronic functional constipation. These can include dietary changes, medications, dehydration, psychological or environmental stress, hormonal variations during the menstrual cycle, certain diseases and disorders, lifestyle, movement, and age.

• Dietary Changes: The ingestion of inadequate amounts of dietary fiber can lead to chronic constipation. The body needs inordinate levels of fiber to help facilitate stool formation, as well as to maintain regular bowel movements.
• Medications: Certain medications such as opiates, anticholinergics, diuretics, antidepressants and antacids are known to reduce motility and result in constipation
• Dehydration: It is important to note that although various sources suggest that dehydration is not a primary cause of constipation, lack of hydration can contribute to disordered bowel movements.
• Stress: Stress can be a major contributor to constipation as can anxiety and depression resulting from stressful situations.
• Hormonal Variations: Hormonal variations can be brought on by menstrual cycle during certain times of the month or during menopause.
• Diseases and Disorders: Some diseases and disorders such as hypothyroidism, Alzheimer’s disease, irritable bowel syndrome, and diabetes have been observed to have a correlation with constipation.
• Lifestyle and Movement: Lack of exercise or adequate physical activity has been associated with constipation. Additionally, certain lifestyles can also be a contributing factor to chronic constipation.
• Age: Studies have indicated that constipation increases with age because of multiple factors such as decreased mobility, dietary changes and changes in physical activity associated with aging.

At Risk Population

Those most likely to experience nursing diagnosis chronic functional constipation are people over the age of 65, pregnant women, people suffering from mental health issues, people taking certain pharmaceutical medications, and individuals who don't get enough physical activity and eat a diet low in fiber. Additionally, the National Institutes of Health (NIH) report that dehydration and illness can also be risk factors for constipation.

Associated Conditions

Potential health conditions associated with chronic constipation could include abdominal cramping and/or bloating, decreased energy levels, difficulty passing gas, nausea, and confusion about food choices. Additionally, for those individuals whose diets consist of processed foods and who may not be physically active, constipation could increase the chance of developing chronic illnesses such as coronary artery disease, type two diabetes, hypertension, and stroke.

Suggestions of Use

It is important for those individuals who experience chronic constipation to act quickly to develop and maintain a consistent, healthy lifestyle. This should include gradual changes to decrease the severity, frequency and duration of constipation, as well as seek medical attention. Common treatments include dietary modifications, increased physical activity, use of natural supplements and herbs, acupuncture, and proper hydration. Additionally, self-massage techniques can help to stimulate sensation and peristaltic activity in the bowels.

Suggested Alternative NANDA Nursing Diagnosis

There are several other alternative NANDA nursing diagnoses associated with chronic constipation. These alternative nursing diagnoses include:

• Ineffective Peristalsis
• Gas Exchange, Impaired
• Risk for Imbalanced Fluid Volume
• Imbalanced Nutrition: Less than Body Requirements
• Risk for Deficient Fluid Volume
• Risk for Bowel Incontinence

Usage Tips

The following are tips for managing nursing diagnosis chronic functional constipation:

• Drink adequate amounts of water – usually six to eight glasses a day
• Increase intake of fiber, whole grain breads and cereals, fresh fruits and vegetables, and bran in the diet
• Decrease the intake of dairy products, such as milk, ice cream, and cheese
• Reduce intake of caffeine-containing beverages and alcohol
• Increase physical activity, even light exercise
• Consider taking an herbal laxative, such as senna, cascara sagrada or aloe vera
• Perform a rectal massage using an aromatherapy oil
• Practice relaxation techniques
• Discuss any medications that may be contributing to the constipation

NOC Outcomes

The following is a list of the possible NOC outcomes associated with nursing diagnosis chronic functional constipation:

• Bowel Elimination: Refers to the ability to pass stool in an effective manner
• Nutritional Status: Refers to the patient's ability to consume, digest, and absorb nutrients sufficient to sustain their nutritional needs.
• Pain Level: Documents any or an increase in abdominal pain due to constipation.
• Self-care: Evaluations the patient’s ability to practice the self-care activities necessary to reduce constipation.
• Knowledge: Evaluates the patient’s knowledge regarding the risk factors of constipation.
• Gas Exchange: This will evaluate the ability of the patient’s lungs to adequately exchange oxygen for carbon dioxide.

Evaluation Objectives and Criteria

The evaluation objectives for nursing diagnosis chronic functional constipation are to:

1. Reduce symptoms of constipation.
2. Determine whether the patient's condition is manageable with diet and lifestyle changes.
3. Assess the need for further treatment or medication.
4. Analyze the effects of medications, if applicable.
5. Address any associated conditions as needed.
6. Identify any risk factors and develop strategies to reduce them.

Criteria for successful management and resolution of condition would include:

1. Reduction in bloating and abdominal pain.
2. Regular passage of soft and formed stools.
3. No feeling of incomplete evacuation after defecation.
4. Visits to the restroom no longer dreaded.
5. Continued education on the part of the patient to learn lifestyle modifying techniques to prevent recurrence.

NIC Interventions

The following is a NIC Interventions associated with nursing diagnosis chronic functional constipation:

• Bowel Management: Through diet modification and lifestyle adjustments, this intervention focuses on the management of constipation.
• Hydration Promotion: Assists the patient with increasing fluid intake to ensure sufficient hydration for normal bowel function and minimize problems associated with dehydration.
• Pain Management: Assist with using non-pharmacological/ pharmacological approaches to effectively manage pain associated with constipation.
• Nutrition Management: Knowing the importance of a high-fiber diet for optimal bowel function, this intervention involves education about diet and nutrition related to constipation.
• Bowel Training: Utilizing positive reinforcement and behavioral instruction to promote frequent and regular bowel elimination.
• Promotion of rest and relaxation: Encouraging the patient to rest and relax to reduce constipation.

Nursing Activities

Nursing activities for nursing diagnosis chronic functional constipation should involve education, support, and promotion of healthy habits. Nurses should monitor the patient's progress and provide instruction on the use of medication, when applicable, as well as how to make the necessary lifestyle changes for long-term success. They should also discuss the importance of drinking plenty of fluids and maintaining a balanced diet rich in fiber. In addition, nurses should encourage regular physical activity, stress reduction techniques and relaxation exercises, and provide emotional support and guidance.

Conclusion

Nursing diagnosis chronic functional constipation is a condition that affects many people and is often coupled with both physiological and psychological factors. Patients should follow diet and lifestyle recommendations to reduce and eliminate symptoms, as well as receive proper assessment and treatment if needed. While many cases of constipation can be managed with dietary adjustments, physical activity, and herbal or natural supplements, if symptoms do not improve and an individual is particularly at risk due to age, environmental stress, or the presence of an underlying medical condition, it is imperative to get medical assistance right away.

FAQs

What are common symptoms of nursing diagnosis chronic functional constipation?

Common symptoms of nursing diagnosis chronic functional constipation include infrequent, incomplete defecation, straining at stool without passage of soft, formed stools, a feeling of incomplete evacuation after defecation, abdominal cramping and/or bloating, and decreased energy levels.

Who is most likely to experience chronic constipation?

Those most likely to experience chronic constipation are people over the age of 65, pregnant women, people suffering from mental health issues, people taking certain pharmaceutical medications, and individuals who don't get enough physical activity and eat a diet low in fiber.

What types of treatments are available for constipation?

Common treatments for constipation include dietary modifications, increased physical activity, use of natural supplements and herbs, acupuncture, and properly hydration. Additionally, self-massage techniques can help to stimulate sensation and peristaltic activity in the bowels.

What are the possible long-term health effects of constipation if left untreated?

If not addressed, chronic constipation can increase the chance of developing chronic illnesses such as coronary artery disease, type two diabetes, hypertension, and stroke.

What are the NOC outcomes associated with nursing diagnosis chronic functional constipation?

The NOC outcomes associated with nursing diagnosis chronic functional constipation are Bowel Elimination, Nutritional Status, Pain Level, Self-care, Knowledge, and Gas Exchange.

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