Using Electronic Medical Records of Nursing Care to Characterize Constipation in Patients with Intracerebral Hemorrhage.

INTRODUCTION: Constipation is one of the common poststroke complications that directly affect the patients' quality of life in patients with intracerebral hemorrhage (ICH), which has not been paid enough attention. OBJECTIVE: This study investigates constipation's clinical characteristics and its risk factors in ICH patients driven by the electronic medical records of nursing care. METHODS: This retrospective chart review investigated patients with acute spontaneous ICH admitted at a tertiary care center from October 2010 to December 2018. Poststroke constipation was defined as a first stool passage occurring after 3 days postadmission and the use of enemas or laxatives after ICH. The associations between constipation present and potential factors were evaluated. RESULTS: Of 1,748 patients, 408 (70.3% men, mean age 58 ± 14 years) patients with poststroke constipation were identified. After adjusting for potential confounding variables, the risk factors independently associated with poststroke constipation are admission Glasgow Coma Scale score (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.44-0.88; p = 0.007), use of mechanical ventilation (OR 3.74, 95% CI 2.37-5.89, p < 0.001), enteral nutrition (OR 2.82, 95% CI 1.85-4.30, p < 0.001), hematoma evacuation (OR 2.10, 95% CI 1.40-3.16; p < 0.001), opioid analgesics (OR 1.86, 95% CI 1.32-2.62; p < 0.001), sedation (OR 1.83, 95% CI 1.20-2.77; p = 0.005), and vasopressors (OR 1.81, 95% CI 1.26-2.61; p = 0.001) in order. Similar associations were observed in the prespecified length of the stay subgroup. Patients with constipation were associated with a longer hospital stay length (2.24 days, 95% CI 1.43-3.05, p < 0.001) but not with in-hospital mortality (OR 1.05, 95% CI 0.58-1.90, p = 0.871). CONCLUSIONS: Our findings suggested that risk factors influence the absence of constipation after ICH with the synergy of different weights. The occurrence of constipation likely affects a longer length of stay, but not in-hospital mortality. Future prospective investigations are warranted to validate our findings and identify the optimal management of constipation that may improve the quality of life in patients with ICH.

Nonpharmacological Clinical Effective Interventions in Constipation: A Systematic Review.

PURPOSE: To identify nonpharmacological clinically effective interventions for constipation in adults. METHODS: A systematic review of experimental studies of nonpharmacological interventions addressing participants' management of constipation using samples of adults over 18 years of age was conducted. In evaluating the methodological quality of the eligible studies, we used the assumptions of the Cochrane Collaboration, and for the reporting of items in the systematic review we used the Model of Preferential Reporting Items for Systematic Reviews and Meta-Analyses. The protocol of this review was recorded in the International Prospective Register of Systematic Reviews of the University of York under number 43693. RESULTS: This review included 12 randomized controlled trials. Nonpharmacological effective interventions for the resolution of constipation were identified: individualized intervention based on the participant's modifiable risk factors of constipation promoting literacy in health; educational measures in dietary modification and lifestyle; and abdominal massage. CONCLUSIONS: Specific nonpharmacological interventions are crucial for nurses' clinical practice and of major importance for clients and families. Evidence on these interventions in resolving constipation is still scarce and fails to provide evidence-based data to support nursing clinical practice. CLINICAL RELEVANCE: Personal lifestyles, comorbidities, medication, and sedentary habits are likely to be risk factors in constipation. Thus, it is important to invest in nonpharmacological interventions that promote changes in behavior regarding prevention or resolution of constipation. Moreover, nursing researchers worldwide should conduct research for clinical practice regarding the fundamentals of care.

Evaluación y abordaje del estreñimiento en el paciente crítico / Evaluation and handling of constipation in critical patients

Objetivo: Valorar la eficacia de los cuidados enfermeros frente al estreñimiento e identificar, analizar y evaluar sus causas y consecuencias. Metodología: Estudio observacional, descriptivo y prospectivo, en UCI polivalentes de un hospital de tercer nivel (2013-2015). Criterios de inclusión: >18 años, estancia >7 días, con ventilación mecánica, portadores de sonda nasogástrica y nutrición enteral o mixta. Se excluyeron pacientes con enfermedad digestiva, encefalopáticos y con yeyunostomía/ileostomía. Las variables estudiadas (edad, sexo, peso, talla, enfermedad, tratamiento médico, tipo de nutrición y volumen, características deposicionales, cantidad y frecuencia, medidas correctoras y complicaciones) se recogieron mediante parrilla ad hoc. Dispone de autorización CEIC. Resultados: Se analizaron 139 pacientes con edad media de 62 años y estancia media de 11 días; un 63% padecieron estreñimiento. Opiáceos y antiácidos fueron los fármacos más administrados (99%), aunque los relajantes musculares, suplementos de hierro y/o calcio y antihipertensivos fueron los que dieron más estreñimiento (77, 75 y 70%). La dieta sin fibra fue la más utilizada (60% estreñidos), seguida de dieta con fibra (51% estreñidos) y la combinación de ambas (85% estreñidos) Un 56% usó laxantes como medida correctora, siendo el hidróxido de magnesio el más utilizado; un 54% las iniciaron el primer día. La retención gástrica fue la complicación más relevante (49%). Conclusión: El estreñimiento es un problema real multifactorial. Recomendamos: · Intensificar la vigilancia en pacientes con fármacos que favorecen el estreñimiento. · Utilizar dietas con fibra desde el inicio. ·Aplicar de forma precoz y combinada procinéticos y laxantes. Creemos necesario crear un protocolo para la profilaxis y manejo del estreñimiento (AU)

Objective: To evaluate the effectiveness of nursing care against constipation and to identify, analyze and evaluate causes and consequences. Methodology: Observational, descriptive and prospective study in polyvalent ICU tertiary hospital (2013-2015). Inclusion criteria: >18 years, stay >7 days, connected to respiratory support, with nasogastric tube and enteral or mixed nutrition. Patients with gastrointestinal pathology, encephalopathic and jejunostomy/ileostomy were excluded. The studied variables (age, sex, weight, height, pathology, medical treatment, nutrition and volume type, depositional characteristics, quantity and frequency, corrective measures and complications) were collected by ad hoc grill. It is authorized by the CEIC. Results: 139 patients with a mean age of 62 years and average stay of 11 days were analyzed; 63% suffered from constipation. Opiates and antacid were the drugs administered most frequently (99%), even though patients who took muscle relaxants, iron supplements and/or calcium and anti-hypertensive were the ones who suffered most from constipation (77%; 75%; 70%) The fiber free diet was the most widely used (60% constipated), followed by dietary fiber (51% constipated), and the combination of both (85% constipated). 56% used laxatives as a corrective measure, Magnesium Hydroxide being the most widely used; 54% began the first day. Gastric retention was the most relevant complication (49%). Conclusion: Constipation is a real multifactorial problem. We recommend: ·Intensified surveillance in patients with drugs that promote constipation. ·Use high-fiber diets from the outset. ·Apply laxatives and prokinetics early and in combination. We need to create a protocol for prophylaxis and management of constipation (AU)

Evaluation and handling of constipation in critical patients. / Evaluación y abordaje del estreñimiento en el paciente crítico.

OBJECTIVE: To evaluate the effectiveness of nursing care against constipation and to identify, analyze and evaluate causes and consequences. METHODOLOGY: Observational, descriptive and prospective study in polyvalent ICU tertiary hospital (2013-2015). INCLUSION CRITERIA: >18 years, stay >7 days, connected to respiratory support, with nasogastric tube and enteral or mixed nutrition. Patients with gastrointestinal pathology, encephalopathic and jejunostomy/ileostomy were excluded. The studied variables (age, sex, weight, height, pathology, medical treatment, nutrition and volume type, depositional characteristics, quantity and frequency, corrective measures and complications) were collected by ad hoc grill. It is authorized by the CEIC. RESULTS: 139 patients with a mean age of 62 years and average stay of 11 days were analyzed; 63% suffered from constipation. Opiates and antacid were the drugs administered most frequently (99%), even though patients who took muscle relaxants, iron supplements and/or calcium and anti-hypertensive were the ones who suffered most from constipation (77%; 75%; 70%) The fiber free diet was the most widely used (60% constipated), followed by dietary fiber (51% constipated), and the combination of both (85% constipated). 56% used laxatives as a corrective measure, Magnesium Hydroxide being the most widely used; 54% began the first day. Gastric retention was the most relevant complication (49%). CONCLUSION: Constipation is a real multifactorial problem. We recommend: • Intensified surveillance in patients with drugs that promote constipation. • Use high-fiber diets from the outset. • Apply laxatives and prokinetics early and in combination. We need to create a protocol for prophylaxis and management of constipation.

Assessment and treatment options for patients with constipation.

Constipation is a common complaint for people of all ages, with prevalence increasing with age and during pregnancy. Women are more likely to be affected than men. Severity of constipation varies from person to person; most people experience short periods of constipation during their lives, including possibly after surgery, while others have constipation as a chronic long-term condition that can significantly affect their quality of life. There are a number of factors that can contribute to developing constipation including diets low in fibre, changes in lifestyle, side effects of certain medications and low fluid intake. People can successfully treat constipation by making changes to their diet and lifestyle. However, medication may be required to manage constipation for some.

Childhood constipation: recognition, management and the role of the nurse.

Constipation is a common childhood condition that health professionals will encounter in many different settings. The majority of these cases of childhood constipation are idiopathic in nature. It is considered to exhibit the 'tip of the iceberg' phenomenon as a large number of cases remain undetected due to under-recognition by families, embarrassment regarding the condition, fear of receiving a negative response from health professionals, or parental belief there is actually something more seriously wrong and failure to accept the diagnosis. Prompt evaluation and management is likely to be associated with better outcomes. To ensure this, fast recognition of symptoms, with care taken to exclude any 'red flag' symptoms that could indicate an organic cause and subsequently a different treatment pathway, is essential. Nurses, given their regular contact with families in different settings, are suitably placed to detect these symptoms early and can play a vital role in successful management of the condition. Laxatives are the first line in management of constipation. Polyethylene glycol 3350 is the laxative that evidence-based guidelines from the National Institute for Health and Care Excellence (2010) recommend as the initial pharmacological management. Advice should also be given about supportive measures, including diet and lifestyle changes.

Successful Fecal Bacteria Transplantation and Nurse Management for a Patient With Intractable Functional Constipation: A Case Study.

Intractable functional constipation is a common gastrointestinal disorder that features persistent difficult defecation, reduced bowel movements, or a feeling of incomplete defecation. Despite many therapeutic approaches, there has not been an established standard treatment protocol. Fecal microbiota transplantation (FMT), an innovative therapy that was introduced recently, has been preliminarily shown to have good effects and is expected to have good prospects. However, nursing is also of great importance during the process of FMT. An innovative nursing care protocol is combined with FMT, with a view to improving the clinical symptoms and quality of life of patients with intractable functional dyspepsia. This case-based study addresses the effects of nursing interventions used during the treatment of one patient with intractable functional constipation who received FMT.

Looking after your health. 2. Avoiding constipation at work.

This article is to summarise key concepts for the health of the midwife, with particular focus on constipation. This is often a taboo subject even amongst women whi aren't midwives, so they do not always freely discuss the issue. It is a key discussion when talking through iron supplementation, hormonal changes and nutrition within the realm of the midwife. Raising awareness and taking care of your own bowel habits is key to enjoying future health and wellbeing.

Outcomes in non-surgical management for bowel dysfunction.

This retrospective review considers clinical outcomes of patients following non-surgical management of bowel dysfunction (faecal incontinence and constipation), within a tertiary centre's pelvic floor unit. Between November 2010 and January 2013, 443 patients were entered into a database and the results of their treatment were recorded. To capture the treatment modalities that patients received they were grouped into three categories: defaecatory techniques and/or pelvic floor exercises; dietary advice and/or medication recommendations; rectal irrigation or the use of anal plugs. Patients received a median number of three sessions with a specialist nurse or physiotherapist. After completing a programme of therapy, 81% of patients had an improved St Mark's incontinence score and 75% of patients had an improved Thompson's functional constipation score. Subjective symptom improvement was reported in 78% of patients. The majority of these patients were discharged in 2011 and 2012 and have not required follow-up, suggesting that non-surgical management is effective on a medium-term basis.

A multi-centre, randomised trial to assess whether increased dietary fibre intake (using a fibre supplement or high-fibre foods) produces healthy bowel performance and reduces laxative requirement in free living patients on peritoneal dialysis.

BACKGROUND: Constipation is a significant problem for many patients on peritoneal dialysis (PD). Due in part to dietary restrictions it is a common cause of technique failure and poor dialysis efficacy. Both consequences have an economic cost as well as contributing to a poor patient experience. OBJECTIVE: This study aimed to investigate whether an appropriate daily bowel habit could be achieved through a higher fibre intake, minimal use of laxatives and with no adverse effect on potassium, phosphate and fluid balance. METHODS: One hundred and seven patients who had been on PD for at least three months were recruited from seven renal units. They were asked to record daily bowel habits (Bristol Stool Form Scale: BSFS) and laxative use for four weeks. From this group 41 suitable patients with regular laxative use were identified and invited to enter the Intervention stage, Stage 2. Patients were randomised into one of three intervention arms: high fibre supplement (HFS); high fibre diet (HFD) or placebo. RESULTS: During the intervention stage, intake of HFS increased significantly between week 1 and week 4 (p = 0.04) and in the placebo group between week 1 and week 3 (p = 0.02). There was no significant increase in fibre intake for those on the HFD. Laxative dose appeared to decrease in the HFS group (38%) and the HFD group (16%) but these changes were not significant when compared to the placebo. CONCLUSION: This study has confirmed the prevalence of laxative use amongst patients on PD and shown that fibre use can confer improvements in bowel function without affecting biochemistry.

Milk and molasses enemas: clearing things up.

INTRODUCTION: We aimed to describe current nursing practice and clarify the safest and most effective dose of milk and molasses enemas used to relieve constipation in pediatric patients presenting to a suburban pediatric emergency department. METHODS: We surveyed emergency nurses about current practice in administration of milk and molasses enemas. In addition, we identified consecutive patients aged 2 to 17 years with a discharge diagnosis of constipation or abdominal pain between 2009 and 2012. Stable patients were included from the emergency department, in the absence of chronic medical conditions. For each patient, we recorded demographic characteristics, chief complaint, nursing administration technique, stool output, patient tolerance, side effects, amount of enema given, and patient disposition. RESULTS: We identified 500 patients with abdominal pain or constipation, 87 of whom were later excluded. Milk and molasses enemas were found to be effective at relieving constipation in our population, with a success rate averaging 88% in patients given 5 to 6 mL/kg with an institutional guideline maximum of 135 mL. The success rate was found to vary with age, along with the amount of enema given. DISCUSSION: Our nursing survey showed that varying practice exists regarding technique and dosing of milk and molasses enemas. Historical chart review showed that milk and molasses enemas in our emergency department were safe and effective with minimal side effects.

Constipation in palliative care: treatment options and considerations for individual patient management.

Constipation is an all too common symptom in palliative care patients and may be associated with a range of severe issues and experiences. Its effects on patients contribute to both physical and psychological scarring during a very distressing stage of life not only for the patient but also for their caregivers. It is during this time that, too often, the complexity of managing the condition moves the locus of control away from the patient toward the health professionals. This article considers a number of different treatment options and facets of individual management that may enable patients to move the locus of control back to a position of joint management by patients, caregivers, and health professionals.

[Phosphate containing enemas: one undervalued risky practice? The management of an adverse event]. / Gli enteroclismi a base di fosfati: una pratica rischiosa sottovalutata? La gestione di un evento avverso.

INTRODUCTION: The phosphate-containing enemas are widely used, both to manage constipation and as a preparation for endoscopic procedures and surgery in adults and children. Many studies report that the use of these laxatives can be dangerous. OBJECTIVE: To identify possible prevention strategies starting from a severe adverse reaction due to repeated administrations of phosphate enemas. METHODS: A working group was started, the literature was reviewed and recommendations for an appropriate use of enemas were discussed and implemented, to improve patients' safety. RESULTS: Phosphate-containing enemas were replaced with 125 ml water enemas; recommendations were spread to strongly limit the use of phosphate containing enemas and the use of laxative in the first and second semester of 2012, were confronted showing a change in habits and a reduction in the use of phosphate containing enemas. CONCLUSIONS: The implementation of several strategies, originated from an adverse event, succeeded in modifying the use of laxatives and phosphate-containing enemas.

Trajectory of medication-induced constipation in patients with cancer.

PURPOSE/OBJECTIVES: To determine the severity and trajectory of constipation among patients with cancer from opioids and/or vinca alkaloids. DESIGN: Exploratory, descriptive. SETTING: Moffitt Cancer Center, a National Cancer Institute-designated comprehensive cancer center in Tampa, FL. SAMPLE: 400 patients at risk for developing medication-induced constipation from opioids, vinca alkaloids, or both. METHODS: Patients' baseline data included the Constipation Assessment Scale (CAS), the constipation item from the Memorial Symptom Assessment Scale (MSAS) for intensity and distress, and the laxative interview. Following the interview, the medical chart was reviewed for clinical and demographic data. Patients were asked about constipation (CAS) and laxatives consumed (laxative interview) during eight weekly telephone calls. MAIN RESEARCH VARIABLES: Constipation presence, intensity, and distress. FINDINGS: At baseline, 63% of patients reported some level of constipation. During the eight weeks, constipation fluctuated with scores ranging from 0-16, with the opioid-only group showing a small but statistically significant decrease in intensity. Constipation intensity and distress on the MSAS were significantly correlated (r = 0.76; p = 0.000). CONCLUSIONS: The majority of the sample reported constipation that ranged from mild to severe, persisted over time, and caused symptom distress. Therefore, healthcare providers in the cancer center likely were neither adequately managing the medication-induced constipation nor apparently teaching patients to manage it themselves. IMPLICATIONS FOR NURSING: National Comprehensive Cancer Network guidelines support the importance of managing medication-induced constipation. However, guidelines are not being followed in many cases; therefore, more focus is needed on constipation in clinical and educational settings as well as more research. KNOWLEDGE TRANSLATION: Patients receiving opioids and vinca alkaloids are at risk of constipation. Currently, medication-induced constipation is poorly managed. Managing constipation may lessen symptom distress, thereby improving quality of life in these patients.

The effect of biofeedback training on patients with functional constipation.

The aim of this prospective quasi-experimental study was to explore the influence of biofeedback training on patients with functional constipation (FC). Changes in clinical symptoms, psychological status, quality of life, and autonomic nervous function in 21 FC patients before and after biofeedback training were investigated. The psychological status and quality of life were evaluated with the Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), and a Chinese version of the MOS 36-Item Short-Form Health Survey. Autonomic nervous function was assessed on the basis of heart rate variability recorded with a HANS-1000 autonomic nervous biofeedback apparatus. After a complete course of training (10 sessions), clinical symptoms were greatly improved (p < .01), and the SAS and SDS scores were markedly decreased. There was a significant difference in the SAS and SDS scores before and after biofeedback (p < .01). The scores of general health perceptions, physical functioning, emotional role functioning, bodily pain, and vitality were increased significantly (p < .05), especially the scores of general health perceptions and emotional role functioning (p < .01), which indicated that quality of life in FC patients was significantly improved. No marked improvement of autonomic nervous function was found. Although a slight improvement in autonomic nervous activity was found, there was no significant statistical findings (p > .05). We conclude that biofeedback training can improve clinical symptoms, psychological status, and quality of life in FC patients, but further research is needed to determine whether biofeedback training can improve the autonomic nervous function in FC patients.

Experiences of abdominal massage for constipation.

AIM: This study aims to illuminate participants' experiences of receiving abdominal massage for constipation. BACKGROUND: Abdominal massage has been found to decrease the severity of constipation and abdominal pain, but little is known about how patients experience receiving abdominal massage. DESIGN: The present study is a qualitative descriptive study, based on individual interviews. METHOD: Nine adults receiving abdominal massage for constipation were invited to participate. Semi-structured interviews were conducted in Sweden between 2005-2007. The interviews were transcribed and subjected to qualitative content analysis. RESULTS: Four themes were formulated: 'being on one's guard', 'becoming embraced by safe hands', 'being touched physically and emotionally' and 'feeling vulnerable'. The participants reported that they were on guard, i.e. they were sceptical about whether or not abdominal massage was effective and suitable. However, as the massage sessions continued, they found the massage pleasant and began to feel embraced and in safe hands. They described how the abdominal massage made them feel as 'being touched physically and emotionally' and their bowel habits were improved. Along with the improvements, their agony was gone and they felt relieved. However, they considered their new condition fragile and they felt vulnerable to relapse. CONCLUSIONS: Abdominal massage was experienced as pleasurable, and after treatment, the participants felt more comfortable with their bowel function. Participants described abdominal massage as affecting the whole person. RELEVANCE TO CLINICAL PRACTICE: Abdominal massage has been shown to be an effective intervention for constipation. A crucial aspect is that nurses need to be sensitive and respect the intimacy associated with the abdomen.

Does abdominal massage relieve constipation?

BACKGROUND: Abdominal massage has been used to treat constipation since the 19th century, yet questions remain over its effectiveness and which patient groups benefit from it the most. AIM: To determine whether abdominal massage is effective for the relief of constipation. METHOD: A review of observational studies, case reports and randomised controlled trials was carried out to determine whether abdominal massage is effective in relieving constipation. RESULTS: Abdominal massage can relieve constipation of various physiological causes. It stimulates peristalsis, decreases colonic transit time and increases the frequency of bowel movements. It also reduces discomfort and pain, induces. CONCLUSION: Abdominal massage should be considered when treating patients with constipation. It has no adverse side-effects and can easily be taught to patients and carers so they can undertake it themselves.