Nursing Care Plan for Constipation / Encopresis

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Pathophysiology

Constipation is when a child has less than two or three bowel movements per week or dry, hard to pass stools. This is a common problem in toddlers who are toilet training and children.

Encopresis is when a child involuntarily passes stool in the clothing, despite being fully potty trained, most often as a result of constipation or withholding stool.

Etiology

Constipation occurs when stool stays in or moves too slowly through the colon. The extra time spent in the colon causes the fluid to be absorbed from the stool into the body, leaving hard, dry stool that is difficult to pass.

Encopresis occurs with chronic constipation. When the stool remains in the colon for too long, it causes the colon to stretch and the nerves are no longer able to send signals to the brain that create the urge to defecate. As the lower colon fills and expands, semi-solid stool from the upper colon leaks around the solid mass of stool and is passed without the child having control. This often gives the appearance of diarrhea and can be misleading.

Desired Outcome

Patient will experience a normal bowel pattern; patient will have soft, formed, easy-to-pass stools; patient will be free from incontinence

Constipation / Encopresis Nursing Care Plan

Subjective Data:

  • Abdominal pain
  • Loss of appetite
  • Pain when having a bowel movement
  • Avoidance of bowel movements (withholding, especially in public)
  • Repeat bladder infections (girls)

Objective Data:

  • Large, dry stools that are difficult to pass
  • Less than three bowel movements per week
  • Bright red blood on surface of stool
  • Bedwetting or daytime wetting

Nursing Interventions and Rationales

  1. Obtain medical and bowel history from parent

  2. Determine if constipation is an effect of other treatment or is functional. Many supplements (iron) and medications may cause constipation. Get information about regular bowel habits or changes in diet or routine.

  3. Assess abdomen:

    • Look for distention
    • Listen for slow bowel sounds
    • Feel for palpable mass or tenderness
  4. Child may have palpable mass on left side that is indicative of constipation. The back-up of stool may cause trapped gas and lead to distention of the abdomen as well.

  5. Assess vital signs

  6. Determine baseline. Severe constipation can lead to perforation and peritonitis – vital signs can indicate signs of infection.

  7. Assess anus and rectum for signs of bleeding

  8. Small fissures around the anus from the pressure of or from passing large stools may cause bright red, superficial bleeding. These fissures can become infected if not treated.

  9. Administer stool softeners or laxatives; suppositories or enemas as needed

  10. To soften stool and help pass impacted stool, a regular stool softener may be added to patient’s daily routine to help encourage normal bowel habits.

    Suppositories or enemas may be given to help relieve severely impacted feces.

  11. Encourage warm tub bath

  12. The warm water helps to relax the muscles in the rectum and soothe the perianal area.

  13. Educate parents on diet and lifestyle modifications for child

    • Increase dietary fiber intake
    • Decrease or avoid cow’s milk to check for intolerance
    • Encourage fruits and vegetables
    • Avoid processed foods or fast food
    • Avoid large amounts of fruit juice as it has a large amount of sugar which can lead to constipation
    • Encourage regular play and activity
    • Promote bowel training
    • Provide plenty of time and comfortable atmosphere for bowel movements
  14. Dietary changes help the colon process stool and help make the stool more easy to pass.

    Sugar and processed foods are convenient, but lead to constipation.

    Activity and exercise help promote peristalsis and the passage of stool.

    Routines are important for children, so setting times for bowel movements can help eliminate the need to withhold stool.

    Children need to have plenty of time, especially if passing hard stools. Rushing can cause them to withhold and make constipation worse.


References

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