Who doesn't love to sit back and read a good article about Constipation? After pain, constipation is one of the most frequent complaints received from oncology patients. This month's posting tells you everything you may need to know about constipation in the oncology population. The goal of this post is to give you some excellent teaching points to pass onto your patients regardless of what area of the hospital you may work in.
Please forward your answers to: melissa.luebbe@ctca-hope.com
Questions
1. Your patient complains of being constipated for three days, which is unusual for them.
What important questions do you need to ask them about their constipation?
2. It has been determined that it is appropriate for your patient to start a bowel regimen for
opioid induced constipation. Help your patient navigate the laxative isle at their local
pharmacy. What different products are available, and what makes them different from
each other?
Discussion Question to blog
Why does an Oncology Nurse need to be an expert on constipation? How often does this topic come up in your area of practice?
Interesting Video
Pathophysiology of Opioid Induced Constipation
Geriatrics and Palliative Care Blog has been added to "Links You Might Enjoy."
I have yet to take care of patient that moves their bowels regularly without any assistance from conscious dietary changes or supplemental changes. Many patients under our care require high levels of pain medication to adequately treat their pain. Most of these patients use opioids to control their pain, but the most common complication that occurs from opioid use is constipation. Patients who regularly taking opioids for pain control are typically well-versed in their need for proper bowel regimen and therefore understand that dietary changes, increased exercise, and supplemental changes are necessary to encourage a healthy colon.
ReplyDeleteOncology nurses need to be experts on constipation so they can be proactive in preventing bowel obstructions caused by chronic constipation. When we are able to actively prevent constipation from occurring we can save our patients from unnecessary pain or discomfort. Most doctors prescribe stool softeners or laxatives as prophylaxis treatment when our patients are admitted to the hospital to prevent constipation from becoming an issue. As a nurse, we should be encouraging our patients to ambulate and stay active because that alone can be preventative of constipation and can help to keep our patients’ bowels moving. We need to keep constipation on the forefront of all care for patients, especially those that we are administering narcotics. Most patients are ordered stool softeners/laxatives as a PRN order and we need to be able to assess the patient’s normal bowel patterns, assess the last bowel movement, and use critical thinking to be proactive against constipation and administer the PRN stool softeners/laxatives before our patient’s develop constipation.
Very well said, Sammy!! :D
DeleteI totaly agree! As oncology nurses we are always facing constipation irregardless of cliical setting we are in. often on a daily basis. We must be the experts and be advocates for our patients as well as resources as we are often who they turn to for help and relief. I agree with the comments of all who have. Thanks shared.
DeleteI agree with Smantha in being proactive against constipation in trying to prevent constipation issues for the patients.
Deletei agree with Samantha about as oncology nurses, we need to be the experts and advocates on the field on constipation for our patients. We are the staff that they looked forward to and they listen to what we say to them.
DeleteSamantha, you are so right about being proactive when it comes to the patients and thier bowel habits whether they are using pain medications or not. When patients become constipated it affects their activity, appetite, and pain levels. We sure can help them out by being proactive and providing medications to prevent the constipation in the first place.
DeleteGreetings from Infusion! Oncology nurses must be familiar with constipation because most of our patients have it, at some point during treatment. This is because activity can be decreased, especially when one isn't feeling well or post-op, and many are on pain medication, for their cancer-related pain. Interestingly, there are even a couple chemos that cause constipation, as opposed to diarrhea! Usually infusion patients have just been assessed by the RPC, so these issues have been addressed. However, many times they are returning patients for whom the issue has since arisen, or they neglected to mention it earlier, and it dawns on them as they are in Infusion. We direct the pt to the RPC doctor or to the CM if we are unable to provide a solution.
ReplyDeleteGood points Theresa! And I did not know there were some chemos that cause constipation as a side effect. Learn something new everyday!
DeleteYes :) I agree with Theresa, all nurses MUST be familiar with constipation and be able to provide recommendations on it's management. It's extremely important to treat the condition before it becomes a bigger problem causing further emotional and physical distress to the patient.
DeleteAs Sam stated above, VERY few of our patients in Inpatient Oncology have normal bowel movements. Many are dehydrated from nausea and vomiting, weak and not getting enough exercise, and/or in constant pain. One huge side effect of narcotics is constipation. Most of our patients are ordered a minimum of senokot while inpatient. However, on admission, we ask the patient what medications they are taking at home and are sure to tell the doctor if they have any specific bowel regimen that is working for them. We also have a two day rule in our department: If a patient hasn't had a BM in two days, we are dispensing any prn softeners or laxatives. Id none are ordered, we are sure to inform the doc to get something on board. That is an uncomfortable feeling and can add to any misery they are already feeling. :(
ReplyDeleteKari that is great that your are vigilant to inquire what the patient may already be taking for their bowel regimine. I believe that this falls in line with the importance of good medication reconcilation. All to often they will have medications on their medication list that would sound like a sufficient bowel program but not asking the patient specifically about their bowel program sets us up for complications later. Many times there may be measures they are taking at home that may not be listed on the medication list because the patient may have started on their own. Great Post!
DeleteThe topic of constipation does not come up in the port rooms as often as it probably does in other areas of the hospital but I certainly do have quite a few patients that have expressed discomfort from constipation. In the oncology field there are several different reasons why constipation could occur as stated by several of my coworkers already. One of the major reasons would most likely be pain medication. Most of our patients are in some kind of pain and if they use medications to alter the pain then a good chance is you will have a change in bowel movements. Other reasons may include not moving around as much or not feeling well therefore the decrease on their intake can cause constipation.
ReplyDeletePatients seen in GI have complaints of either diarrhea or constipation. Constipation causes abdominal pain and discomfort and rectal pain/bleeding for patients with hemorrhoids or fissures.
ReplyDeleteMethods for management of constipation range from stool softeners to prescribing a full colon cleanse. The patient is taught how to titrate their own management once the initial problem has been tackled.
Samantha and all,
ReplyDeleteI am so glad to hear that the nurses are proactive in preventing constipation. Removing impactions in GI is embarrasing and difficult for the patient.
Cancer patients can face constipation for many different reasons. Many patients are on pain medications that cause constipation, chemotherapy, or the disease itself can cause it. It's important for oncology nurses to have the most update to date information on constipation to know how to treat it the best way possible. In Care Management this topic comes up often and probably daily. Sometimes it is difficult to narrow down the exact reason the constipation is occurring and often it's a combination of things. The continuity of our care in care management helps with this.
ReplyDeleteAndrea, I completely agree that nurses need to have the most up to date practice standards. I believe nursing can improve outcomes using current information related to constipation. Knowledge deficits, once patients receive education and subsequent reinforcement, become knowledge assets that will maintain patient health and well-being. It is every nurses responsibility to keep abreast on standard and new trends in therapy.
DeleteI agree that it is very important to have the most up-to-date information for our patients and assess frequently for any further education/ teaching the patient may need to help prevent constipation.
DeleteConstipation is common in the oncology practice. Some causes of constipation include chemotherapy, Opiods, sedatives, anticholinergic preparations, Diuretics, vitamins, sleeping meds, all of which are used by our patient population.
ReplyDeleteOther factors that can cause constipation include tumors, diet, decreased mobility, inadequate fluid intake and lack of exercise.
In survivorship patient are usually post treatment but still have complaints regarding constipation.
Helping the patient to understand the importance of increasing fiber and water intake and increasing exercise routines is very helpful for these patients.
It is also important as Jessica noted that even patients who are not on active treatment can suffer from constipation and need accurate assessment and treatment of bowel issues. Our patients' need for education does not end when treatment is completed.
DeleteNursing has a key role to positively impact patients’ bowel patterns. Thorough assessment of each patient’s usual bowel pattern should be documented with the first nursing encounter. Any subsequent nursing contact is an opportunity for education and evaluation towards patient wellness. The nursing process guides our practice standards; assess, diagnose (nursing diagnosis such as Alteration in Elimination: Constipation), plan, implement, and evaluate.
ReplyDeleteI feel the care management department is proactive with our oncology patient population’s bowel functionality. The care management department has taken a multidisciplinary approach working with physicians, naturopaths, and dietician to incorporate the necessary nursing, dietary, supplement, and medication interventions for oncology patients to maintain normal bowel patterns. Care management currently utilizes Eastern Cooperative Oncology Group (ECOG) Common Toxicity Criteria to grade constipation. 0: None, 1: Occasional or intermittent symptoms, 2: Persistent symptoms, 3: Obstipation with manual evacuation indicated, 4: Life threatening consequences.
I believe nursing can improve outcomes through patient education related to constipation. Knowledge deficits, once patients receive education and subsequent reinforcement, become knowledge assets that will maintain patient health and well-being.
Great point! We do often get the input of the other clinicians such as nautropaths and dieticians and all come together to give all the options. The nurses are the follow through!
DeleteIt is important as nurses that we remember to utilize all the ancillary departments to benefit our patient's in this matter. Diet modifications and suggestions can be so important, and our dietary department has unique knowledge in this area that the nurse may not have. Same with Naturopath; natural supplementation that can help with constipation can work in conjunction with medication therapy or stand alone. Thank you for the reminder Kelly.
DeleteI agree with using our CAM services for recommendations with constipation. In Radiation Oncology we refer to them often for constipation, diarrhea, N/V, esophagitis and fatigue.
DeleteI am in agreement with the use of our CAM. They are such a great resource for our patients. I am big supporter of natural methods for assiting in constipation relief.
DeleteAs most of our patients choose the natural method of dealing with side effects, it is most satisfying to have the CAM teams to help with the issues of chronic nausea, vomiting and constipation ( diarrhea too). We are fortunate to have this available to our patients and ourselves here at CTCA
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ReplyDeleteI agree with Sam, constipation is pain on top of another pain.
ReplyDeleteConstipation is very painful problem. Here In SDS part of our assessment is asking them when was their last bowel movement , their pattern and the quality of their BM . Most of our patients are on pain medications , they have decreased mobility, , lack of exercise that causes this problem, We as oncology nurses should be an expert with constipation issues because its a commom problem to oncology patients.We can help them a lot through proper education
ReplyDeleteI completely agree! Educating our patients and implementing appropriate interventions based on the cause and duration of the patients constipation are very important.
DeleteWe need to be experts because it is very common in oncology for several reasons such as use of pain meds, immobility, chemo-med induced, tumors causing blockage, and malnutrition due to N/V to name a few. I also feel many patients don't realize how serious constipation is and what can happen if it is not addressed.
ReplyDeleteI also feel we need to really assess the patients to see if they have signs of constipation because they don't always realize that they are constipated and focus on the pain alone. There have been several patients who were constipated and we helped them realized that and placed them on a consitpation management program set up by our doctor in conjunction with our dietician.
DeleteAs an inpatient nurse on the surgical units; constipation is definately one of the most important factors to consider. Return of normal bowel function after surgery is often complicated by such factors as increase in opiod medications, pain and fear of straining after surgery; and decreased mobility. For patient's with large abdominal surgeries, we anticipate and watch for carefully the return of bowel function, and question our patient's for signs of return such as passing flatus. As a nurse, I make sure that there is some kind of bowel regimen prescribed for the patient's in conjunction with their pain medications. Educating patient's on the necessity of laxatives and stool softeners of very important, especially as they go home to manage their bowel function. Many patient's not only experience anxiety over the return and maintanence of normal bowel function, but also over the use of laxatives. Many of their concerns involve how quick the onset of action, whether they will lose control of function before arriving to the bathroom, and developing dependency. In addition, constipation can prolong a hospital stay and even cause a return to the hospital. It can not be stressed enough how important this issue is to patient's and how important it is for nurses to not only be aware of bowel function, but be advocates for good bowel regimens and excellent educators of our patient's
ReplyDeleteMichelle,
DeleteYes, we definitely need to be advocates for good bowel regimens. It's almost embarrassing to say, but I rarely think of bowel regimen education when discharging a patient, even if they came in for constipation. It's often very busy on the inpatient unit and discharge education is usually very basic. Education involves return appointments, taking care of a drain, port, or PICC line, wound education, and emergency situations. Although I do review the patient's home medications with them, I rarely think to reiterate the importance of a good bowel regimen. This could most certainly prevent some of the readmissions.
As mentioned by many others already, oncology nurses are experts on managing constipation because it is so common in cancer patients. Care managers address bowel habits frequently, whether it be part of our nadir calls to patients post chemotherapy, as part of our assessment of GI symptoms, post surgical follow ups, etc. Not only does it affect patients' general health and physical comfort, appetite, and quality of life, if left untreated it poses a serious risk of bowel obstruction. I find that patients often try to manage it on their own and need specific guidance to develop an individualized constipation management plan, with the input of their physician, nutritionist, and naturopathic provider. Nurses are at the forefront of patient education and are instrumental in communicating instructions to patients and ensuring they understand the instructions and how to apply them.
ReplyDeleteConstipation does come up in other areas of nursing. I think, as Julie mentioned, the oncology patient tries to manage it on their own, maybe because it can be an embarrassing topic or they think "we" only manage oncology. I agree educating ahead of the problem is so important.
DeleteWhy does an Oncology Nurse need to be an expert on constipation? How often does this topic come up in your area of practice? In the outpatient surgical clinic, educating patients on constipation management and prevention is daily. Post-op patients have many obstacles to battle including pain and malnutrition (contributing factors) as well as ileostomy and colostomy cares. Oncology patients can develop bowel obstructions due to tumor involvement, so a top priority is prevention.
ReplyDeleteGood point! Post-op patients should be monitored carefully and are at a highter risk than the average oncology patient for becoming constipated. Nurses can certainly help patients by stressing the importance of monitoring thier bowels and adhering to a good program.
DeleteIn oncology patients it is important that we pay attention to their bowel patterns. Constipation in patients can cause patients to stop eating because of nausea, vomiting,and pain. . Also patients could stop taking their pain medications because of their fear in becoming constipatied. In oncology patients the topic of constiaption is a daily subject for our patients. That is why Oncology Nurses should be experts in this topic and give the patients the education they need in dealing with constipation.
ReplyDeleteYes, Jen. It always makes me feel bad when patients tell me in a weekly that they have been constipated for days and never mentioned it to anyone. I prefer to be proactive in educating/arranging appropriate consults for them.
DeleteGreat point Jennifer,
DeleteHere in OICC I have seen on more than one occasion the patient reports for uncontroled pain only to find that they are not taking their pain medications as prescribed. Often it will be because the patient is trying to manage their constipation on their own. It is a private matter for most people, and they will go to lengths to just deal with it themselves even if it means doing without their pain medications. As nurses we are primary teachers of appropriate medication administration and side effect management. All to often the patient receive prescriptions and cannot keep track of what they are taking and why they are taking it. Nursing education is such an important part of our jobs. Great Pot Jen.
Constipation is very common among all people but especially among cancer patients. Our patients have many contibuting factors that can cause constipation. Therefore, it is crucial that we as oncolgy nurses are well educated on constipation.
ReplyDeleteConstipation affects all aspects of the patient. If they are constipated they may experience decreased appetite, nausea and pain. This will lead to the patient consuming less that will prolong constipation. It is a cycle.
I have conversations about constipation with our patients almost daily. I always ask what they are already doing for the constipation and educate on additional things that they can try both OTC and dietary modifications (increase fluid, prune juice, warm liquids etc.). I always inform them that if the changes made due not manage the constipation, to let me know so that additional steps can be made (GI consult etc).
do not due
DeleteI agree that oncology nurses need to be constipation experts. We of course constantly see this in our practice, and have to know how to properly address it. It can cause our patient's to have further problems such as fecal impactation, bleeding, anal fissures, hemorrhoids, etc. I am a strong believer in managing constipation from a nonmedication standpoint also. I think incorporating the proper diet that becomes a regular part of person's lifestyle, normal exercise and activity, and using natural remedies such as foods to help aid in relief are extremely important parts of managing this. I realize these methods may sometimes not be enough for our patient's, but I think it is important that it is part of the treatment modality.
ReplyDeleteI like this repsonse Angela and I completely agree with you. Try and resolve the constipation naturally before taking medication. Patients take enough as it is.
DeleteAs an Oncology nurse, working in Radiation, constipation is always a concern. Our patients are on chemotherapy and taking opiods AND may be having pelvic irradiation. Most common side effects of radiation to the GI is diarrhea, but as a nurse, it is important to assess bowel habits on the first intervention with the patient , and in our department on each subsequent visit. Many times, I have educated my patients on relief of constipation using diet, fluid and exercise prior to requesting the addition of laxatives. Many weight fluctuations are a result of nausea, vomiting or anorexia that may have its roots in constipation. Addressing this issue can then resolve nausea vomiting and anorexia and improve qualtity of life.
ReplyDeleteI agree Judy, resolving these issues results in improved quality of life. Interesting point that diarrhea is a common side effect of radiation.
DeleteJudy, thanks for pointing out the role radiation plays in GI symptoms. I often forget what an impact radiation has, since I am not actively treating patients in a radiation setting.
DeleteI like what Tina does with her patients by asking them what they are already doing for their constipation and then offering more suggestions for ways to prevent it. In Infusion, like Theresa mentioned, patients often have just seen their doctor and it has already been addressed. But for those that are here for multiple days, it is part of our daily assessment to ask them about constipation/diarrhea. Also, a reminder that we do have patient education handouts on constipation that we can print for our patients.
ReplyDeleteI believe the issue of constipation arises in almost all areas of nursing. As a clinic RN, GI issues are discussed daily with each patient that passes through the clinic. There are so many factors that could cause the constipation, including: tumor location, oral intake, mobility, exercise, medications (both chemotherapy and pain meds). Many times, patients are unaware of how to take their constipation relief meds. Patient's get help managing their GI issues through the entire PEC team, which is helpful to the patients.
ReplyDeleteI agree Sheila! We have to make it a priority to educate our patients on constipation and help prevent this! We also utilize the PEC team to help provide the highest quality of care to our patients.
DeleteI think it is important for oncology nurses to be experts on constipation because our patients are at high risk for developing constipation. A lot of our patients are on high dose narcotics, have poor intake, and have a decreased level of mobility. All of these are risk factors for our patients developing constipation. Thus it is extremely important that we nurses educate our patients about constipation and be proactive on preventing it. The last thing our patients need is another problem and constipation can be extremely unpleasant!
ReplyDeleteAs previously mentioned, oncology nurses need to be experts on constipation because oncology patients are often afflicted with this condition. Many patients are taking pain medication which can cause constipation if not addressed ahead of time. Chemotherapy, lack of exercise, and poor fluid intake can also slow the bowels. Oncology patients tend to struggle to keep up their physicial momentum and often have a difficult time drinking as much as they should due to other symptoms. It is important to provide as much education as early as possible in order to help prevent this uncomfortable situation. This is a very common complaint expressed by patients at CTCA and it is not a stretch to say it is discussed at least once every couple of days.
ReplyDeleteI agree with Kelley H. Cancer is a very stressful disease, both physically and mentally. The medications used to treat this disease can cause numerous side effects. It's important to be knowledgable so that we can educate patient's as early as possible in order to prevent it.
DeleteOncology Nurses need to be experts on constipation on an everyday basis. Constipation comes up quite frequently in the infusion center due to patients receiving premeds for their chemo infusions, which in fact can increase the chance of constipation, along with patients being on pain meds or other medications. We make sure that we educate the patients to have a stool softener available if needed. .
ReplyDeleteI agree that the patients should have a stool softner avalible if needed because they have a good chance of getting constipated from the medications we give in the infusion center.
DeleteIt is good to know alot about constipation because the oncology patients can be affected because they are usually on so many medications and the tumor could also be in an area that makes for more constipation. In infusion the patients have usually just started to take their new medications, such as pain meds and then they have questions about how to take the medication and how to deal with side effects.
ReplyDeleteThis comment has been removed by the author.
ReplyDeleteIn my opinion the most important reason that we need to treat constipation in our oncology population is to improve quality of life and make it more acceptable for patients to help decrease their pain with narcotics
ReplyDeleteI agree. Constipation does highly impact quality of life. Sadly this is often overlooked.
DeleteGood point, Mary!
DeleteGreat comments by Samantha and Kelly's comments are well stated such as the patient being knowledgable on the need to recognize and manage constipation. In radiation oncology, I assess bowel habits with every consultation and with weekly visits as appropriate. Pain med use is an automatic assessment. It is surprising how many patients are unaware of the constipation potential. This is a great opportunity for teaching on the side effect of constipation and management with diet, activity, and constipation medications. I agree quality of life is signifficanctly effected by constipation.
ReplyDeleteConstipation comes up in the clinic by almost every patient! It's a common side effect of many medications, therefore, an oncology nurse needs to be an expert on constipation and be able to discuss simple solutions/recommendations when the problem arises.
ReplyDeleteConstipation may be caused by a multitude of factors, some of these include poor dietary intake, a sedentary lifestyle and poor fluid intake. Recommendations such as increasing the intake of fruits and veggies, water, and incorportation of some sort of physical activaty can go a long way! Most of patient's howeve,r require a bit more. This is when pharmacologic interventions and recommendations from the PEC team come in handy.
I agree, Jess, that PEC team recommendations can come in handy. Natural remedies can be a great alternative to conventional meds. I was also surprised that the article did not mention Relistor, as we had seen its effectiveness in the clinic.
DeleteIt is so important that all Oncology nurses need to be an expert on constipation because most if not all Oncology patients experience constipation at some point in their disease process. It is not usual for this issue to arise on a daily basis. Primarily because surprising to me is how often pain medication is prescribed without mention of constipation and proactive prevention education. Often if we do not initiate the conversation about the need for laxatives / stool softners it remains a mystery to the patient. Then they suffer in misery until it gets bad enough that they finally tell someone. Constipation is not something the average person likes to go around discussing. This is why it is so important for Oncology nurse to be good educators regarding constipation and prevention there of.
ReplyDeleteI agree with Debbie that constipation prevention education should be initiated at the begining of opioids therapy and that the patient needs to understand how important it is to take preventive action before constipation becomes a problem.
DeleteI agree! If patients are well educated on the liklihood of developing constipatin while taking opiod pain medications, they can be proactive in preventing it. As nurses we are primary educators for our patients and need to let them know that simple things such as increasing oral fluid intake and increasing movement (like walking in the halls) can really help them. I think it's also important to make sure the provider writing the script for the pain medication is also writing a script for a prophylactic stool softener.
DeleteI agree that often a pt is started a a new opioid pain medication without being advised of the common side effect of constipation. Pts don't like to discuss constipation. I often wonder if they even know initially that the abdominal discomfort they're experiencing is from constipation until a nurse directly inquires about their bowel habits. Thank you Debbie for reminding us that pts often aren't told about the side effect of constipation.
DeleteIt's especially important for all oncology nurses to understand constipation since most if not all cancer patients experience constipation for various reasons. This issue is very common in my unit. Most if not all patients come to my unit with a pca pump and are post surgical patients. Their bowels are still in the process of waking up from being manipulated during surgery and as we all know with surgery comes pain which is why pca's are often prescribed. Education is extremely important with each patient to help them understand the physiology behind what causes constipation and ways to help alleviate the effects. Activity, high fiber diet, and medications (laxatives, stool softeners, suppositories) are great ways to help with constipation.
ReplyDeleteOncology nurses need to be an expert on constipation because it is a very common problem among oncology patients.Opioids induced constipation can be prevented and patients need to be educated on ways to "stay regular"-proper diet, physical activity, adequate fluid intake are the basics in prevention but very often it is not enough and patients need to know what kind of over the counter medication is available to them. It's so much easier to prevent than to treat.
ReplyDeleteI usually prefer to push the natural methods first-the increase in fluids, prune juice, increase in fiber and activity and the ingestion of Senokot-S before starting the laxatives
DeleteAs an oncology specialized nurse it is very important know how to help our patients when constipated. Oncology patients have a high risk for constipation due to many reasons including tumor location, treatment, pain medications, altered diet, and decreased movement etc. As a nurse, one of our primary responsibilities is to educate our patient on how to prevent and manage consipation. As an outpatient stem cell care manager, constipation is a very common reported symptom and something that can have a large impact on a patient's quality of life when managed appropriately.
ReplyDeleteI agree with you Julie, There are many reasons why constipation occurs. Education about prevention is the is the building block our patients need to know in order to prevent further medical/health issues that could impact the little qualilty of life that oncology patients have left. Tami Z.
DeleteI agree with you Julie. The pain from constipation can be devilitating and can decrease any activity out of bed.
DeleteOncology nurse need to be experts in constipation due to the type of patient we treat. Our patients have many battles to face such as the use of pain medications, lack of mobility, lack of appropriate diet, and lack of fluid intake and issues with the cancer itself that places our population at risk. By teaching the patient and family memebers as we do in CM about prevention of constipation in decreases the possiblity of a negative issues on the patients quality of life. We see constipaton issues alot while we triage phone calls.
ReplyDeleteWe need to be experts in order to be able to assess the correct cause of the constipation first of all, and then formulate a plan. For example, is the condition simply from travel? Or is it from a combination of opioid therapy, poor dietary choices, and immobility? How often does it come up? Daily:-)
ReplyDeleteJulie is right by using the word experts , and formulating a plan because i believe that is what the patients are expecting from us , to be able to deliver to them the best care plan possible that will lead to their road to recovery . The more Knowledgeable their healthcare providers are , the faster will their healing process be.
DeleteYes, Julie, I think that is important to look at the whole picture. It is a very common issue but can have many causes. Each patient has a different story.
Deletean oncology nurse needs to be cognizant of constipation to be competant in constipation to prevent and treat constipation in the oncology patient population. I work in the radiation oncology dept and our patients are frequently are on opioids or constipated from tumor bed involvement and I am frequently teaching to prevent/treat constipation in my clients
ReplyDeleteAs port nurses, we have an opportunity to "check in" with the patient. They are so busy getting to all their appointments that they can forget to bring up their issues. Most the the oncology patients have pain. When we talk about the pain, it's a great time to bring up the side effects that come with pain medicine. The topic of constipation should be coming up with all of us at some point with our patients. We need to be experts as they have enough trouble already. They don't need to add another problem. Helping them to maintain quality and comfort through their journey is so important.
ReplyDeleteAs Oncology Nurses I feel we need to be experts on opioid induced constipation because our pts look to us for appropriate guidance as well as support for all aspects of the care. Being an expert is needed so that we can educate /guide our pts to preventative measures & if needed the curative measures of constipation. Many pts come to MRMC after being under the care of another professional that didn’t provide enough education about their disease, treatment options, possible side effects, or general bedside manner that these pts need & appreciate all of the education, no matter how what topic, we provide because it shows that we care.
ReplyDeleteAll very good points, I especially like the caring aspect as we do practice the mother standard of care. Most of our patients travel far and leave their homes to treat at CTCA. Education and guidance in a caring manner is important to our patients during their time at CTCA.
DeleteOften Nurses are the "front line" of care for patients and spend a lot of time doing education. Nurses need to understand the problem in order to be an effective and efficient educator on symptoms and symptom management. Constipation has always been a big concern for patients and they are very vocal in expressing their discomfort. Unfortunately, constipation and pain can be a never ending cycle. Patients experience abdominal pain/discomfort due to constipation and will then take more pain meds to alleviate the discomfort, which ultimately creates more constipation. Unless patients are educated about the relationship of constipation and discomfort, they may not "connect the dots" and find themselves in a worse situation. As a side note, I am surprised the article didn't mention Relistor (injection) for use in opiod-induced constipation. (we've had luck with that medication).
ReplyDeleteNicole,
DeleteIs relistor a medication easily covered by insurance? Is it a high cost medication? Just wondering?
Debra, the video on this month's posting " Pathophysiology of Opioid Induced Constipation" was produced by Relistor. If you look at the site, it allows you to contact a representative that could answer your questions.
DeleteConstipation can be a real issue for a lot of our patients, especially from opioids. Some are embarrassed to discuss this subject in detail, until it becomes too painful or uncomfortable. Being expert clinicians on constipation or any subject, the better we can teach and guide our patients. I would say we hear about this topic just about daily.
ReplyDeleteAs many of my colleagues have mentioned, oncology nurses are the experts in constipation management and it is important to always start a bowel program with our oncology patients. It is eually improtant to know and understand the mechanism's by which bowel medications work. Such as prescribing motolitics that increase persistalsis when a patient has tumors on or pressing on the colon or GI system. The use of these bowel medications can cause even more pain than that of the constipation it'self.
ReplyDeleteConstipation is one thing that most of our patients are having a hard time discussing with their health care providers. So by simply asking them about their last bowel movement , or are they having cramps , nausea or vomitting , and make them really feel how much we care for them , how much we want to see them to get well . Treat them like how we will treat our families i know that they will open up.
ReplyDeleteRonnie,
DeleteI agree. In addition, I also think that many of our physicians are not comfortable doing a complete bowel assessment and leave it up to the nurses. Often, in my opinion, when this happens medications are suggested to take care of the immediate problem but noting is done to prevent constipatin from happening in the begining.
When I worked in hospice care we had a actucal process and procedure for bowel programs based on the disease process and reasons for constipation along with an algorythm that would suggest the correct bowel program to place the patient on.
Constipation continues to be a daily topic here in radiation. Our patients are many times struggling with dietary and elimination issues. They are dealing with differences in their health and also with being away from home and their normal routine. Radiation can cause a lot of changes depending on where they are being treated. Living in a hotel room can cause stress that would contribute to constipation. Even the way food is spiced differently from what they are used to can make the patients not want to eat or make poor food choices. Then, of course, depression can cause them to change their diet or activity level.
ReplyDeletethat is so true.I agree that our patients are dealing with lots of issues that can contribute to abnormal elimination patterns.
Deleteas nurses who deal with the type of patient population we have,we should be knowledgeable with the effects of the different types of medications they are getting.Cancer means pain and as such,your typical oncology patient is probably on high doses of opioids which helps control their pain.Constipation unfortunately is one major side effect of opiod therapy.They should be on the right bowel regimen to counteract the effects of constipation.
ReplyDeleteIn SCTU, we see patients who complains of constipation from the chemo they received. Also if they have pain and are on narcotics, it's a double whammy for them to deal with the constipation. So, as nurses on the forefront we need to be the experts on educating our patients. Oral laxatives interfere with body's absorption of some medications and food nutrients. Rectal laxatives do not have this effect. We don't usually give rectal laxatives in SCTU due to the fact that our transplant patients have low platelet counts and may start bleeding. Oral and rectal laxatives can lead to electrolyte imbalance especially after prolonged use. That's why we monitor the labs daily as closely as possible. Electrolytes which include calcium, chloride, magnesium, potassium and sodium regulate muscle contractions, heart rhythm, nerve functions, fluid balance and other body functions. An electrolyte imbalance can cause abnormal heart rhythms, weakness, confusion and seizures.
ReplyDeleteOncology nurses need to be experts on constipation due to the overwhelming instances of constipation in cancer patients. Constipation is likely to occur in cancer patients due to a high use of opioid analgesics related to cancer pain. Cancer patients are also often rendered immobile or have severely limited mobility due to cancer pain or the location of the tumor. This is also a major causative factor of constipation. Other factors include poor diet/appetite, bowel obstruction, organ failure, and depression.
ReplyDeleteBeing a medical surgical oncology nurse I see this problem in the majority of patients. I would say the greatest instance is due to the use of opioids. There are also many instances in which the constipation is due to a variety of factors. Very few inpatients feel like ambulating due to pain, lethargy, nausea/vomiting, or depression. Also, most of them have very poor appetites. It’s very difficult to get a patient to eat, drink, ambulate, and sometimes it’s even difficult to get them to take their stool softeners or laxatives. Constant education and encouragement is key in dealing with constipation in oncology patients.
Very well said Krista - I definitely agree. I did not mention the domino effect of inadequate pain relief on the other things such as not wanting to ambulate, depressed mood, etc. - but that is very true!
DeleteOncology nurses need to have expertise in constipation. It is important to understand the causes of constipation in the oncology patient. Not all constipation should be treated the same as this Journal Club Topic points out. In my unit the OICC there are many people that do present with constipation. Sometimes it is believe to be opiod induced and other times it is not. Quite often we see patients that are severely constipated and are not on a bowel regimen. As Oncology nurses we are often the ones taking the time to do patient teaching about constipation. We teach them what medications they should look for over the counter, suggest what dosages to start at, how to titrate, what other things they can do to promote healthy bowel habits, and most importantly when to ask for help before it gets really bad.
ReplyDeleteJohn, you raise a great point that our patient's should be on a bowel regimen. We have some patients that keep taking their pain medications but do not take anything for constipation and wait until they are in severe pain. Also, some patient's have diarrhea from some of the chemo therapies that we give and therefore don't need a bowel regimen.
DeleteAs an oncology nurse we need to be an expert on constipation as this is a common side effect to our most effective pain management options. This topic comes up often on 2nd floor after our patients come from surgery. Many patients express concerns regarding pain medication and the possibility of constipation. As nurses we need to be educated so that we may adequately and successfully educate our patients.
ReplyDeleteIn the hospital where 99% of our patients are oncology, it is very important that we become experts on constipation. Our patients takes pain medications, usually opoids, to alleviate pain as one of the major problem having cancer. They also take chemotherapies that slow the motility of GI system. Also causes nausea & vomiting; loss of appetite; dehydartion to name a few. All these problems leads to constipation. So it imperative that we really know how to assess, adress, educate and treat constipation. Thank You! Melissa for this very good article.
ReplyDeleteI agree with Ma Vilma, We both work In SDS, as part of our assessment, we always ask the LBM for all our pre surgical patients. Our aim is twofold, one to evaluate the bowel prep given to our patients who's having abdominal related surgeries, the patient will tell us the last bowel movement; it's consistency, and for the non abdominal surgical patient, we will know if patient is having constipation prior to surgery. We are being proactive adressing the problem. We educate them on diet, fluid and remind them to take the medication prescribed like stool softener, laxatives etc. Also adressing this problem to their physician and care manager will alleviate their constipation.
DeleteEvery Nurse needs to be an expert on constipation but its especially important for oncology nurses as our patients are on pain medications and drugs that cause severe constipation. Not all constipation is treated the same way and it's important to differentiate what the underlying cause of constipation is. we also need to be familiar with different types of medications that can be used to treat constipation so that we can educate our patients on proper use.
ReplyDeleteOncology nurses need to be experts on constipation because most oncology patients are on pain medications. As a nurse in the Infusion Center we see a good amount of patients with constipation. We give IV fluids and sometimes Relastor which is a subcutaneous injection to relieve the effects of opioid induced constipation.
ReplyDeleteWe always need to be an expert on constipation. This problem comes up daily with most of our patients as most of them take pain medications. Some patients have always had a problem with constipation and some get constipated after chemotherapy. So we have a regimen on how to handle the constipation with senna S and give instructions and education of the how to use the medication and its benefits. Patients just don't think it is anything unusual when they have lived it for so long.
ReplyDeleteI competely agree with you! Patient's really don't "get it" when it comes to constipation. They have dealt with it so long that they don't realize there is something we can do to help them and they don' t have to be constipated forever.
DeleteI agree with Pamela. Many people do not see that taking the pain pills, lack of activity, poor diet choices can make them more at risk for the complications of constipation.Teaching is a must.
DeleteI think it has been said numerous times, but I will say it again. as nurses, we NEED to be experts in constipation as the majority of our patients will experience it at some point. In Care Management, we receive numerous phone calls daily from patients and caregivers asking about constipation. We have standing orders that are okay'ed by all the med oncs that we go by to instruct our patients on how to help.
ReplyDeleteAs a Care Manager it is part of every nadir call to ask about diarrhea and constipation. I try to ask these questions even if the patient states that all is fine, because sometimes they do not think of this to bring up on their own. Asking more questions re: dietary habits, hydration and activity can also help to identify those at risk.
ReplyDeletei've read the article by Theresa Brown titled one drug, two names, many problems. yes, i agree that it's too confusing having both the generic and trade name of drugs. You need to be always on alert when giving these drugs. so far, in my experience, our pharmacist have always been helpful in case we have questions about the drugs that we used. i try to memorize the names so i don't get confused but you're right, there's just too many drugs out there in the market. Some people prefers the brand name even though it's more expensive cause they think it's more effective. i agree that we should have a better system in the future how to categorize these drugs.
ReplyDeleteA lot of our oncology patients experience constipation due to the use of opiods. Also, we see patients come in bowel obstructions due to opiod use & due to tumor growth. This is why it's so important to promote early ambulation in our patients.
ReplyDeletePamela is right, patients sometimes don't realize that opiods can cause constipation. This is why pt education is a must.
ReplyDeleteI agree with BPatel in that we need to determine the exact etiology of the pt's constipation in order to treat it accurately.
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