Case Study of Managing patient suffering Opoid constipation

Case Study of Managing patient suffering Opoid constipation This case study outlines the clinical management of a client with a problem with Opioid induced constipation. Opioid analgesics (narcotics) cause constipation in most people. Opioids slow down the stool as it passes along the intestinal tract. This causes the stool to become hard. If you have hard stools, have difficulty passing bowel movements and the movements become infrequent, then you have constipation. Constipation can be very bothersome and last as long as you are taking narcotics on a regular basis. Therefore, it is important that we learn to manage our bowels effectively. Throughout the analysis the anonymity and confidentiality of this patient will be protected as outlined by the Nursing and Midwifery Council (2008) and therefore the patient will be referred to as Mark Scott. Additionally consent was gained by Mark to allow the author to use his case for my assessment. History of present illness Mark Scott is a 64 year old gentleman who is 2 days post op following a Right Total Hip Replacement (RTHR). Total hip replacement involves removal of a diseased hip joint and replacement with a prosthetic joint. Whilst doing the medications Mark confided in the nurse that he may have a problem with his bowels and that he may be constipated. To enable the nurse to assess Mark she would have to understand constipation, it helps to know how the colon, or large intestine, works. As food moves through the colon, the colon absorbs water from the food while it forms waste products, or stool. Muscle contractions in the colon then push the stool toward the rectum. By the time stool reaches the rectum it is solid, because most of the water has been absorbed. Constipation occurs when the colon absorbs too much water or if the colon’s muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. As a result, stools can become hard and dry. Mark asked the nurse if there was anything she could give him to ease the discomfort he wa s experiencing, However as Mark has presented with a new problem with the possibility of him needing medication, the nurse would first need to undertake a holistic assessment of Mark. The purpose of assessment is to allow the nurse to examine all relevant factors of the problem and allow her to make the decision of whether prescribing a patient group directive (PGD) is an appropriate intervention (Humphries, 2002). Consider the patient When Mark stated he thought he was constipated, it was important to ascertain his own interpretation of what this meant. For example, Wondergerm (2005) states that for some, constipation may mean opening their bowels less than three times a day. On the other hand, constipation may mean opening of the bowels less than three times a week. There appears to be a general consensus that the range for normal bowel activity lies somewhere between three bowel motions daily to one bowel motion every three days. However, it is important to remember that a change from three bowel motions a day to one every three days may represent a significant change for the patient, despite remaining within the normal limits (Peate, 2003).