Bowel issues in the elderly Flashcards
what are main causes of constipation of the elderly in care homes
immobility
PRN prescribing rather than on a regular basis which would be preferred
what symptoms may patients experience as a consequence of constipation
N+V abdo pain + rectal discomfort delirium depression urinary retention overflow diarrhoea UTI haemorrhoids
what is overflow diarrhoea
large amount of impacted stool blocks the rectum and above that level, the stool liquidises and runs down the sides of the impacted stool
why is it important to identify overflow diarrhoea
because treating it as ‘normal’ diarrhoea with loperamide will make it worse
list causes of constipation
immobility dehydration lack of fibre / diet medications: - opioids - anticholinergics - iron, calcium, vit D supplements parkinsons and drugs loperamide
what drugs have anticholinergic activity
antidepressants: tricyclics anti-emetics: cyclizine antipsychotics: clozapine antimuscarinics: oxybutynin antihistamines
what are the 3 main questions to ask in a patient with constipation
- frequency of bowel movement and what is their normal
- consistency using BSS
- difficulty evacuating / feeling of incompleteness
what examinations should you do for a patient with constipation
abdominal
PR
what pathologies can cause constipation
neurological
diverticulosis
polyps
strictures/adhesions
what stool type is ideal from the BSS
type 3 or 4
type 1 is bad
how should you manage constipation pharmacologically
first soften the stool then stimulate the bowels
what are the different types of laxatives and what is their method of action
hard stools - osmotic, softener
stimulant issue - stimulant
bulk forming agents do both
how do osmotic laxatives work
they pull water from the colon into the stool
give examples of osmotic laxatives
lactulose
laxido
what are potential disadvantages to osmotic laxatives
lactulose is thick and gloopy
laxido needs to be taken with a lot of water - dexterity issues
