Ward Issues

Question 1

Constipation

1) RF

Answer 1

1) - Advanced age
- Reduction in mobility
- Fluid intake < 1500cc/day
- Inadequate dietary fibre
- Medication or disease

Question 2

Contipation

2) Prevention: Non-pharma

Answer 2

2) - Increase fluid
- Exercise
- Regular toileting
- Privay
- Check for impaction

Question 3

Constipation

3) Laxatives: 4 types and Examples

Answer 3

3)
- Bulk-forming laxative metamucil (psyllium), Citrucel (methylcellulose), and FiberCon (Ca polycarbophil)

• Surfactants (Lower surface tension of stool and allow H20 to enter stool easily, but little evidence for chronic constipation): Colace (docusate sodium).
• Osmotic (Most commonly used in hospital):
  a) PEG3350 17g PO daily in 4-8ounce of fluid
  b) Lactulose
  c) Microlax (Sorbitol)
• Stimulant (Given with osmotic agent if using opioid)
  a) Senna 17.2mg PO qHS
  b) Bisacodyl suppository 10mg PR in AM.
  c) Microlax

Also, fiber (e.g., prunes) very helpful.

Question 4

Constipation

4) Condition to r/o

Answer 4

• Bowl obstruction must first be ruled out before giving laxatives. (i.e., Ask if passing gas.)
• On Day 4, if still no BM despite maximum medical therapy (PO and enema), then consider AXR.