Page 91 Complete Your CE Test Online - Click Here Nursing consideration: When questioning patients about constipation, it is important to realize that constipation means different things to different people. Some adults believe that they are constipated unless they have a bowel movement every day. Others believe that a normal bowel routine is to have a bowel movement every two days. Three bowel movements a week or less is usually suggestive of constipation [9]. Ask patients not only how many bowel movements they have per day or per week, but to describe them. For example: Are they hard? What color are they? Do you have any pain when having a bowel movement? Have you noticed any changes in the number of times you have a bowel movement or in color? Some medications such as antidepressants and some antihypertensive medications can cause constipation. Be sure to get a though medication history when assessing bowel status. Here are some tips to reduce constipation [9,14]: ● ● If constipation is due to medications, consult with healthcare providers about possible changes in the medication regimen. ● ● Increase fluid intake unless contraindicated. ● ● Increase fiber intake. ● ● Increase whole grain, fruits, and vegetables intake. ● ● Participate in exercise as tolerated. ● ● Add stool softeners and/or laxatives under medical supervision. Nursing consideration: Patients need to be evaluated for possible serious causes of constipation such as impaction or bowel obstruction. Be alert to additional symptoms such as: severe abdominal pain, nausea, and/or vomiting, which may indicate bowel obstruction; or a lump or thickening in the lower abdomen, indicating a growth or tumor [9]. Fecal incontinence and diarrhea Diarrhea is generally defined as the passage of abnormally loose stool accompanied by a change in frequency or volume [9]. When evaluating diarrhea, determine the quality of diarrhea. For example: Are the stools loose but formed, or watery? Is the diarrhea accompanied by cramps, frequency, and/or urgency? How many times a day does diarrhea occur? Nursing consideration: Remember that, like constipation, diarrhea may mean different things to different people. Be sure to get a complete description of the patient’s bowel movements. Diarrhea may be due to viral, bacterial or parasitic infection, medications, tumors, or stress. Treatment measures include identifying and correcting underlying causes and medications to relieve symptoms [9,13,53]. Fecal incontinence may accompany diarrhea or exist with normal quality bowel movements. It may be due to cognitive impairment, tumors, or muscle weakness. Correction of underlying causes is necessary, and a bowel training program is often indicated [9]. Nursing consideration: Bloody stools or passage of blood is a medical emergency and requires immediate evaluation and intervention [9]! Gastroesophageal reflux disease Gastroesophageal reflux disease (GERD) is the backflow of gastric and/ or duodenal contents into the esophagus. GERD is due to problems with deficient pressure of the lower esophagus, Symptoms range from none to heartburn of varying degrees of severity, and pain that radiates to the neck, jaws, and arms. The patient may awaken during the night with coughing and a mouthful of saliva [13]. Many patients, and even healthcare professionals, may believe that these symptoms are trivial and unlikely to indicate a serious health problem. In reality, GERD may be responsible for 1,700 deaths annually in the U.S. [9]. Complications include esophageal ulcers, hemorrhage, esophageal stricture, hoarseness, esophagitis, and inflammation of the esophagus that can predispose the patient to the development of adenocarcinoma [9]. Certain medications or chemicals can increase the risk of GERD. These include anticholinergics, caffeine and alcohol, nicotine, beta-blockers, potassium supplements, and non-steroidal anti-inflammatory agents [9,17]. Treatment of GERD focuses on relief and control of symptoms and promotion of esophageal healing [9]. Lifestyle changes are the first line of treatment and include the following items [9,13]: ● ● Diet: Avoid caffeine, chocolate, spicy foods, carbonated beverages, orange juice, tomato juice, alcohol, and other beverages that stimulate the production of gastric acid. Reduce fat content in diet. ● ● Positioning: Avoid lying down for at least two hours after eating. Sleep with the head of the bed elevated six to eight inches. Avoid lying on right side, which encourages reflux. ● ● Weight: Achieve or maintain normal weight. ● ● Tobacco products: Avoid use of tobacco products. ● ● Stress: Participate in stress reduction efforts. ● ● Alcohol: Reduce or avoid the intake of alcohol. ● ● Medications: Ask about possible alterations in medical regimen. ● ● Clothing: Avoid clothing that fits tightly. ● ● Exercise: Do not exercise for one hour after meals. ● ● Hydration: Drink six to eight ounces of water with medications. If lifestyle changes do not control GERD, medications may be necessary. These include [13,17]: ● ● Promotility agents that improve lower esophageal sphincter tone and stimulate upper GI motility. ● ● Proton pump inhibitors and histamine receptor antagonists to reduce gastric acidity. ● ● Over-the-counter antacids reduce symptoms, but may cause side effects such as diarrhea, constipation, and acid-base disturbances. In severe cases, surgery may be necessary to control symptoms, prevent complications, and stop hemorrhage. Nursing consideration: Stress the importance of lifestyle changes as the first line of treatment for GERD. Such changes are also helpful to promote over-all health and, if effective, can reduce or eliminate the need for medications and/or surgery. Laryngeal reflux disease Mr. Wilson is 70 years old and subject to frequent sinus infections. He suspects that he has yet another sinus infection, his third this year. However, his doctor diagnoses laryngopharyngeal reflux (LPR). “Reflux? But I don’t have any heartburn! And I have all of these sinus infection symptoms. How can it be reflux?” Mr. Wilson is not alone in assuming that heartburn must accompany acid reflux disease. Laryngopharyngeal reflux disease (LPR) is sometimes called silent reflux and occurs when stomach contents back up into the back of the throat (pharynx) or voice box (larynx) or even into the back of the nasal airway. Inflammation can occur in areas that are not protected against gastric acid exposure [55,56]. Symptoms of LPR include [55,56]: ● ● Hoarseness. ● ● Chronic cough. ● ● Excessive throat clearing. ● ● Sensation of a lump in the throat. ● ● Sensation of mucous sticking in the throat and/or post-nasal drip. ● ● Sore throat. ● ● Red, swollen, or irritated voice box.