Patient reports distressing constipation

1. Is patient having a low volume of stool? Is patient having stool infrequently? Is patient having hard stool? Reassess 24-72 hrs and then q visit chronically Reassess 24-72 hrs and then q visit chronically Reassess 24-72 hrs and then q visit chronically Reassess within 30 days or RN discretion Does patient have continued hard infrequent stool? Does patient have continued hard infrequent stool? Notify MD Pain Management Constipation Algorithm Patient reports distressing constipation + + Yes Yes Yes Increase fluids and Add fiber product* Ask MD to consider: Bisacodyl 10- 30 mg po q hs or Laculose 30 – 60 cc po qd - tid Ask MD to consider: Senna 1 tab po qd to 3 tabs qid or Docusate 250 – 500 mg qd - bid Yes No No Ask MD to consider: Milk of Magnesia 30 – 60 cc qd or Magnesium citrate ½ to 1 bottle qd or Cisapride or Metoclopramide 10 mg a meals and hs Yes Constipation is the most common opioid side effect and should be aggressively prevented and managed. All patients on around-the-clock (ATC) opioids regardless of the route of administration require a prophylactic bowel management plan. Stool softeners, by themselves, are usually insufficient. *In the absence of adequate fluid intake, bulk laxatives such as Psyllium (Metamucil ®) can cause fecal impaction and should be avoided. Revised based on www.CityOfHope.org