Outcome Evaluation

• Ask the patient about the absence or improvement in symptoms to determine whether laxative therapy is effective. Patients should have an increase in stool frequency to three or more well-formed stools per week. Patients should report the absence of prolonged defecation time or the absence of the need for excessive straining.

Patient Care and Monitoring for Constipation

1. Assess the patient's symptoms to determine if patient-directed therapy is appropriate or whether the patient should be evaluated by a physician. Determine type and frequency of symptoms.

2. Review available information to determine the most likely cause or type of constipation.

3. Obtain a thorough history of prescription, nonpre-scription, and dietary supplement use. Determine what treatments have been helpful in the past. Is the patient taking any medications that may contribute to constipation?

4. Remember that no single therapy has proven effective for all patients who present with constipation.

5. Develop a plan to assess the effectiveness of laxative use in cases of functional constipation.

6. Evaluate the patient for the presence of adverse drug reactions, drug allergies, and drug interactions.

7. Provide patient education about constipation, general and dietary modifications, and drug therapy.

• When acute overuse or chronic misuse of saline or stimulant laxatives is suspected, it may be necessary to check for electrolyte disturbances (e.g., hypokalemia, hyper-natremia, hyperphosphatemia, or hypocalcemia).

• Some laxatives (e.g., bulk producers) contain significant amounts of sodium or sugar and may be unsuitable for salt-restricted or diabetic patients. Monitoring of fluid retention (edema) and blood pressure changes are indicated in patients on sodium-restricted diets. Glucose monitoring maybe required in diabetic patients as needed with chronic use. Use of low-sodium or sugar-free products maybe indicated.

• Saline laxatives containing magnesium, potassium, or phosphates should be used cautiously in persons with reduced kidney function. Monitor appropriate serum electrolyte concentrations in patients with unstable renal function evidenced by changing serum creatinine or creatinine clearance.

• All laxatives are contraindicated in patients with abdominal pain, nausea, vomiting, symptoms of appendicitis, or undiagnosed abdominal pain. Patients should consult their physicians if sudden changes in bowel habits persist for more than 14 days or if use of a laxative for 7 days results in no effect.

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