For constipation in a patient nearing the end of life, what is the initial intervention after physician consultation?

For constipation in a patient nearing the end of life, what is the initial intervention after physician consultation?

• A. Administer a stool-softening suppository.
• B. Administer a cleansing enema.
• C. Remove fecal impactions.
• D. Administer a bulk-forming agent, such as Metamucil.

Answer: (A)

Relief of constipation in someone nearing the end of life is pursued with measures that are gentle, quick-acting, and comfortable. Using a rectal stool-softening suppository as the first step fits this approach because it acts locally, eases stool passage, and reduces the need for straining without being invasive. The suppository lubricates and softens stool, often providing rapid relief and improving comfort for a patient who may be fatigued or unable to tolerate more invasive procedures. Cleansing enemas are more invasive and can be distressing at the end of life, so they’re not first-line unless there’s a clear need. Removing fecal impactions is reserved for confirmed impaction and involves a more invasive procedure. A bulk-forming agent taken by mouth requires adequate fluids and time to work, which may not be feasible in this setting. If the stool softener alone doesn’t relieve the constipation, the care plan can be escalated under physician guidance.

Relief of constipation in someone nearing the end of life is pursued with measures that are gentle, quick-acting, and comfortable. Using a rectal stool-softening suppository as the first step fits this approach because it acts locally, eases stool passage, and reduces the need for straining without being invasive. The suppository lubricates and softens stool, often providing rapid relief and improving comfort for a patient who may be fatigued or unable to tolerate more invasive procedures.

Cleansing enemas are more invasive and can be distressing at the end of life, so they’re not first-line unless there’s a clear need. Removing fecal impactions is reserved for confirmed impaction and involves a more invasive procedure. A bulk-forming agent taken by mouth requires adequate fluids and time to work, which may not be feasible in this setting. If the stool softener alone doesn’t relieve the constipation, the care plan can be escalated under physician guidance.