ONS Connect - May 2008 - (Page 21)

Figure 1. interventions for constipation in Adult Patients With cancer Recommended for Practice None Likely to Be Effective Opioid-induced constipation • Prophylactic bowel management regimen • Opioid rotation Persistent constipation • Polyethylene glycol 3350 (PEG 3350) • Stimulant or osmotic laxatives Benefits Balanced With Harms Opioid-induced constipation • Oral naloxone, an opioid receptor antagonist Effectiveness Not Established See Figure 2 Not Recommended for Practice Managing opioid-induced constipation • Nalmefene • Naltrexone Constipation in adult patients not specific to opioids • Cisapride • Corn syrup • DantronTM (chrysazin; 1,8-dihydroxyanthraquinone, Hexal Pharma) Note. Based on information from Woolery et al., 2008. Figure 2. interventions Whose Effectiveness is not Established Pharmacologic Interventions • Laxatives – Bulk-forming laxatives (e.g., methylcellulose) – Lubricants (e.g., glycerin suppositories, mineral oil) – Osmotic laxatives (e.g., magnesium salts, magnesia hydroxide) – Stimulant laxatives (e.g., bisacodyl, senna) – Non–bulk-forming fiber laxatives – Stool softeners (e.g., docusate sodium and calcium) • Prokinetic agent: erythromycin • Enemas: phosphate enema and sodium citrate enema) Nonpharmacologic Interventions • Activity or increased mobility • Aromatherapy, massage therapy, and aromatherapy massage • Biofeedback • Dietary fiber • Fresh baker’s yeast • Herbal supplements • Paraffin • Seeds dils or arachisoil • Stercullia (type of fiber) Note. Based on information from Woolery et al., 2008. commonly prescribed laxatives, were categorized as “effectiveness not established” because the data related to their efficacy were conflicting or of insufficient quality. Also included in this category are investigational agents methylnaltrexone and alvimopan because they have not yet been approved by the U.S. Food and Drug Administration. Nonpharmacologic interventions often are discussed in the literature but lack significant study using randomized, controlled trials to recommend them for practice. See Figure 2 for a list of interventions whose effectiveness has not been established. Expert opinion recommends an individualized bowel management program that includes increasing fluids and fiber and decreasing constipating medications or providing medications to offset constipating side effects of medications. Trial-anderror approaches with nursing guidance are common. Other recommendations include • Providing a comfortable, quiet, private environment for defecating • Providing a toilet, bedside commode, and any necessary assistive devices while avoiding the use of a bedpan whenever possible • Encouraging adequate fluid intake (64 ounces of fluid per day) • Performing valsalva maneuver in patients with neurogenic problems • Using mealtime for bowel routines to capitalize on the gastrocolic reflex • Initiating a bowel management program Refer to Woolery et al. (2008) for additional information, as well as specific information on impactions and constipation in the pediatric cancer population. The ONS PEP card on constipation is in volume 2 of the ONS PEP cards, which also contains cards on caregiver burden and strain, mucositis, depression, dyspnea, and peripheral neuropathy. To order the pocket cards, visit http://esource .ons.orgPublications or e-mail customer .service@ons.org. All of the ONS PEP cards (volumes 1, 2, and 3) and their supporting resources and materials can be viewed online at www.ons.org/outcomes. ✱ Woolery, M., Bisanz, A., Lyons, H.F., Gaido, L., Yenulevich, M., Fulton, S., et al. (2008). Putting Evidence Into Practice®: Evidence-based interventions for the prevention and management of constipation in patients with cancer. Clinical Journal of Oncology Nursing, 12(2), 317–337. Retrieved April 22, 2008, from http://ons .metapress.com/content/48m2733876488056/ fulltext.pdf. MAY 2008 ONS CONNECT 21 http://esource.ons.org http://esource.ons.org http://www.ons.org/outcomes http://ons.metapress.com/content/48m2733876488056/fulltext.pdf http://ons.metapress.com/content/48m2733876488056/fulltext.pdf

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ONS Connect - May 2008 Contents Editor's Note Just In ONS Leadership Development Institute A Year in the Life - Month Five Web Content Capitol Connection Notice Nursing Now Caregiver Care Put Evidence Into Practice to Prevent and Manage Constipation in Patients With Cancer Giant Database Allows Scientists to Share Information Calendar of Events Working for You Staying on Top

ONS Connect - May 2008

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