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NR565 Wk 7 - Case Study: Management of Chronic
Constipation in Lourdes Ayala
Describe your assigned client’s situation. Why are they presenting to the clinic? What
medications are they currently taking?
The client is Lourdes Ayala. She is a 47-year-old female presenting to the clinic with difficulty in
bowel movements for six days. The client’s last bowel movement, six days ago, was hard, small,
with straining and with pain. She has been taking lactulose since NP prescribed at last visit one
month ago without change in stool patterns. The client is also currently taking paroxetine. She
has a past medical history of depression, and alcohol addiction (previous), no known drug
allergies listed. The client does not smoke and has not consumed alcohol for five years.
Assess the applicable clinical practice guideline (CPG) for your assigned client linked on the
same page in the lesson where the client case is located. What treatment is recommended by
the CPG for your client’s situation?
There has been no improvement despite a one-month lactulose treatment, increased hydration
intake, and fiber. Because of its anticholinergic properties, the SSRI paroxetine is known to
promote constipation, which could be making her situation worse. As a further step in
treatment, guidelines highly recommend using stimulant laxatives such bisacodyl (5 mg PO
daily). Guidelines recommend starting secretagogues such as linaclotide (145 mcg daily) or
lubiprostone (24 mcg BID) if stimulant laxatives are not working. For patients who do not
respond to OTC alternatives, linaclotide is frequently advised above no treatment at all. Given
its significance in constipation, the practitioner should think about tapering paroxetine or
switching to an SSRI with fewer GI side effects, like sertraline.
Discuss your personal professional assessment of the client’s situation provided in the
scenario. What pharmacological treatment is necessary and why?
Getting a complete history of the patient's typical bowel habits, including frequency,
consistency (using the Bristol Stool Scale), and deviations from their norm, is the most crucial
part of diagnosing constipation. This creates a baseline and aids in identifying the kind and
degree of constipation. An abdominal palpation (for fecal loading) and, if required, a digital
rectal exam to detect impacted stool or anatomical problems are used during a physical
examination.
Based on the clinical presentation of Lourdes Ayala—a 47-year-old female with chronic
constipation refractory to lactulose and current use of paroxetine (an SSRI known to cause
constipation)—the following pharmacological treatment plan is indicated: Given the 6-day gap
in bowel movements and failure of osmotic agents (lactulose), a stimulant laxative is
recommended to initiate bowel activity, such as bisacodyl (Dulcolax) 5mg PO daily. Stimulant
laxatives are commonly used as a second-line, short-term treatment for constipation. This is
used after failure of osmotic laxatives. These are not advised in cases of bowel obstruction or
severe abdominal pain.
NR565 Wk 7 - Case Study: Management of Chronic
Constipation in Lourdes Ayala
Describe your assigned client’s situation. Why are they presenting to the clinic? What
medications are they currently taking?
The client is Lourdes Ayala. She is a 47-year-old female presenting to the clinic with difficulty in
bowel movements for six days. The client’s last bowel movement, six days ago, was hard, small,
with straining and with pain. She has been taking lactulose since NP prescribed at last visit one
month ago without change in stool patterns. The client is also currently taking paroxetine. She
has a past medical history of depression, and alcohol addiction (previous), no known drug
allergies listed. The client does not smoke and has not consumed alcohol for five years.
Assess the applicable clinical practice guideline (CPG) for your assigned client linked on the
same page in the lesson where the client case is located. What treatment is recommended by
the CPG for your client’s situation?
There has been no improvement despite a one-month lactulose treatment, increased hydration
intake, and fiber. Because of its anticholinergic properties, the SSRI paroxetine is known to
promote constipation, which could be making her situation worse. As a further step in
treatment, guidelines highly recommend using stimulant laxatives such bisacodyl (5 mg PO
daily). Guidelines recommend starting secretagogues such as linaclotide (145 mcg daily) or
lubiprostone (24 mcg BID) if stimulant laxatives are not working. For patients who do not
respond to OTC alternatives, linaclotide is frequently advised above no treatment at all. Given
its significance in constipation, the practitioner should think about tapering paroxetine or
switching to an SSRI with fewer GI side effects, like sertraline.
Discuss your personal professional assessment of the client’s situation provided in the
scenario. What pharmacological treatment is necessary and why?
Getting a complete history of the patient's typical bowel habits, including frequency,
consistency (using the Bristol Stool Scale), and deviations from their norm, is the most crucial
part of diagnosing constipation. This creates a baseline and aids in identifying the kind and
degree of constipation. An abdominal palpation (for fecal loading) and, if required, a digital
rectal exam to detect impacted stool or anatomical problems are used during a physical
examination.
Based on the clinical presentation of Lourdes Ayala—a 47-year-old female with chronic
constipation refractory to lactulose and current use of paroxetine (an SSRI known to cause
constipation)—the following pharmacological treatment plan is indicated: Given the 6-day gap
in bowel movements and failure of osmotic agents (lactulose), a stimulant laxative is
recommended to initiate bowel activity, such as bisacodyl (Dulcolax) 5mg PO daily. Stimulant
laxatives are commonly used as a second-line, short-term treatment for constipation. This is
used after failure of osmotic laxatives. These are not advised in cases of bowel obstruction or
severe abdominal pain.
