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  • 1. Chemotherapeutic agents associated with constipation Cyclophosphamide Mechlorethamine Chlorambucil Melphalan Carmustine (BCNU) Lomustine (CCNU) Semustine (Methyl-CCNU) Thiotepa Triethylenemelamine Busulfan Procarbazine Dacarbazine Hexamethylmelamine Cisplatin Vinblastine Vincristine Vinorelbine Source: Palliative Care Nursing- A Guide to Practice. 733 Dr. Geminer St., Karkafa, Bethlehem –Palestine. P.O. Box: 19960 East Jerusalem 97200 Telefax: 972 2 2767337 , Mobile: 972 522495249 , E-mail: sadeelsoc@yahoo.com
  • 2. Causes of constipation in end-stage disease General factors • anorexia; • decreased food intake and inadequate dietary fiber; • dehydration (due to poor fluid intake, vomiting, sweating, or polyuria); • lack of activity, immobility, weakness; • decreased abdominal muscle tone; • Inconvenient toilet access and suboptimal posture. • fear of incontinence; • lack of privacy (shared accommodation); • distress through loss of independence (reliance on others for assistance); • adverse past experiences (inability to access or use toilet facility; past use of aperients • that were too strong); • Confusion (perhaps due to sedation). Specific pathology • depression; • impaired cognitive function; • spinal cord compression; • cerebral tumour; • hypercalcaemia; • hypokalaemia; • hypothyroidism; • Abdominal tumour (intestinal tumour, or compression from tumour external to bowel). • Painful ano-rectal conditions. Medications • opioids, non-steroidal anti-inflammatory drugs (NSAIDs); • antidepressants, phenothiazines, haloperidol; • antispasmodics; • anticonvulsants; • antiemetics; • diuretics; • iron; • Antacids. Source: Palliative Care Nursing- A Guide to Practice. 733 Dr. Geminer St., Karkafa, Bethlehem –Palestine. P.O. Box: 19960 East Jerusalem 97200 Telefax: 972 2 2767337 , Mobile: 972 522495249 , E-mail: sadeelsoc@yahoo.com
  • 3. Consequences of constipation Psychological and cognitive • distress, anxiety; • confusion. Perianal problems • anal fissure; • haemorrhoids. Faecal impaction • spurious diarrhoea; • faecal incontinence. Gastrointestinal symptoms • anorexia, nausea, vomiting; • abdominal distension; • abdominal pain; • bowel obstruction. Urinary • urinary retention; • urinary tract infections. Source: Palliative Care Nursing- A Guide to Practice. 733 Dr. Geminer St., Karkafa, Bethlehem –Palestine. P.O. Box: 19960 East Jerusalem 97200 Telefax: 972 2 2767337 , Mobile: 972 522495249 , E-mail: sadeelsoc@yahoo.com

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