The nurse is planning care for the 78-year-old patient with recurrent fecal impaction. The patient has prostate cancer that has metastasized to the bone. In addition to palliative chemotherapy, the patient receives a fentanyl transdermal patch and intravenous hydromorphone. The patient is neutropenic and thrombocytopenic. The nurse works with the provider to plan which intervention to manage the opioid-induced constipation and subsequent fecal impaction?

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Begin therapy with bisacodyl and fiber supplementation. Bisacodyl and fiber supplementation are an appropriate bowel regimen for the patient with opioid-induced constipation. Daily tap water enemas place the patient at risk for fluid and electrolyte imbalance, hemorrhage and infection due to the patient&rsquo;s thrombocytopenia and neutropenia. The patient has bone metastases which are excruciatingly painful. Weaning the hydromorphone to prevent constipation is not the appropriate intervention for this patient. Although ambulation as tolerated is helpful to treat constipation, it is unlikely that the patient&rsquo;s pain is controlled well-enough to allow that.

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