Prophylactic Care

•Fiber-rich nutrition: wholemeal products, cooked vegetables, raw fruit (e.g., berries), and raw vegetables (e.g., carrot or cucumber salad); if patient’s condition allows, cooked fiber-rich vegetables (e.g., leeks and green beans, dried fruit)

•Avoidance of foodstuffs that can cause constipation: carrot soup, white rice, white bread (white flour products), black tea, chocolate, hard cheese, boiled eggs

•The patient needs to drink plentifully

•As much physical activity as possible

•Psychological measures: no time pressure, paying attention to ensuring privacy

•When signs of constipation are present, discuss with physician

Treatment

Constipation can be treated in many ways. Usually laxatives with different modes of action are used:

•Osmotic laxatives: not resorbable, bind water. Saline laxatives are used frequently

•Enemas: act locally in the gut. If thrombocytopenia and/or leukopenia are present, use only with doctor’s consent

•Lubricants: facilitation of bowel movement by way of lubrication. Paraffin and glycerin are commonly used

•Expanding agent: substances containing cellulose, which, at intake of water, swell and thereby expand the volume of intestinal content

19.2.6.2Diarrhea

•Increased frequency of bowel movements: three or more per day, stools being unformed, mushy, or liquid

•Concomitant phenomena can include pain with bowel movements, abdominal cramps

•General health is usually compromised, often also electrolyte shifts occur and, as a consequence, dehydration may ensue

Causes

•Medication: chemotherapeutic agents (impairment of mucous membranes with methotrexate, doxorubicin, daunorubicin), antibiotics (alteration of natural intestinal flora), laxatives

•Radiation of abdomen and pelvis

•Inflammatory bowel diseases

•Tube feeding

•Dietary errors

•Food poisoning

Treatment

Following establishment of cause, according to doctor’s orders:

•Medication

•For patients not able to take in sufficient fluids orally, rehydration via nasogastric tube or i.v.