Constipation
1. Characteristics: What is the frequency, consistency, color
of the stools? Is this a change in bowel habits? If a change,
has this been gradual or sudden? What is the size of the
stools? Have there been dietary changes? Is there blood or
mucus in the stools? Any laxative use?
2. Associated factors: Are there periods of diarrhea? Is
there abdominal pain or distention? Is the patient expe-
riencing stress? Is there a change in activity level? Does
the patient have a regular time for defecation? Does the
patient use antacids containing calcium or an anti-
cholinergic? Have there been any fevers, chills, night
sweats, or weight loss?
3. History: Any family history of colorectal cancer? Any
history of depression or metabolic disorders, such as
hypothyroidism or hypercalcemia?
Dysphagia
1. Characteristics: Is the onset acute or gradual? Is the prob-
lem with swallowing intermittent or continuous? Is this
associated with solid foods, liquids, or both? Has there
been any nasal regurgitation? Where does the food stick:
neck (cricopharyngeal), midesophagus, or sternal xiphoid
process?
2. Associated factors: Is there any regurgitation, heartburn,
chest or back pain, weight loss? Any hoarseness, voice
change, or sore throat? Have there been any fevers, chills,
night sweats, or weight loss?
3. History: Is there a family history of esophageal cancer?
Is there a history of stroke, palsy, or any other neuro-
logic conditions? Is there a history of alcohol or tobacco
intake?
PHYSICAL EXAMINATION
When performing a physical examination of the abdomen,
include the following: inspection of the abdomen, ausculta-
tion of all four abdominal quadrants, percussion for tympany
or dullness, light and deep palpation.
NURSING ALERT Auscultation should be performed before
percussion and palpation, which may stimulate bowel sounds.
Deep palpation in noted areas of tenderness or pain should be per-
formed last.