A client is starting scheduled opioid therapy for chronic cancer pain. Which intervention is most appropriate to prevent opioid-induced constipation?
1Begin docusate, then add a stimulant if no bowel movement occurs within 3 days.
2Begin a bulk-forming fiber supplement and restrict fluids to reduce abdominal distention.
3Wait for constipation to develop, then administer an osmotic laxative as needed.
4Begin a scheduled stimulant laxative and encourage fluids and activity as tolerated.✓ Correct answer
Explanation
Constipation is an expected persistent effect of opioid therapy, so prophylaxis should begin when scheduled opioids are started. A scheduled stimulant laxative, together with hydration, fiber, and activity as tolerated, is an appropriate initial regimen. Docusate alone is often insufficient. A bulk-forming agent without adequate fluid can worsen obstruction risk. Waiting until constipation is established delays prevention and may make symptoms harder to control.
Clinical reasoning summary Start bowel prophylaxis when scheduled opioid therapy begins. A stimulant laxative is usually required; add hydration, dietary fiber, and activity when appropriate. Docusate alone or delayed as-needed treatment may be inadequate.