Related To: [Check those that apply]
Neuromuscular problems:
As evidenced by: [Check those that apply]
Objective/Expected Outcome;The patient will:
| Nursing Interventions | Scientific Rationale |
|---|---|
| Assess patient's level of anxiety. | There is a wide range of normal for bowel elimination; some patients have two bowel movements per day, whereas others may have a bowel movement as infrequently as every third or fourth day. |
| Perform manual check for fecal impaction. | When patient has a fecal impaction (hard, dry stool that cannot be expelled normally), liquid stool may leak past the impaction. |
| Assess whether current medications or treatments may be contributing to bowel incontinence. | Hyperosmolar tube feedings, bowel preparation agents, some chemotherapeutic agents, and certain antibiotic agents may cause explosive diarrhea that the patient cannot control. |
| Assist in preparing patient for diagnostic measures. | To determine cause(s) of bowel incontinence. |
| Assess degree to which patient's daily activities are altered by bowel incontinence. | Patients may restrict their own activity or become isolated from work, family, and friends because they fear odor and embarrassment. |
| Assess use of diapers, sanitary napkins, incontinence briefs, fecal collection devices, and underpads. | Patients or caregivers may substitute familiar products (i.e., sanitary napkins) for more appropriate incontinence products out of ignorance or embarrassment. |
| Assess perineal skin integrity. | Stool can cause chemical irritation to the skin, which may be exacerbated by the use of diapers, incontinence briefs, and underpads. |
| Ensure fluid intake of at least 3000 ml per day, unless contraindicated. | Moist stool moves through the bowel more easily than hard, dry stool and prevents impaction. |
| Provide high-fiber diet under the direction of a dietitian, unless contraindicated. | Fiber aids in bowel elimination because it is insoluble and absorbs fluid as the stool passes through the bowel; this creates bulk. Bulky stool stimulates peristalsis and expulsion of stool from the bowel. |
| Encourage mobility or exercise if tolerated. | This enhances gravity, stimulates peristalsis, and aids in bowel evacuation. |
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