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BOWEL INCONTINENCE Nursing Care Plan

ASSESSMENT
Subjective:
"I'm unable to control my defecation," as verbalized.

Objectives:
I observed from the client that his/her clothing and bedding were stained by feces. The room has a fecal odor which was came from the patient. The patient had a red in his/her perianal skin and there's a soft stool protruding in his/her rectal orifice.  Vital signs were taken and noted as follows: Body temperature of 37.5 degrees Celcius, blood pressure of 130/90, respiratory rate of 18 cycles per minute and pulse rate of 98 beats per minute. Both of his/her respiratory and pulse rate are normal but his/her body temperature and blood pressure are above normal.

DIAGNOSIS
Bowel incontinence related to inability to control defecation as evidenced by fecal staining of clothing. (Defecation is a process when a person eliminates his/her own feces).

PLANNING
After 4 hours of nursing intervention, the patient will participate in therapeutic regimen to control incontinence and maintain a regular pattern of bowel function.

INTERVENTIONS

Identify pathophysiology factors present such as multiple sclerosis, acute and chronic cognitive and self-care impairments, spinal cord injury, stroke, ileus, ulcerative colitis. Rescue results of diagnostic studies such as abdominal x-ray, colon imaging, complete blood count, serum chemistries, stool for blood guaiac as appropriate. Determine historical aspects of incontinence with preceding/precipitating events. Review medication regimen that might increase potential for bowel problems. Auscultate the abdomen and look for the presence, location, and tenderness. Palpate the abdomen for distention, masses and tenderness.



Establish bowel program worth predictable time for defecation efforts, use suppositories and digital simulation when indicated. Place bedpan at specified interval to take into consideration of individual needs and incontinent patterns. Maintain daily program initially. Progress to alternate days dependent on usual pattern of amount of stool. Take client to the bathroom or place on commode or bedpan at specific intervals, taking into consideration individual needs and incontinence patterns to maximize success of program. Provide perineal care and hygiene to prevent perineal infection and excoriation. 


Promote exercise program, as individually able, to increase muscle tone and strength, including perineal muscles. Provide incontinence aid or pads until control is obtained. Note that incontinence pads should be changed frequently to reduced incidence of skin rashes or breakdown. Demonstrate techniques such as contacting abdominal muscles, leaving forward on a commode, manual compression to increase intra-abdominal pressure during defecation, and left to right abdominal massage to stimulation of peristalsis.

Refer to ND diarrhea if incontinence is due to uncontrollable diarrhea and ND constipation if incontinence is due to impaction.

Instruct the use of suppositories or stool softeners, if indicated to stimulate timed defecation. Note the stool characteristics such as color, odor, consistency, amount, shape and frequency to provide a comparative baseline. Identify foods such as daily bran muffins, prunes that promote regular bowel and encourage the client in high-fiber diet and adequate amount of warm fluids. 

Provide emotional support to client, especially when condition is long-term or chronic because it enhances coping with difficult situation.

EVALUATION
After 4 hours of nursing intervention, the patient participated in therapeutic regimen to control incontinence and maintained a regular pattern of bowel function.

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