BOWEL INCONTINENCE Nursing Care Plan

Jimmy, 35 years old who works as a freelance grass cutter in a small town. One day, while he was doing his job on a national road to clear some tall grasses, a small van approached and hit him at his back which later the driver was identified drunk and caught to jail. Unfortunately, Jimmy was unconsciously transferred to the hospital nearby. After a few hours, Jimmy wakes up and didn't remember so much about the incident. he confined and admitted to the hospital while waiting for his test results. Suddenly, an alarm rang in the nurses station which indicates that someone must need a nurse's attention and it was at Jimmy's room. Below is a sample of a bowel incontinence nursing care plan of Jimmy who recently admitted to the hospital due to an incident of being hit by a small van.

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

- Establish bowel program worth predictable time for Jimmy's defecation efforts, use suppositories and digital simulation when indicated. Place bedpan at specified interval to take into consideration of his needs and incontinent patterns. Maintain daily program initially. Progress to alternate days dependent on usual pattern of amount of stool. Take Jimmy to the bathroom or place on commode or bedpan at specific intervals, taking into consideration Jimmy needs and his incontinence patterns to maximize success of program.

- Promote exercise program, as Jimmy is a individually able, to increase his muscle tone and strength, including his lower 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 Jimmy 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 Jimmy, especially when his condition is long-term or chronic because it enhances his 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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