Transcript NAII-Module 11

Break-up
and
Removal
of a Fecal
Impaction
By Elya (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0
(http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
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NCBON Learning Objectives
1. State 3 probable signs of fecal impaction
2. Discuss the procedure for removal of fecal impaction
3. Identify at least 3 observations to report to the licensed nurse
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NCBON Special Directions
The patient must be assessed by the RN prior to delegating
this activity to the NA II
OH NO! It is a
fecal impaction!
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Bowel Elimination
• Affected by illness, injury, immobility, and certain
medications
• Monitoring the patient’s bowel movements (BM’s) is an
important responsibility
• If a patient does not have a BM in three days, notify the
RN
• Constipation can result in discomfort
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Fecal Impaction
• The most serious
form of constipation
• Unrelieved, it can
be life threatening,
especially for the
elderly
• The feces becomes
hard and dry and
the patient is unable
to pass it
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Probable Signs of Impaction
• Seepage of liquid stool around the
impaction
• Abdominal distention
• Nausea and Vomiting
• Patient may have loose stools , giving
the impression of diarrhea
• This is because the hard mass in the
rectum prevents fecal matter above it
from passing
• Pressure from the stop may cause
more frequent urination
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Illustration: http://www.clipartbest.com/mud-splash
Removing a Fecal Impaction
•
•
•
•
Elimination procedures are private
Use Standard Precautions
Receive direction from the RN
Gather your equipment, including water-soluble
lubricant
• Position the patient in Sims’ position
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Illustration: http://www.moondragon.org/health/disorders/patientpositions.html
Breaking Up an Impaction Con’t
• After applying lubricant to your
index finger, gently insert your index
finger into the rectum
• Instruct the patient to take slow,
deep breaths
• After the anus relaxes, two
lubricated fingers can be inserted, if
necessary
• Move your finger upward, probing
for a hard fecal mass
• Continue to manipulate the stool,
breaking it into small pieces
• Then bend your finger forward slightly and hook a piece of
stool, pulling it downward and removing it from the rectum
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Complications: Vagus
Nerve Stimulation
• May cause the patient’s pulse to decrease, especially
one with heart disease
• May see decreased pulse and respirations
• What should you do?
STOP
the procedure and call for the nurse
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Other Indications for Stopping the Procedure
• Stop if the patient complains of unusual pain
• Stop if there is any bleeding, skin color changes,
respiratory changes, or if the resident complains of
feeling faint
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Post
Evacuation
• After evacuating the impaction clean the anal area
• May sure the patient is comfortable
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Reporting and Documentation
• Report to the nurse:
(1) amount, color,
and consistency of
stool, (2) tolerance of
the patient
• Document your
findings in the
resident’s chart
PHOTO:http://upload.wikimedia.org/wikipedia/com
mons/f/f4/Hospitalgownspatients.jpg
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