Nursing Dx

Actions/Interventions
NURSING PRIORITY NO. 1. To identify causative/contributing factors:
• Review daily dietary regimen. Note oral/dental health that can impact intake.
• Determine fluid intake, to note deficits.
• Evaluate medication/drug usage and note interactions or side effects (e.g., narcotics, antacids, chemotherapy, iron, contrast media such as barium, steroids).
• Note energy/activity level and exercise pattern.
• Identify areas of stress (e.g., personal relationships, occupational factors, financial problems).

• Determine access to bathroom, privacy, and ability to perform self-care activities.
• Investigate reports of pain with defecation. Inspect perianal area for hemorrhoids, fissures, skin breakdown, or other abnormal findings.
• Discuss laxative/enema use. Note signs/reports of laxative abuse.
• Review medical/surgical history (e.g., metabolic or endocrine disorders, pregnancy, prior surgery, megacolon).
• Palpate abdomen for presence of distention, masses.
• Check for presence of fecal impaction as indicated.
• Assist with medical workup for identification of other possible causative factors.

NURSING PRIORITY NO. 2. To determine usual pattern of elimination:
• Discuss usual elimination pattern and problem.
• Note factors that usually stimulate bowel activity and any interferences present.
NURSING PRIORITY NO. 3. To assess current pattern of elimination:
• Note color, odor, consistency, amount, and frequency of stool. Provides a baseline for comparison, promotes recognition of changes.
• Ascertain duration of current problem and degree of concern (e.g., long-standing condition that client has “lived with” or a postsurgical event that causes great distress) as client’s response may be inappropriate in relation to severity of condition.
• Auscultate abdomen for presence, location, and characteristics of bowel sounds reflecting bowel activity.
• Note laxative/enema use.
• Review current fluid/dietary intake.
NURSING PRIORITY NO. 4. To facilitate return to usual/acceptable pattern of elimination:
• Instruct in/encourage balanced fiber and bulk in diet to improve consistency of stool and facilitate passage through colon.
• Promote adequate fluid intake, including high-fiber fruit juices; suggest drinking warm, stimulating fluids (e.g., decaffeinated coffee, hot water, tea) to promote moist/soft stool.
• Encourage activity/exercise within limits of individual ability to stimulate contractions of the intestines.
• Provide privacy and routinely scheduled time for defecation (bathroom or commode preferable to bedpan).
• Encourage/support treatment of underlying medical cause where appropriate (e.g., thyroid treatment) to improve body function, including the bowel.
• Administer stool softeners, mild stimulants, or bulk-forming agents as ordered, and/or routinely when appropriate (e.g., client receiving opiates, decreased level of activity/immobility).
• Apply lubricant/anesthetic ointment to anus if needed.
• Administer enemas; digitally remove impacted stool.
• Provide sitz bath after stools for soothing effect to rectal area.
• Establish bowel program to include glycerin suppositories and digital stimulation as appropriate when long-term or permanent bowel dysfunction is present.
NURSING PRIORITY NO. 5. To promote wellness (Teaching/ Discharge Considerations):
• Discuss physiology and acceptable variations in elimination.
• Provide information about relationship of diet, exercise, fluid, and appropriate use of laxatives as indicated.
• Discuss rationale for and encourage continuation of successful interventions.
• Encourage client to maintain elimination diary if appropriate to facilitate monitoring of long-term problem.
• Identify specific actions to be taken if problem recurs to promote timely intervention, enhancing client’s independence.

Documentation Focus
ASSESSMENT/REASSESSMENT
• Usual and current bowel pattern, duration of the problem, and individual contributing factors.
• Characteristics of stool.
• Underlying dynamics.
PLANNING
• Plan of care/interventions and changes in lifestyle that are necessary to correct individual situation, and who is involved in planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Responses to interventions/teaching and actions performed.
• Change in bowel pattern, character of stool.
• Attainment/progress toward desired outcomes.
• Modifications to plan of care.
DISCHARGE PLANNING
• Individual long-term needs, noting who is responsible for actions to be taken.

• Recommendations for follow-up care.
• Specific referrals made.