Nursing diagnosis – bowel incontinence

Bowel Incontinence
DEFINITION
Change in normal bowel habits characterized by involuntary passage
of stool
DEFINING CHARACTERISTICS
• Constant dribbling of soft stool
• Fecal odor
• Fecal staining of clothing or bedding
• Inability to delay defecation
• Inability to recognize urge to defecate
• Recognizes rectal fullness but reports inability to expel formed stool
• Inattention to urge to defecate
• Self-report of inability to recognize rectal fullness
• Red perianal skin
• Urgency
RELATED FACTORS
• BOWEL INCONTINENCE
• Abnormally high abdominal
pressure
• Abnormally high intestinal
pressure
• Chronic diarrhea
• Colorectal lesions
• Dietary habits
• Environmental factors (e.g.,
inaccessible bathroom)
• General decline in muscle tone
• Immobility
• Impaired cognition
• Impaired reservoir capacity
• Incomplete emptying of bowel
• Laxative abuse
• Loss of rectal sphincter
control
• Lower motor nerve damage
• Medications
• Rectal sphinter abnormality
• Impaction
• Stress
• Toileting self-care deficit
• Upper motor nerve damage
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Fluid and electrolytes
• Elimination
• Neurocognition
EXPECTED OUTCOMES
The patient will
• Experience a bowel movement every ___ day(s) when placed on
commode or toilet at ___ AM/PM.
• Maintain clean and intact skin.
• Have improved control of incontinent episodes.
• State understanding of bowel routine.
• Demonstrate skill in using commode.
• Demonstrate skill in the use of suppository if indicated.
• Express an understanding of the relationship between food and
fluid regulation and the promotion of continence.
• Maintain self-respect and dignity through participation and acceptance
within group.
SUGGESTED NOC OUTCOMES
Bowel Continence; Bowel Elimination; Self-Care: Toileting
INTERVENTIONS AND RATIONALES
Determine: Establish a regular pattern for bowel care; for example,
after breakfast every other day, place patient on the commode chair
1 hr after inserting suppository, allow patient to remain upright for
30 min for maximum response, and then clean the anal area. Procedure
encourages adaptation and routine physiologic function.
Monitor and record incontinent episodes; keep baseline record for
3–7 days to track effectiveness of toileting routine.
Perform: Clean and dry perianal area after each incontinent episode
to prevent infection and promote comfort.
Inform: Demonstrate bowel care routine to family or caregiver to
reduce anxiety from lack of knowledge or involvement in care.
Arrange for return demonstration of bowel care routine to help
establish therapeutic relationship with patient and family or
caregiver.
Establish a date when family or caregiver will carry out bowel
care routine with supportive assistance; this will ensure that patient
receives dependable care.
Discuss bowel care routine with family or caregiver to foster compliance.
Instruct family or caregiver on need to regulate foods and fluids
that cause diarrhea or constipation to encourage helpful nutritional
habits.
Attend: Maintain patient’s dignity by using protective padding under
clothing, by removing patient from group activity after incontinent
episode, and by cleaning and returning patient to the group without
undue attention. These measures prevent odor, skin breakdown, and
embarrassment and promote patient’s positive self-image.
Manage: Maintain diet log to identify irritating foods, and then
eliminate them from patient’s diet.
SUGGESTED NIC INTERVENTIONS
Bowel Incontinence Care; Bowel Management; Perineal Care; Skin
Surveillance
Reference
Dowd, T., & Dowd, E. T. (2006, January–February). A cognitive therapy
approach to promote continence. Journal of Wound, Ostomy and
Continence Nursing, 33(1), 63–68.

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