Section 2: digestive: Removal of Fecal Impaction



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Digestive – Removal of Fecal Impaction
SECTION: 2.15
Strength of Evidence Level 3
__RN__LPN/LVN__HHA
PURPOSE:
To remove hardened or putty-like stools from the rectum to prevent interference with the normal passage of feces.
CONSIDERATIONS:
1. Explain treatment and procedure to patient as well as teach that proper diet, sufficient fluid intake and adequate exercise will assist in preventing further impactions.
2. The nurse should assess for impaction when patient has poor results from an enema, when the rectal tube is inserted with difficulty or when there is a history of no elimination fora long period of time.
3. Obtain physician order for both manual disimpaction and enemas.
EQUIPMENT:
Plastic-lined under pads Disposable enema set with castile soap or oil retention enema Bedpan Toilet tissue Gloves Disposable apron
Water-soluble lubricant
PROCEDURE:
1. Adhere to Standard Precautions.
2. Explain procedure to patient.
3. Position patient on left side, if possible, with right knee flexed.
4. Administer cleansing or oil retention enema. This step may not be possible due to severe impaction; therefore, proceed to Step 5 after completing Step
3.
5. Lubricate index finger liberally.
6. Advise patient to breathe with mouth open.
7. Insert index finger into rectum and remove fecal particles by finger manipulation. Gently stimulate the anal sphincter by two or three circular motions of the finger before finger is removed (this stimulates peristalsis and aids evacuation. Discontinue
treatment if bleeding or any untoward reaction
occurs, e.g., extreme pain, shock, etc. Notify
physician immediately.
8. Follow removal of impaction with a cleansing enema.
9. Discard soiled supplies inappropriate containers.
AFTER CARE
1. Cleanse reusable equipment, rinse, dry and replace in proper place.
2. Document inpatients record a. Procedure and observations. b. Results. c. Patient's response to procedure. d. Instructions given to patient/caregiver. Last Update 9/10

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