Removing Stool Digitally

Removing Stool Digitally

Equipment
■ 2 pairs of clean procedure gloves.
■ Water-soluble lubricant (containing lidocaine, if agency policy permits).
■ Bedpan and cover.
■ Washcloth, soap, and towel or toilet tissue (or moistened towelettes).
■ Basin of warm water.
■ Bath blanket.
■ Waterproof pad.

Assessment
■ Assess:
■ Cognitive level and mobility status.
■ History of fecal impaction.
■ Time of last bowel movement.
■ Stool consistency.
■ Desire and ability to defecate.
■ Pain on defecation.
■ Pattern of bowel movements, diet, exercise, mobility status, and medications (e.g., iron supplements or narcotic analgesics).
■ Bowel sounds and abdominal distention.
■ Be Safe! Assess the patient’s baseline VS and history of heart disease. Be sure to monitor the patient’s pulse before and during the procedure; be alert for bradycardia.
■ Be Safe! Assess the patient’s WBC count. If low, discuss this procedure with the primary care provider to evaluate the risks and benefits of the procedure.
■ Be Smart! Determine whether the procedure will be accompanied by suppository insertion or enema administration.

Post-Procedure Reassessment
■ Determine whether evacuation of the retained stool was complete. Perform a rectal exam to assess for presence of stool.
■ Reassess VS, and compare the results to the initial assessment.
■ Continue to monitor for 1 hour for bradycardia.
■ Assess bowel sounds; palpate the abdomen for nontenderness and softness; ask the patient whether he feels relief from rectal pressure and abdominal discomfort.

Key Points
■ Be Smart! Be aware that this procedure is both painful and embarrassing to your patient.
■ Be Safe! Do not delegate this procedure to nursing assistive personnel.
■ Trim and file your fingernails so they do not extend over the ends of your fingertips.
■ Be Smart! You may wish to double-glove for this procedure.
■ Lubricate your gloved finger generously.
■ Use only one or two fingers, and remove stool in small pieces.
■ Allow the patient periods of rest, and monitor for signs of vagal nerve stimulation.
■ Teach the patient lifestyle changes necessary to prevent stool retention.

Documentation
■ Document the bowel movement on the graphic record.
■ Record the procedure and the patient’s tolerance for the procedure, and any unusual characteristics of the stool (e.g., black or green color, blood, or mucus) in the nursing notes.
■ Chart the pulse rate on the VS record.

Gently rotate your finger around and into the mass

Break the stool into smaller pieces