1. CONSTIPATION & IMPACTION By Faith-Insight Nursing Consultants

2. CONSTIPATION Definition Difficult, incomplete, or infrequent evacuation of dry hardened feces from the bowels Possible causes of constipation: Slow digestion of food Narcotics, Iron medicines, Seizure medicines Immobility Decreased fluid intake Certain diseases

3. Signs & Symptoms of Constipation Decreased appetite Slight opening of the rectal area Incomplete evacuation after a BM Watery stool, such as diarrhea around hard stool Abdomen feeling full Nausea and/or vomiting

4. Constipation Action Plan DOCUMENTATION 1.C.N.A. will document progress in BM Tracker 2.Document prn on 24- hour report form. 3.Document on BM Tracker (small, med, or large). ACTION 1.C.N.A. will verbally communicate resident’s lack of BM to the nurse. 2.Nurse will implement protocol for Senokot S, tabs 2 @ hs. 3.Each shift C.N.A. will monitor for effectiveness of Senecot-S.

5. CONSTIPATION DOCUMENTATION 4.Nurse will document notification of physician. 5.Nurse will document assessment of resident for fecal impaction. ACTION 4.Nurse will review BM records for effectiveness of Senokot protocol. If positive results are not obtained, nurse will notify physician. 5.Nurse will assess resident for fecal impaction.

6. REVIEW Monitor residents for signs and symptoms of constipation and document daily BM’s. Accurately communicating the size of the BM is very important in preventing fecal impactions. If no BM in 2 days implement Senekot protocol and assess residents for effectiveness.

7. FECAL IMPACTION Fecal impaction is a large mass of dry hard stool that can develop in the rectum due to chronic constipation. This mass may be so hard that it cannot be expelled from the body. Watery stools from higher in the bowel may move around the mass and leak out resembling diarrhea.

8. Preventing Fecal Impaction Causes of fecal impactions Chronic constipation Immobility Disease of the nervous system Medications (anticholingenic, narcotic) Constipation Protocol Increase fiber and fluid intake Constipation Identified

9. FECAL IMPACTION ACTION PLAN ACTION 1.Identify fecal impaction 2.Manually removed by nurse 3.Contact physician for orders, i.e., Fleet enema, Senokot-S DOCUMENTATION 1.Nurse’s assessment of rectal exam. 2.Physician notification in nurses’ notes. 3.Manual removal of impaction documented in nurse’s notes.

10. REVIEW Fecal impaction is never an acceptable state for any of our residents. Ongoing assessment must be performed to prevent impaction. Our goal?

11. Constipation & Fecal Impaction Post-Test 1.How will the nurse know a resident’s bowel habits? _______________________________________ 2.If there are two days of “0’s” on BM Tracker, what action should be taken? _______________________________________ 3.Under what circumstances should nurse assess resident for fecal impaction? ______________________________________ 4.What are the steps to prevent fecal impaction? _______________________________________

12. CONTRACT OF COMPREHENSION I have received the “Constipation and Fecal Impaction” training as indicated by my signature below. I participated in the question and answer portion of the “Constipation and Fecal Impaction” training which provided an opportunity to ask questions. I fully understand the information covered in this training session. ________________________________________ EmployeeDate ________________________________________ RNDate