Skill 30
Fecal Impaction
Removing Digitally
Fecal impaction is the inability to pass a collection of hard stool. This condition occurs in all age-groups. Physically and mentally incapacitated persons and institutionalized older adult patients are at greatest risk. Symptoms of fecal impaction include constipation, rectal discomfort, anorexia, nausea, vomiting, abdominal pain, diarrhea (leaking around the impacted stool), and urinary frequency. Digital removal of an impaction is very uncomfortable and embarrassing for the patient. Excessive rectal manipulation causes irritation to the mucosa and subsequent bleeding or vagus nerve stimulation, which can cause a reflex slowing of the heart rate.
Delegation Considerations
The skill of removing a fecal impaction digitally cannot be delegated to nursing assistive personnel (NAP). The nurse directs the NAP to:
