You are on page 1of 1

Al

gor
it
hm #4Gener
alAs
ses
smentofBowel
Funct
ion
I
dent
if
yRi
skF
act
orsf
orBowelDys
funct
ion

-
Cogniti
veimpairment /memor yimpairment- -deler i
um/ dement ia/disori
entationorconf usi
onorf orgetfulnes -
li
mitedmobi li
ty
L
-imi
tedMobi l
i
ty--Weaknes sorcompl etel
yimmobi lei noneormor elimbs
-
Hist
oryofboweldi s
turbance- -e.g.chroniccons t
ipat ion,gas tropar esis
,fecal incontinence,gas tr
iti
sorgas t
roenter i
ti
s,r
ectal
tr
aumaorr ectalpr olaps e,hemor rhoids
-
Recentsurgerywithgener alanesthes
iaorepi duralbl ock
-
Therapeut
icmedi cationswithadverses i
deef f
ects( e. g.opi oi
ds ,psychot ropics,antidepres s
ants,NSAIDS ,ant i
bioti
cs,
ant ihi
stami nes,hyper tensi
onagent s
:cal ci
um channel blockers,cloni
dine,
diuretics),sympat homi met i
cs,andant i
cholinergi
cs
-
DysphagiaorNPO s tatusand/ortubef eedings--incr eas edr i
skofdehydr at
ion,mal abs orpti
ons ympt oms ,cons ti
pation,poor
ornof i
beri ntake
-
Hist
oryofbowelobs tructi
on--wi
thorwi thoutsurger yorcol ostomy/ i
leos t
omyorr ectal prolapse
-
Hist
oryofboweldi s
eas e--CrohnsDisease,C-diffcol iti
sinfection,irr
itablebowel syndrome,cel i
acdi seas e,diabet i
cgas t
ropares
is

Pr
oceedwi
thScr
eeni
ngQues
ti
onsf
orBowelDyf
unct
ion
I
dent
if
ynew bowel
probl
emsdur
ingpat
ienti
nter
view:
1.Areyouhavinganypr oblemswithnor malbowel movement s?
(st
rai
ningorpain,hardsmallst
ools,i
ncompl etesenseofevacuati
on,l
ooses t
ool
sordiar
rhea)
2.Haveyouhadpr obl
emswi thnormal bowel movement si
nthepast?
3.Whatisyournormal s
tool
ingpattern?How of t
endoyoumoveyourbowel s
?
4.Haveyouus edmedi cati
onsforbowel functi
oninthepastsuchaslaxat
ivesorant
idi
arr
heals
?
5.Doyous ometi
mesl eakstoolwhenyoui ntendt opassgass?

REDF
LAG Sympt
oms
:vi
si
bleoroccul
tbl
oods
tool
s,nar
rowi
ngofs
tool
diamet
er,r
epor
tofuni
ntent
ional
wei
ghtl
ossandanemi
a

Us
etheBr
is
tolSt
oolScal
etoas
si
styourpat
ienti
ndecr
ibi
ngt
hei
rbowel
movement
s.

Col
l
ectDat
a
-
Determinethepatient
scur r
entdi
et?Cal culatehow muchf i
beristhepatientcurrentl
ytakinginfr
om meal sorsuppl
ements.
-
Evaluat
et hepati
entshydrati
onstatus;est
imatethepat ient
sfl
uidneeds( usualybetwen2L -
3L/
day)
-
Determinethelas
tbowel movementandr eview st
oolcons i
st
ency( usetheBr i
st
olStoolScaletodes cr
ibequalit
yofst
ool)
-
Compl eteamedi cati
onreview:aret heremedi cati
onsthatarecont ri
buti
ngt obowel dysfuncti
on( const
ipat
ionordiar
rhea)
-
Ini
ti
ateanElimi
nationChar t(i
ncl
udingf r
equencyandf orm)foratleast7days .
-
Ift
herewasar ecentbowel acci
dent ,whatwer ethecircums t
ances ?

ConductPhys
icalAs
ses
sment
NeuroExam: As s
essori
entati
on,commandf ol
l
owing,recall
ofinfor
mat i
onands us
tainedat
tenti
on
Oral/
Swall
ow:Evaluatepatientfordysphagiaandtol
eranceofs oli
df oodcons i
st
enciesandsafetol
eranceofthi
nli
qui
ds
Abdominal: Checkbowel s
ounds ,palpat
eabdomenandeval uatef ordis
tensi
on,reboundtender
nes s
,orpai
n
Peri
analSki
n: I
nspectperi
anal t
iss
uef orhemorr
hoi
ds,rash,r
ectalfi
ss
ur es,ski
ntagsandf ecalr
esi
due

Exter
nal
AnalRefl
ex: Gent l
ystr
oket heanusi naqui ckupwar dsmot i
onatthe3o cl
ockor9o cl
ockr egion:whens t
rokedt hesphi
ncter
wil
lconstri
ct,call
edt heanal wink--thist
eststhepudundeal nerveatt
hes acralnervelevelS2-
S3.Ifnegati
ve,
evaluatepat i
entforfecali
ncont i
nenceordi arr
heainAlgori
thm #6)
I
nter
nal
AnalRefel
x: Withagl ovedf i
nger,asses
sthemus cletoneoft heanalsphincter
,whichshouldpresentwi t
hresi
stenceandt ensi
on
thr
oughoutt hes phi
nctermus cle.Evaluateforlow ornotone,orlackofsensor
yawar enessbythepat ient
.

I
dent
if
yPr
imar
yBowel
Sympt
omsandI
nit
iat
eaPl
anofCar
e

Forpati
entswit
hri
sksbutno Forpat ient swit
hpos i
ti
vef i
ndings : F
orpat i
entswi thpos i
tivefindings :
evi
denceofcons t
ipati
on, -thepat ienthas<3s toolsperweekat -
low ornor es t
inganal t
oneonex am
f
ecal i
nconti
nenceordiarr
hea: bas eli
ne -
fecal urgencywi t
hhi storyofbowel
-stoolpres entorstuck int her ectum accident s(soil
inglinenorcl othing)
-
Promot eadequat ehydr
ati
onand (fecal i
mpact i
on/ r
ecal i
mpct ion) -
noct urnalfecal acci dent sduring
fi
berintake -decr easeds t
ool f
requencyf rom sleep
-
Promot emobili
ty bas eli
ne -
fecal accident swithex erti
on
-
Educat eregar
dingris
kfact
ors -Abdomi nal dis
tension/ bl
oating -
stoolcons i
stencyi sloos e,wat ery,
forconsti
pati
on -hard,dr y,pellet-
li
kes tools mus hyordi ff
iculttocont r
ol
-
cont i
nuall
yass
essforanynew -hemmor hoids
dist
urbance. -patientrepor tssensat i
onofi ncompl ete
evacuat i
on
-patientrepor tsrectal painorbl eeding
Fol
l
ow
Fol
l
ow Al
gor
it
hm#6:FecalI
nconti
nenceand
Al
gor
it
hm #5:Cons
ti
pat
ion orDiar
rhea