NAME___________________________________ DATE_____________________

COURSE & SEC__________________________ RLE GROUP ______________

H. CHECKLIST ON FECAL IMPACTION REMOVAL

Able to
Unable
Able to Perform
Procedure to
Perform with
Perform
Assistance

Assessment
1. Check the physician’s order and the client’s chart.
2. Determine the indication of fecal impaction.
3. Assess the status of the anus and skin surrounding the
buttocks.

Planning
4. Wash hands.
5. Assemble the equipment.

Implementation
6. Identify the client and explain the procedure.
7. Obtain blood pressure and rate and rhythm of pulse.
8. Position client in side-lying with knees flexed.
9. Drape client so that only buttocks are exposed.
10. Place linen savers under buttocks.
11. Wear gloves. Lubricate the first two gloved hands of the
dominant hand.
12. Gently spread buttocks with non-dominant hands.
13. Instruct client to take a slow deep breath through mouth.
14. Insert index finger into rectum (directed toward umbilicus)
until the fecal mass is palpable.
15. Gently break up hardened stool remove one piece at a time
until all stool is removed.
16. Place a stool in a bedpan as it is removed.
17. Remove finger, wipe excess lubricant from the perineal
area, and release buttocks.
18. Discard articles used.
19. Wash hands.
20. Wear gloves.
21. Wash, rinse, and dry buttocks.
22. Reposition client.
23. Discard gloves and articles used.
24. Spray air freshener at the bedside.
25. Wash hands.
Evaluation
26. Evaluate color, consistency, and amount of stool.
27. Evaluate the client’s response and tolerance to the
procedure.

Documentation
28. Record the color, consistency, and amount of stool.
29. Record vital signs before and after removal.
30. Record the client’s tolerance and response to the
procedure.

Remarks:
_____________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________

Grade: __________
Rating Scale:

Excellent : 96 - 100%
Very Satisfactory : 90 - 95%
Very Good : 85 - 89%
Good : 85 - 89%
Fair : 75 - 79%
Poor : 74 & below

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Clinical Instructor Student’s Signature