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Chronic Confusion

This is a care plan guide for the Chronic Confusion nursing diagnosis. Chronic Confusion is defined as an irreversible, long-standing, and/or progressive deterioration of intellect and personality characterized by decreased ability to interpret environmental stimuli, decreased capacity for intellectual thought processes, and manifested by disturbances of memory, orientation, and behavior.

Me…

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Emilia Clarke Becomes a Nursing Now Ambassador

Emilia Clarke Becomes a Nursing Now Ambassador

Popular actress Emilia Clarke was announced on March 14 as First Ambassador for the global Nursing Now Campaign. On this platform, she will be joining Kate Middleton, Her Royal Highness the Duchess of Cambridge, patron of Nursing Now.

“I am privileged to be asked to join Nursing Now’s global movement by becoming their Ambassador and help them empower nurses. I believe strongly in the need to…

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25 Inspirational Quotes Every Nurse Should Read

25 Inspirational Quotes Every Nurse Should Read

There is no doubt that Nursing is still one of the most inspiring and fulfilling careers ever created. However, we also know that some of us do not feel fulfilled being a nurse all day at work. Discouragement, disappointment, failure, and setbacks—these are all things that we have to deal with at some points in our lives.

Sometimes, all we need is a little inspiration to keep rolling. Nurseslabs…

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Situational Low Self-Esteem

The nursing diagnosis Situational Low Self-Esteem is defined as the development of a negative perception of self-worth in response to current situation.

Self-esteem is defined as the way an individual thinks about himself or herself, and how good he or she feels. Positive self-esteem develops when a person feels good and capable of responding to challenges and stressors. Nevertheless, when a…

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Top graduate nursing schools in the US for 2020

Top graduate nursing schools in the US for 2020

The School of Nursing at Johns Hopkins University achieved the distinction of being ranked top for both its Master’s and Doctor of Nursing Practice (DNP) programs for 2020.  This was in the U.S. News’ recently released rankings of graduate programs in nursing.

Top nursing schools 

The top three nursing schools on the lists were:

Best nursing schools for Master’s program

#1 Johns Hopkins University

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Thousands of nurses in New York City authorize strike action

Thousands of nurses in New York City authorize strike action

Nurses at three hospital systems in New York City voted by an overwhelming margin of 97% to authorize a strike action. The vote, announced on March 7, is in response to months of inaction by hospitals on calls for improved staffing and other conditions in hospitals to ensure quality care for patients.

The strike will affect more than 10,000 nurses at the Mount Sinai, Montefiore, and Presbyterian…

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Bronchodilators and Antiasthmatics

In this nursing pharmacology guide for student nurses, learn about bronchodilators or antiasthmatics, its uses, and the nursing considerations for patients using them.

Bronchodilators or antiasthmatics are medications used to facilitate respiration by dilating the airways. They are helpful in symptomatic relief or prevention of bronchial asthma and for bronchospasm associated with COPD.

Bronchodil…

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Dear World Here's 10 Reasons Why You Should Hire Filipino Nurses

Dear World Here’s 10 Reasons Why You Should Hire Filipino Nurses

Wherever medical facility you may go, you are bound to meet at least one Filipino nurse. From the US to Europe, to Australia, Singapore, Japan, and the Middle East, you name it, Filipino nurses are there to care! Hosts of the 70th Primetime Emmy Awards, Michael Che and Colin Jost even cracked a joke about Filipino nurses, “I mean, can you believe that they did 15 seasons of ER without one…

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10 Geriatric Nursing Care Plans

Nursing care plans and nursing diagnosis for the older adult

In this nursing care plan guide are ten (10) nursing diagnosis for the care of the elderly (older adult) or geriatric nursing. Learn about the assessment, care plan goals, and nursing interventions for gerontology nursing in this post.

Gerontology nursing or geriatric nursingspecializes in the care of older or elderly adults. Geriatric nursing addresses the physiological, developmental,…

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Bowel Incontinence

Bowel Incontinence nursing diagnosis and care plan guide

Bowel Incontinence: Change in normal bowel habits characterized by involuntary passage of stool.

The nursing diagnosis bowel incontinence, also known as fecal incontinence, is the inability to control bowel movements, causing stool to leak unexpectedly from the rectum. It may occur as a result of damage to nerves or muscles and other structures associated with normal elimination or as a result of…

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Expectorants and Mucolytics

Expectorants are drugs that liquefy the lower respiratory tract secretions. They are used for the symptomatic relief of respiratory conditions characterized by a dry, nonproductive cough.

Mucolytics work to break down mucus to aid high-risk respiratory patients in coughing up thick, tenacious secretions.

Learn about the uses and nursing care plan considerations needed for patients taking…

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Risk for Electrolyte Imbalance

Risk for Electrolyte Imbalance Nursing Diagnosis and Care Plan

The nursing diagnosis Risk for Electrolyte Imbalance is defined as at risk for change in serum electrolyte levels that may compromise health.

Electrolytes regulate nerve and muscle function, hydrate the body, balance blood acidity and pressure, and further rebuild damaged tissue. Sodium, calcium, potassium, chloride, phosphate, and magnesium are all electrolytes. When these substances become…

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WHO launches smartphone app to screen for hearing loss

Do you have hearing loss? Find out with this app by the WHO. #HearWHO

The World Health Organization (WHO) launched a free app that anyone can use directly on a smartphone to screen their hearing directly. The launch of the HearWHO app coincided with World Hearing Day with the theme for 2019 being early identification and intervention for hearing loss.

We don’t always easily notice when someone has hearing loss. Even those who are affected often go through life…

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ER nurses should assess patients for in-home firearm risks

Do you ask at-risk patients in about access to firearms in the home? Do you believe that you could do this and that it is important for the future safety of your patients?

Nurses should be more involved in identifying patients at risk of injury from firearms at home so that appropriate intervention can take place. This was the conclusion of a recent study by the Emergency Nurses Association (ENA).

The study “Emergency Nurses’ Perception of Risk for Firearm Injury and Its Effect on Assessment Practices: A Mixed Methods Study,” used a quantitative survey and…

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8 Reasons Why Your Nurse Best Friends Are Just the Best!

You know your nurse best friend is like no other. Did you know that nurse besties increase your resilience, reduce your stress levels and protect you from nurse burnout? If you agree with the reasons why your nurse best friend is so valuable tag her and give her a shout-out or tell a story about your friendship.

We nurses just know that there’s nothing like having a nurse best friend at work. You…

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Paper

Would you do the same? Read this nursing short story entitled "Paper"

At around ten past noon, Ella heard the familiar tinkling of the door chime, indicating that a patient just opened the door of the OB clinic that she is volunteering in. She was inside the clinical room with Doctor Linda, prepping a patient for a Depo injection, when Pauline, the clinic nurse, came knocking on the frame outside the curtain that blocks them from the world.

“Do you still have time…

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Fecal analysis is a noninvasive laboratory test useful in identifying disorders of the digestive tract. These disorders may include malabsorption, inflammation, infection (bacteria, viruses, or fungi), or cancer. It is performed in combination with blood work, physical examination, x-ray imaging, and endoscopy in order to confirm these conditions. The most common test done on a stool is called fecal occult blood test (FOBT) wherein it can detect traces of blood in the feces.

Feces is a solid body waste discharged from the large intestine through the anus by the process of defecation. It is made of cellulose and other indigestible food matter, water, and bacteria. Furthermore, other substances usually found in feces include epithelial cells shed from the gastrointestinal tract, small amounts of fats, bile pigments in the form of urobilinogen, GI and pancreatic secretions, electrolytes, and trypsin. Trypsin is a proteolytic enzyme produced in the pancreas.

About 100 to 300 gram of fecal material is being excreted by an average adult daily, the residue of approximately 10 liters of liquid material that enters the GI tract each day. The laboratory analysis of feces includes macroscopic examination (volume, odor, shape, color, consistency, the presence of mucus), microscopic examination (leukocytes, epithelial cells, meat fibers), and chemical tests for specific substances (occult blood, trypsin, estimation of carbohydrates).

The role of the nurses during a stool collection and fecal analysis are as follows: proper specimen collection and handling, accurate sample identification, ensure all supplies are appropriate for collection, and timely transport of specimen to the laboratory.

This fecal analysis study guide can help nurses understand their tasks and responsibilities when collecting a stool sample.

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Indications of Fecal Analysis

Stool analysis is used to:

Aid in diagnosing disorders related to gastrointestinal (GI) bleeding or medication therapy that results in bleeding

Assist in the diagnosis of pseudomembranous enterocolitis following the use of broad-spectrum antibiotic therapy

Help diagnose suspected inflammatory bowel syndrome (IBS)

Identify the cause of diarrhea of unknown origin

Investigate disorders of protein digestion

Screen for colorectal cancer

Screen for cystic fibrosis

Determine intestinal parasitic infestation, as indicated by diarrhea of unknown cause

Evaluate the effectiveness of therapeutic regimen for intestinal malabsorption or pancreatic insufficiency

Interfering Factors

These are factors or conditions that may affect the outcome of the study:

Medications that irritate the gastric mucosa such as non-steroidal anti-inflammatory medicines (NSAIDs), anticoagulants, colchicine, corticosteroids, phenylbutazone, and iron preparations can cause positive results for occult blood

High doses of vitamin C (more than 250 mg per day) can cause false negative occult blood

Dietary intake of high in red meat, certain vegetables (radish, turnips, cauliflower, broccoli), and fruits (bananas, apples, cantaloupe) can cause false-positive results for occult blood

Constipated stools may not show any trypsin activity due to prolonged exposure to intestinal bacteria

Procedure for Stool analysis

The following are steps in collecting a stool specimen:

Collect a fecal sample Wear clean gloves and collect a stool specimen and put it directly in a leak-proof container with a tight-fitting lid. If the patient is bedridden, collect the specimen in a clean, dry bedpan, and then, using a tongue blade, transfer into a properly labeled container. If doing a rectal swab, insert the swab 2-3 cm through the rectal sphincter, rotate gently, and remove. Transfer swab in the container.

Fill out the test request form completely Note on the laboratory request the patient’s demographics, stool consistency, and date and time of collection. Indicate previous or present antibiotic therapy and any pertinent history

Transport the specimen to the laboratory Send the specimen to the laboratory immediately for processing and analysis. If a liquid or soft stool sample can’t be processed within 30 minutes of passage, placed in a preservative; If a formed stool specimen can’t be studied immediately, place it in a preservative or refrigerator.

Nursing Responsibility for Stool Analysis

The following are the nursing interventions and nursing care considerations for the patient

Before the procedure

The following are the nursing interventions prior to a stool analysis.

Assess the patient’s level of comfort. Collecting stool specimen may produce a feeling of embarrassment and discomfort to the patient.

Encourage the patient to urinate. Allow the patient to urinate before collecting to avoid contaminating the stool with urine.

Avoid laxatives. Advise patient that laxatives, enemas, or suppositories are avoided three days prior to collection.

Instruct a red-meat free and high residue diet. The patient is indicated for an occult blood test, must follow a special diet that includes generous amounts of chicken, turkey, and tuna, raw and uncooked vegetables and fruits such as spinach, celery, prunes and bran containing cereal for two (2) days before the test.

After the procedure

The nurse should note of the following nursing interventions after fecal analysis:

Instruct patient to do handwashing. Allow the patient to thoroughly clean his or her hands and perianal area. 

Resume activities. The patient may resume his or her normal diet and medication therapy unless otherwise specified.

Recommend regular screening. The American Cancer Society recommends yearly occult blood test as part of the screening for colorectal cancer starting at the age of 45 years old for people with average risk.

Normal Results

There are two methods where stool can be examined:

Macroscopic examination: for appearance and color

Microscopic examination: for cell count and presence of meat fibers; leukocyte esterase, for leukocytes; Benedict’s solution (copper sulfate) for reducing substances; guaiac, for occult blood; x-ray paper, for trypsin

Characteristic of stool Normal findings Appearance Solid and formed Color Brown Epithelial cells Few to moderate Fecal fat Less than 7 grams of fat per 24 hours Leukocytes (white blood cells) Negative Meat fibers Negative Occult blood Negative Reducing substances Negative Trypsin 2+ to 4 +

Abnormal Results

Abnormal findings in a stool exam may reveal the potential medical diagnosis. These includes:

Unusual appearance:

Mucous: Intestinal wall inflammation

Bloody: Excessive intestinal wall irritation or malignancy

Frothy or bulky: Malabsorption

Ribbonlike or slender: Obstruction

Unusual color:

Red: Beets and food coloring, lower GI bleed, phenazopyridine hydrochloride compounds, rifampicin

Black: Bismuth (antacid) or charcoal ingestion, iron therapy, upper GI bleeding

Yellow: Rhubarb

Green: Antibiotics, biliverdin, green vegetables

Grayish white: Barium ingestion, bile duct obstruction

Increased:

Blood: related to GI bleeding

Occult blood: Diverticular disease, esophagitis, gastritis, esophageal varices, anal fissure, hemorrhoids, infectious diarrhea, inflammatory bowel disease, polyps, tumors, ulcers, Mallory-Weiss tears

Leukocytes: Inflammation of the intestines related to bacterial infections of the intestinal wall, ulcerative colitis, shigellosis, or salmonellosis

Epithelial cells: Inflammatory bowel disorders

Carbohydrates/reducing substances: Inability to digest some sugar, malabsorption syndromes

Fats: Sprue (celiac disease), cystic fibrosis related to malabsorption, pancreatitis

pH: Related to inflammation in the intestine from colitis, cancer, or antibiotic use

Meat fibers: Pancreatitis, impaired protein digestion

Decreased:

Leukocytes: Disorders resulting from toxins, cholera, viral diarrhea, amebic colitis, parasites

Carbohydrates/reducing substances: Cystic fibrosis, sprue, malnutrition, medications such as colchicine or birth control pills

pH: Related to poor absorption of carbohydrate or fat

Trypsin: Malabsorption syndrome, pancreatic deficiency, cystic fibrosis

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References and Sources

Additional resources and references for this guide:

Anne M. Van Leeuwen, Mickey Lynn Bladh. Laboratory & Diagnostic Tests with Nursing Implications: Davis’s

Davies, R. J., Miller, R., & Coleman, N. (2005). Colorectal cancer screening: prospects for molecular stool analysis. Nature Reviews Cancer, 5(3), 199. [Link]

Suzanne C. Smeltzer. Brunner & Suddarth’s Handbook of Laboratory and Diagnostic Tests: Lippincott Williams & Wilkins

Fecal Analysis (Stool Analysis) Nursing Responsibilities

Fecal Analysis (Stool Analysis) Fecal analysis is a noninvasive laboratory test useful in identifying disorders of the digestive tract. These disorders may include malabsorption, inflammation, infection (bacteria, viruses, or fungi), or cancer.