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California Correctional Health Care Services

Gastrointestinal System

California Correctional Health Care Services

Constipation/Diarrhea

RN Protocol: Constipation/Diarrhea

I. POLICY

A. Function: To facilitate and guide the Registered Nurse (RN) in the assessment and

treatment of patients presenting with symptoms consistent with constipation and diarrhea.

B. Circumstances under which the RN may perform the function:

1. Setting: Outpatient clinic

2. Supervision: No direct supervision required.

II. PROTOCOL

A. Definition: This protocol covers the assessment and treatment of patients presenting with

symptoms consistent with constipation and diarrhea.

Constipation is defined as

abnormally delayed or infrequent passage of usually dry hardened feces (Mirriam

Webster Online Dictionary).

Diarrhea is defined as abnormally frequent intestinal

evacuations with more or less fluid stools.

B. Subjective:

1. Chief complaint (document in the patient’s own words).

2. Date and time of onset.

3. Assess for pain and note location (right/left/upper/lower quadrant; epigastrium) and

quality.

4. Rate severity of pain on a scale of 0-10 (0 = no pain, 10 = worst pain).

5. Does the pain radiate to other parts of the body?

6. What makes the pain better? What makes the pain worse?

7. Accompanying symptoms: (cramping, nausea, vomiting)

8. Recent fever

9. Bowel movements: date of last bowel movement.

Description of last bowel

movement: (diarrhea, constipation, normal, clay colored, black, yellow, green, tarry,

bloody).

10. Recent food or drink.

11. Urinary symptoms (e.g., urinary frequency, dysuria, hematuria).

12. History of chronic diseases (Hepatitis, pelvic inflammatory disease, peptic ulcers,

abdominal surgery, irritable bowel syndrome, inflammatory bowel disease, thyroid

disease).

13. Allergies.

14. Current medications.

C. Objective:

1. Vital signs and weight. If vomiting include postural pulse and blood pressure.

2. General appearance. Note skin color and turgor.

3. Auscultate bowel sounds: normal, hyperactive, hypoactive, absent.

4. Palpate abdomen for the following: soft, rigid, distended, guarding, rebound

tenderness. Note location of your findings.

5. Fecal Occult Blood Testing (FOBT) if history of black, tarry or bloody stools.

______________________________________________________________________________

7/20/2012

5-8a-1

California Correctional Health Care Services

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