The nurse performs digital removal of a fecal impaction for a patient with atrial fibrillation and heart failure. Which is the most serious unexpected outcome that the nurse assesses during the procedure?

Question

a. Rectal bleeding
b. Perianal redness
c. Liquid stool leakage after removal of the impaction
d. Abdominal cramping

Answer 1

A
Patients with atrial fibrillation and heart failure are usually on an anticoagulant to prevent forma-tion of clots; therefore, the most serious unexpected finding during impaction removal is patient rectal bleeding. Rectal bleeding from the patient on anticoagulation is very difficult to control because of the anatomical location and the increased bleeding time of the patient's blood. The nurse should stop the procedure, keep the patient's head low as long as the patient tolerates the position, and notify the provider. Perianal redness can indicate regional irritation or future skin breakdown, and the nurse should plan care to restore the perianal tissue integrity; however, this is not more important than responding to the bleeding. Liquid stool leakage after removal of the impaction can indicate ineffective removal. The nurse should reassess the patient for continuing impaction and increase fluids, fiber, and activity level if possible. Abdominal cramping cues the nurse to stop removal of the impaction and allow the cramping to subside before continuing with the procedure.