Breath odor, fecal
Fecal breath odor typically accompanies fecal vomiting associated with a long-standing intestinal obstruction or gastrojejunocolic fistula. It represents an important late diagnostic clue to a potentially life-threatening GI disorder because complete obstruction of any part of the bowel, if untreated, can cause death within hours from vascular collapse and shock.
When the obstructed or adynamic intestine attempts self-decompression by regurgitating its contents, vigorous peristaltic waves propel bowel contents backward into the stomach. When the stomach fills with intestinal fluid, further reverse peristalsis results in vomiting. The odor of feculent vomitus lingers in the mouth.
Fecal breath odor may also occur in patients with a nasogastric (NG) or intestinal tube. The odor is detected only while the underlying disorder persists and abates soon after its resolution.
Act Now: Because fecal breath odor signals a potentially life-threatening intestinal obstruction, you’ll need to quickly evaluate your patient’s condition. Monitor his vital signs, and stay alert for signs of shock, such as hypotension, tachycardia, narrowed pulse pressure, and cool, clammy skin. Determine if the patient has experienced nausea or has vomited. Find out the frequency of vomiting as well as the color, odor, amount, and consistency of the vomitus. Have an emesis basin nearby to collect and accurately measure the vomitus.
Anticipate emergency surgery to relieve an obstruction or repair a fistula, and withhold all food and fluids. Be prepared to insert an NG or intestinal tube for GI tract decompression. Insert a peripheral I.V. line for vascular access, or assist with central line insertion for large-bore access and central venous pressure monitoring. Obtain a blood sample and send it to the laboratory for complete blood count and electrolyte analysis because large fluid losses and shifts can produce electrolyte imbalances. Maintain adequate hydration and support circulatory status with additional fluids.
Assessment
History
Determine if the patient has had previous abdominal surgery because adhesions can develop and cause an obstruction. Ask if there has been a loss of appetite; abdominal pain with a description of its onset, duration, and intensity; and normal bowel habits, noting constipation, diarrhea, date of last bowel movement, color and consistency of stool, and leakage of stool.
Physical examination
Perform a full GI assessment. Auscultate for bowel sounds — hyperactive, high-pitched sounds may indicate impending bowel obstruction, whereas hypoactive or absent sounds occur late in obstruction and paralytic ileus. Inspect the abdomen, noting its contour and any surgical scars. Measure the patient’s abdominal girth to provide baseline data for subsequent assessment of distention. Percuss for tympany, indicating a gas-filled bowel, and dullness, indicating fluid. Palpate for tenderness, distention, and rigidity.
Rectal and pelvic examinations should be performed. All patients with a suspected bowel obstruction should have a flat and upright abdominal X-ray; some will also need a chest X-ray, sigmoidoscopy, and barium enema.
Pediatric pointers
Carefully monitor the child’s fluid and electrolyte status because dehydration can occur rapidly from persistent vomiting. The absence of tears and dry or parched mucous membranes are important clinical signs of dehydration.
Geriatric pointers
Elderly patients may require early surgical intervention for a bowel obstruction that doesn’t respond to decompression because of the high risk of bowel infarct.
Medical causes
Distal small-bowel obstruction
With late obstruction, nausea is present although vomiting may be delayed. Vomitus initially consists of gastric contents, then changes to bilious contents, followed by fecal contents with resultant fecal breath odor. Accompanying symptoms include achiness, malaise, drowsiness, and polydipsia. Bowel changes (ranging from diarrhea to constipation) are accompanied by abdominal distention, persistent epigastric or periumbilical colicky pain, and hyperactive bowel sounds and borborygmi. As the obstruction becomes complete, bowel sounds become hypoactive or absent. Fever, hypotension, tachycardia, and rebound tenderness may indicate strangulation or perforation.
Gastrojejunocolic fistula
With gastrojejunocolic fistula, symptoms may be variable and intermittent because of temporary plugging of the fistula. Fecal vomiting with resulting fecal breath odor may occur, but the most common chief complaint is diarrhea, accompanied by abdominal pain. Related GI findings include anorexia, weight loss, abdominal distention, and possibly marked malabsorption.
Large-bowel obstruction
Vomiting is usually absent at first, but fecal vomiting with resultant fecal breath odor occurs as a late sign. Typically, symptoms develop more slowly than in small-bowel obstruction. Colicky abdominal pain appears suddenly, followed by continuous hypogastric pain. Marked abdominal distention and tenderness occur, and loops of large bowel may be visible through the abdominal wall. Although constipation develops, defecation may continue for up to 3 days after complete obstruction because of stool remaining in the bowel below the obstruction. Leakage of stool is common with partial obstruction.
Nursing considerations
After an NG or intestinal tube has been inserted, keep the head of the bed elevated at least 30 degrees and turn the patient to facilitate passage of the intestinal tube through the GI tract. Don’t tape the intestinal tube to the patient’s face. Ensure tube patency by monitoring drainage and watching that suction devices function properly. Irrigate as required and monitor GI drainage. Provide meticulous oral care. Send serum samples to the laboratory for electrolyte analysis at least once per day. Prepare the patient for diagnostic tests, such as abdominal X-rays, barium enema, and proctoscopy.
Patient teaching
Explain all procedures and tests. Preoperative teaching is needed if the patient requires surgery. Encourage the patient to brush his teeth and gargle with a flavored mouthwash or half-strength hydrogen peroxide mixture to minimize offensive breath odor. Assure him that the fecal odor is temporary and will abate after treatment of the underlying cause.
Book Source Details
- Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2008 Williams & Wilkins.
More About Causes of Vaginal discharge
» Next page: Breath odor, fruity (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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