Monitoring and managing bowel health is an essential aspect of overall well-being. The Bowel Diary Chart form serves as a practical tool in this regard, providing a structured way to document and analyze bowel movements over time. By incorporating the 'Bristol stool form scale', this form allows patients and healthcare professionals to categorize the type and consistency of stool, which is critical for diagnosing and managing gastrointestinal issues. The form includes sections for personal details such as name, month, and room number, and it systematically collects data on medication, daily observations of bowel movements at different times of the day, and any pertinent remarks. This detailed documentation aids in identifying patterns, evaluating the effectiveness of medications, or dietary changes, and making informed decisions about treatment plans. Reproduced with permission from Dr. KW Heaton from the University of Bristol, the chart is acknowledged for its clinical relevance and ease of use, providing a valued resource for both patients and healthcare providers.
Question | Answer |
---|---|
Form Name | Bowel Diary Chart Form |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | bowel movement chart template, bristol stool chart diary, bowel movement diary template, bowel movement diary |
naam:
maand:
kamernummer:
De 'Bristol stool form scale'
typering stoelgang |
omschrijving |
dosering |
|
1 |
harde losse keutels |
verhoog |
|
(moeilijke stoelgang) |
dosering |
||
2 |
samengekleefde keutels |
verhoog |
|
dosering |
|||
|
|||
3 |
worstvormige stoelgang |
handhaaf |
|
brokkelig van structuur |
dosering |
||
4 |
worstvormige stoelgang |
handhaaf |
|
zacht en glad van structuur |
dosering |
||
|
zachte stoelgang met |
verlaag |
|
5 |
duidelijke scherpe contouren |
||
dosering |
|||
(makkelijke stoelgang) |
|||
|
|||
|
zachte tot zeer zachte |
verlaag |
|
6 |
stoelgang met |
||
dosering |
|||
onduidelijke contouren |
|||
|
|
|
waterige stoelgang, |
stop |
|
7 |
geen structuur aanwezig |
||
dosering |
|||
|
(geheel vloeibaar) |
||
|
|
Reproduced by kind permission of Dr KW Heaton, Reader in Medicine at the University of Bristol. ©2000 Produced by Norgine Limited.
geneesmiddel:.......................
dag ochtend middag avond
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observaties
(hoeveelheid & typering stoelgang)
ochtend middag avond nacht
opmerkingen
SCORE MOV615 09/2010
De mogelijkheid bestaat om dit materiaal te bestellen via telefoon
naam:
maand:
kamernummer:
De 'Bristol stool form scale'
typering stoelgang |
omschrijving |
dosering |
|
1 |
harde losse keutels |
verhoog |
|
(moeilijke stoelgang) |
dosering |
||
2 |
samengekleefde keutels |
verhoog |
|
dosering |
|||
|
|||
3 |
worstvormige stoelgang |
handhaaf |
|
brokkelig van structuur |
dosering |
||
4 |
worstvormige stoelgang |
handhaaf |
|
zacht en glad van structuur |
dosering |
||
|
zachte stoelgang met |
verlaag |
|
5 |
duidelijke scherpe contouren |
||
dosering |
|||
(makkelijke stoelgang) |
|||
|
|||
|
zachte tot zeer zachte |
verlaag |
|
6 |
stoelgang met |
||
dosering |
|||
onduidelijke contouren |
|||
|
|
|
waterige stoelgang, |
stop |
|
7 |
geen structuur aanwezig |
||
dosering |
|||
|
(geheel vloeibaar) |
||
|
|
Reproduced by kind permission of Dr KW Heaton, Reader in Medicine at the University of Bristol. ©2000 Produced by Norgine Limited.
De mogelijkheid bestaat om dit materiaal te bestellen via telefoon
geneesmiddel:.......................
dag ochtend middag avond
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
observaties
(hoeveelheid & typering stoelgang)
ochtend middag avond nacht
opmerkingen