Transcript Guidelines for a Palliative Approach in Residential Aged Care

Bowel Care
A Palliative Approach to Care
Bowel Care
• Bowel care is a key component of the palliative
approach
• Most significant factor affecting bowel care for
residents receiving a palliative approach is
opioid induced constipation
What is Constipation?
• Constipation is difficulty or straining on
defecation of dry, hard stool
• infrequent bowel movements over an extended
period of time, with the sensation of incomplete
evacuation of the bowel
Constipation
Constipation may occur with:
• limitation to fluid intake in faecal waste
• limitation to movement of faeces through colon
• limitation to muscle contraction
Types of Constipation
Primary:
• inadequate dietary fibre/ dehydration
• reduced mobility/ reduced muscle tone
• withholding faecal evacuation
Secondary:
• partial bowel obstruction
• spinal cord compression
• conditions such as hypercalcaemia
Types of Constipation
Iatrogenic:
induced by the administration of drug therapies
such as:
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anti-inflammatory
anticholinergics
antidepressants
opioids
aluminium and calcium antacids
diretics
Principles of Bowel Care
• Initial assessment to be performed to identify
what are normal bowel habits for each individual
resident.
• Daily assessment - includes resident’s treatment
preferences, history of bowel habits and
management
• Ongoing assessment
Principles of Bowel Care
• Prompt and individually tailored treatments
• Minimization of interventions that can cause loss
of dignity
• Comfort for the resident
Bowel Assessment
• Presence of desire to defecate
• Signs of discomfort
• Food and fluid levels
• Full rectum
• Skin problems due to leakage
• medications that may contribute to constipation
Symptoms of Constipation
• Nausea and vomiting
• Straining during defecation
• Infrequent bowel movement
• Feelings of incomplete emptying after bowel
movements
• Frequent small amounts of diarrhoea
Symptoms
• Rectal pain on defecation
• Stomach pain, distension or discomfort
• Hard stools
• Faecal incontinence
Pharmacological Management
• Prophylaxis - essential part of management
• prophylactic aperients should be routinely
prescribed with opioids
• combination of softening agent and stimulant is
best choice eg. coloxyl with senna
Pharmacological Management
• Bulk laxatives when combined with suppositories
associated with low rates of faecal incontinence
• Suppositories after bowel clearing can prevent
recurring constipation
• Consider compensatory measures for
dehydration and electrolyte depletion
Non-pharmacological
approaches
Toileting: ensuring
– comfort
– privacy
– timeliness - gastric reflux occurs after eating
Encourage fluid, fibre intake
Low intensity exercise
Summary
• Ongoing assessment and prompt tailored
treatments
• Consider causes and symptoms of constipation
• Pharmacological management - faecal softener
and bowel stimulant
• Non-pharmacological approaches - toileting,
fluid/fibre intake, exercise