Transcript Textbook for Nursing Assistants

Textbook for Nursing
Assistants
Chapter 21: Assisting With Urinary and
Bowel Elimination
Assisting With
Elimination
Assisting With Elimination
• Some patients or residents may only need a steady arm to lean
on during their trip to the bathroom; others will need more help
• The bathrooms in many health care facilities have special
features that make them easier for people with physical
disabilities to use
Assisting with Elimination
• Modifications allow many
patients or residents to use
the toilet in the bathroom
with very little assistance from
a nursing assistant
Assisting with Elimination Elimination Equipment
• Some patients or residents may not be able to get out of bed at
all, or they may be too weak or ill to walk to the bathroom. These
people may need to use
•
•
•
Bedside commodes
Bedpans
Urinals
Elimination Equipment: Bedside Commodes
• The bedside commode consists of a chair
frame with a toilet seat and a removable
collection bucket
• For a person who is able to get out of bed but who is
not able to walk to the bathroom, a bedside commode
can make toileting easier
Elimination Equipment: Bedpans
• A bedpan is used for elimination when a person is unable to get
out of bed at all
• A woman who cannot get out of bed uses a bedpan to urinate
and for bowel movements. A man who cannot get out of bed
uses a bedpan for bowel movements, and a urinal to urinate
Elimination Equipment :
Fracture Pans
• Arthritis can make using a bedpan very painful, as can fractures
of the back or legs
• In such cases, when using a bedpan is uncomfortable or
dangerous, a special bedpan called a fracture pan is used
Elimination Equipment:
Fracture Pans
• The fracture pan, which is
wedge-shaped, is placed
underneath the person’s
buttocks with the thin edge
toward the person’s back
Fracture Pans and Bedpans:
Useful Tips
• Warm a metal bedpan before offering it to the patient or
resident by wrapping the bedpan in a warm towel, or running
warm water over the seat area and then drying it before use
• Apply a small amount of powder to the rim of the bedpan to
make it easier to slide under the person
• Provide as much privacy as safely possible
Fracture Pans and Bedpans:
Useful Tips
• If the person’s condition
allows, raise the head
of the bed to promote
a more natural elimination
position
Elimination Equipment: Urinals
• A man uses a urinal to urinate when
he cannot get out of bed
Elimination Equipment: Urinals
• To urinate, the man puts his penis in the opening of
the urinal
• If the man is very weak or disabled, you may need to place his
penis inside the opening of the urinal for him
Difficulty With Normal Elimination
• A patient or a resident may have difficulty with elimination, if
elimination occurs under conditions that are not as private as the
person would like
• In a health care facility, people may share a bathroom or use a
bedpan while only being separated from other people in the
room by a curtain
Difficulty With Normal Elimination
• Feelings of embarrassment and shame are made worse when
patients or residents accidentally soil themselves, their bed
linens, or their clothing with urine or feces. This might be due to:
•
•
•
•
The effects of medications
Being in a strange place
Reluctance to ask for help
Physical or mental disabilities
Promoting Normal Elimination
• Kindness, empathy, and a professional attitude can go a long
way toward easing the patient’s or resident’s embarrassment
Promoting Normal Elimination
• Being in a health care facility can change a person’s normal
elimination patterns, which can cause health problems
• The most effective method of treating urinary and bowel
problems is to prevent them from happening in the first place
Promoting Normal Elimination
•
•
•
•
•
•
•
•
Encourage plenty of fluids, unless the doctor has ordered against it
Answer call lights promptly
Encourage the person to call when he first feels the urge to void
Offer people the chance to eliminate frequently
Provide for privacy and comfort
The sound of running water may help some people to urinate
If a person is having difficulty moving his bowels, do not rush the person
Regular exercise and foods containing insoluble fiber help promote
regular bowel movements
Obtaining Urine and Stool Specimens
• The contents of a person’s urine or feces can provide a doctor
with clues about the person’s overall health status
• A nursing assistant may be asked to obtain a urine or stool
specimen (sample) for laboratory study
Obtaining Urine and Stool Specimens
• Before collecting any specimen—of urine, feces, or any other
body fluid—ask yourself the following questions:
•
•
•
•
•
•
•
Do I have the right person?
Do I have the right laboratory requisition slip?
What method is to be used to collect the specimen?
Do I have the right type of specimen container?
Is the specimen container properly labeled?
What is the correct date and time?
What storage and delivery method must I use?
Obtaining Urine and Stool Specimens
• Always remember to wear gloves when assisting with specimen
collection and when handling the specimen containerss
Obtaining Urine and Stool Specimens:
Urinalysis
• Urinalysis, or examination of the urine under a microscope and
by chemical means, is a commonly used diagnostic tool in the
health care setting
• Substances found in urine during urinalysis can help doctors
diagnose kidney disease, certain metabolic diseases, and
infections
• To perform urinalysis, a urine specimen must be obtained
Obtaining Urine Specimens: Routine Urinalysis
• For routine urinalysis, the person is asked to urinate directly into
the specimen cup, if possible. If difficult, the person can urinate
into a specimen collection device.
• The person must not have a bowel movement at the same time
the urine is being collected. Do not place toilet paper in the
collection device. Either of these actions will change the
urinalysis results.
Obtaining Urine Specimens: Midstream
(“Clean Catch”) Urine Specimen
• This method of collecting urine prevents contamination of the
urine by the bacteria that normally live in and around the urethra
• A midstream (“clean catch”) urine specimen is usually ordered
when the doctor suspects a urinary tract infection
• When a midstream (“clean catch”) urine specimen is requested,
•
•
the person is asked to clean the area around the urethral opening
with a special cleansing wipe
The urine flow is started, then stopped, then started again
The urine sample is collected from the restarted flow in a sterile
specimen cup
Obtaining Urine Specimens: Testing
•
A type of routine urine testing involves
dipping chemically treated paper strips
into a urine sample
• Chemicals on the paper react with certain substances that
may be found in the urine, causing the chemical blocks on
the paper to change color if these substances are present in
the urine
• The paper is then compared with a color chart that comes
with the strips
Obtaining Stool Specimens
• Stool is analyzed for the presence of blood, pathogens (such as
parasites or bacteria), fat, and other things that are not normally
found in feces
• If a stool sample is needed, the person should be notified well in
advance so that the specimen can be collected when it becomes
available
• Ask the nurse if there are any particular collection methods that
should be used
Obtaining Stool Specimens
• Stool can be collected in a bedpan, bedside commode, or in a
collection device placed into a regular toilet.
• The person must not urinate at the same time the stool sample is
being collected. Toilet paper must not be placed in the collection
device. Both of these actions will change the test results.
Urinary Elimination
Urinary Elimination: Urinary System
• The urinary system consists of the kidneys,
•
•
•
•
urinary bladder, ureters, and urethra
Blood is filtered by the kidneys, forming
urine
The urine is stored in the urinary bladder
As the bladder fills, we begin to feel the
urge to urinate
Urine leaves the body through the
urethra
Urinary Elimination: Expressions
• The process of passing urine from the body is known by several
terms, including:
•
•
•
Urination
Voiding
Micturition
• Patients or residents will have their own terms for urinating, such
as “peeing” or “passing water”
• When talking about urination, use words that the person is
familiar with. This is especially important when talking with
children.
Urinary Elimination: Color and Odor
• In healthy people, urine is
•
•
Clear, without cloudiness or particles
Pale yellow, straw-colored, or dark gold (amber) in color, with a slight
odor
Urinary Elimination: Color and Odor
• Foods and drugs can affect the color and odor of urine
• When you are helping a patient or resident with urination,
observe the urine and report any abnormalities to the nurse
• Urine with an unusual odor or appearance could be a sign of
illness or infection
Urinary Elimination: Hematuria
• A slight red tinge to the urine may indicate hematuria, or the
presence of blood in the urine
• Sometimes hematuria is occult and must be detected using
urinalysis
Factors Affecting Urinary Elimination
• Many factors influence a person’s urinary pattern, including
•
•
•
•
The amount of fluids the person drinks
The types of medications the person takes
The person’s age
The person’s lifelong elimination habits
• A nursing assistant soon becomes aware of the urinary pattern
•
that is normal for each person in her care
This knowledge allows her to recognize any changes that
may occur
Urination: Frequency and Nocturia
• Frequency is the term used to describe voiding that occurs more
often than usual
• Frequency is often accompanied by a feeling of urgency, or the
need to urinate immediately
• Nocturia is the need to get up more than once or twice during
the night to urinate, to the point where sleep is disrupted
Urination: Dysuria
• Dysuria is difficulty voiding that may or may not be associated
with pain
• Some people describe the discomfort they feel during urination
as a “burning” or “cramping” sensation
• Dysuria is often associated with bladder infections, prostate
problems, and some sexually transmitted diseases (STDs)
Measuring Urine Output
• In a person maintaining a good fluid balance, urine output is
neither too high nor too low. Complications associated with urine
output are:
•
•
•
Oliguria (the state of voiding a very small amount of urine over a given
period of time)
Polyuria (the state of excessive urine output)
Anuria (the state of voiding less than 100 mL of urine over the course of
24 hours)
Measuring Urine Output
• People who have illnesses or take medications that may alter
their body’s ability to maintain a healthy fluid balance will need
to have their urine output measured regularly
• Some people who are critically ill will have their urine output
measured and recorded every hour, but most people in the
health care setting have routine orders for their urine output to
be measured and recorded each shift
Measuring Urine Output: Process
•
If a person uses a regular toilet, you will need to remind
the person:
•
•
•
To void into a specimen collection device (“commode hat”)
To call you after he or she has finished voiding so that you can
measure and record the amount of urine
Specimen collection devices, urinals, and the drainage bags used with
urinary catheters often have markings that make measuring urine output
easy
Measuring Urine Output: Process
• Urine output can also be measured
by pouring
it into a graduate
Measuring Urine Output: Process
• If the urine output of one of your residents or patients is being
monitored, you will need to keep a record of the amount of urine
passed at each voiding
• This can be done using an intake and output (I&O) flow sheet,
which has spaces to record the amount of each individual voiding
• To obtain the end-of-shift amount, simply add the individual
amounts and record the total in the appropriate space
Urinary Catheterization
• Urinary catheterization is done when a person is unable to
urinate using a toilet, bedpan, urinal, or bedside commode
• A urinary catheter is a tube that is inserted into the bladder
through the urethra to allow the urine in the bladder to drain out
Urinary Catheterization: Situations When a
Urinary Catheter Is Used
•
A urinary catheter is used in many different situations:
•
•
•
A urinary catheter may be inserted to drain the bladder
before or during a surgical procedure, during recovery from
a
serious illness or injury, or to collect
urine for testing
A urinary catheter may be used for a person who is
incontinent of urine, if the person has wounds
or pressure ulcers that would be made worse
by contact with urine
A urinary catheter is necessary when a person is unable to
urinate because of an obstruction in the urethra
Urinary Catheterization: Insertion of
Urinary Catheter
• Inserting a catheter is a procedure that requires sterile technique
•
•
because it involves putting a foreign object (that is, the catheter)
into a person’s body
Inserting a urinary catheter is usually beyond the scope of
practice for a nursing assistant, although in some facilities,
nursing assistants are provided with additional training that
allows them to catheterize residents or patients
Regardless of whether or not you are trained to actually insert
urinary catheters, caring for people who have urinary catheters
in place will almost certainly be a part of your daily duties
Urinary Catheterization: Types of Urinary Catheters
• You will see many different types of urinary catheters in use
•
•
•
A straight catheter, also known as a Robinson, Rob-Nel, or Red Rubber
catheter, is used when the catheter is to be inserted and removed
immediately
An indwelling catheter, also known as a retention or Foley catheter, is left
inside the bladder to provide continuous urine drainage
A suprapubic catheter is a type of indwelling catheter. The suprapubic
catheter is inserted into the bladder through a surgical incision made in
the abdominal wall, right above the pubic bone
Catheters
Straight
Indwelling
Suprapubic
Urinary Catheterization: Caring for a Person
With an Indwelling Urinary Catheter
• Indwelling urinary catheters are connected by a length of tubing
to a urine drainage bag
• The tubing is secured loosely to the person’s body near the
insertion site using a catheter strap or adhesive tape
• Securing the tubing to the person’s body prevents the catheter
from being accidentally pulled out during repositioning
Urinary Catheterization: Caring for a Person
With an Indwelling Urinary Catheter
• A little bit of slack is left in the tubing to prevent the catheter
from pulling against the bladder outlet and the urethral opening
• The remaining length of tubing is then gently coiled and secured
to the bed linens using a plastic clip
Urinary Catheterization: Caring for a Person
With an Indwelling Urinary Catheter
• Coiling the tubing prevents the tubing from becoming bent or
kinked, which would stop the free flow of urine into the drainage
bag. Coiling the tubing and securing it to the bed linens also
keeps the weight of the tubing from pulling against the person’s
body.
• The drainage bag is then secured to the bed frame or the back of
the person’s wheelchair, at a level lower than the person’s
bladder.
Urinary Catheterization: Caring for a Person
With an Indwelling Urinary Catheter
• If the drainage bag and tubing are higher than the person’s
bladder, then gravity could cause old, contaminated urine to run
back down the tubing and into the person’s bladder, causing an
infection.
Urinary Catheterization: Providing
Catheter Care
• Nursing assistants are usually responsible for providing catheter
care.
• Catheter care involves thorough cleaning of the perineal area
and the catheter tubing that extends outside of the body, to
prevent infection.
Urinary Catheterization: Providing
Catheter Care
• Providing good catheter care is important because the presence
of the catheter in the urethra provides a pathway for bacteria to
travel up from the perineum into the bladder, where they can
cause infection.
• In addition, having a catheter in place eliminates the “flushing”
action of normal urination, which helps to remove bacteria from
the urinary tract naturally.
Urinary Catheterization: Providing
Catheter Care
• Because bacteria can be introduced into the body both when a
urinary catheter is inserted and after it is in place, urinary tract
infections in catheterized people are one of the most common
nosocomial infections.
• In an effort to reduce the risk of nosocomial infection in people
who are catheterized, many facilities require catheter care to be
provided routinely.
Urinary Catheterization: Emptying Urine
Drainage Bags
• Urine drainage bags are routinely emptied and the urine
measured at the end of each shift.
• Urine drainage bags should also be emptied if they are full.
• Leg bags need to be emptied frequently because they are
smaller, and hold less urine.
Urinary Catheterization: Preparing for
Removal of an Indwelling Catheter
•
•
•
•
•
Use of an indwelling catheter can lead to temporary urinary incontinence when the
catheter is removed, because the lack of activity can decrease the muscle tone of the
bladder.
To prepare the bladder for removal of the catheter, it is common to clamp the tubing
of the catheter for a period of time to allow the urine to fill the bladder.
The tubing is then unclamped and the urine is allowed to drain from the bladder.
The procedure is repeated over a period of time, with the time intervals between
clamping and emptying becoming increasingly longer.
Then the catheter is removed and the person is allowed to void normally.
Urinary Incontinence
•
•
•
•
Urinary incontinence is the inability to hold one’s urine, or the involuntary loss of urine
from the bladder
Urinary incontinence may be temporary or permanent
Temporary urinary incontinence can occur as a result of bladder infection, or after an
indwelling catheter that has been in place for a long time is removed
Permanent urinary incontinence can be caused by many things, including
•
•
•
Decreased muscle tone in the bladder or the muscles that support the
bladder, such as occurs after childbirth or from obesity
Injuries or illnesses that affect the spinal cord, the brain, or the nerves
that control bladder function
Dementia
Urinary Incontinence
•
•
•
•
Urinary incontinence can be emotionally devastating for both the incontinent person
and the person’s caregivers
For the person who is incontinent, having wet clothes or smelling like urine can be very
embarrassing. In addition, being incontinent of urine places a person at risk for
developing skin problems and for falling
For the caregiver, caring for a person who is incontinent of urine can be frustrating and
emotionally draining
Because caring for an incontinent person can be so emotionally trying and time
consuming, incontinence is the factor that most often leads family members to have a
relative admitted to a long-term care facility
Urinary Incontinence: Types
•
There are many types of urinary incontinence
•
•
•
•
•
Stress incontinence is the involuntary release of urine from the bladder when
the person coughs, sneezes, or exerts herself
Urge incontinence is the involuntary release of urine right after feeling a
strong urge to void
Functional incontinence occurs in the absence of physical or nervous system
problems affecting the urinary tract
Overflow incontinence occurs when the bladder is too
full of urine
Reflex incontinence occurs when there is damage to the nerves that enable
the person to control urination
Urinary Incontinence: Managing
Urinary Incontinence
• Products available to help manage urinary incontinence include:
•
•
•
Incontinence pads
Incontinence briefs
Condom catheters
• In addition, techniques such as bladder training may be used to
•
help a person overcome certain types of incontinence
For some people, temporary or permanent catheterization may
be necessary to manage incontinence
Urinary Incontinence: Managing Urinary
Incontinence - Incontinence Pads and Briefs
•
•
•
•
•
Incontinence pads and briefs are specially made to absorb urine and hold it away from
the person’s skin
Incontinence pads are placed inside the person’s underpants to prevent wetting of the
clothes and to draw the moisture away from the person’s body
For a person who is confined to bed, bed protectors are used to help to keep the bed
linens and mattress dry and to wick urine away from the person’s skin
Incontinence briefs tend to fit closely, which makes it difficult for air to reach the skin.
Switching between briefs and bed protectors helps expose the skin to air at night
A nursing assistant must make sure that these incontinence products are changed
frequently and that urine is cleaned from the skin whenever the change occurs
Urinary Incontinence - Managing Urinary
Incontinence - Condom Catheters
• A condom catheter consists of
a soft plastic or rubber sheath,
tubing, and a collection bag
for the urine. The sheath is
placed over the penis and the
collection bag is attached to
the leg.
Urinary Incontinence: Managing Urinary
Incontinence - Condom Catheters
• The urine flows through the tubing into the collection bag,
•
allowing the man to urinate at will
The condom must fit the penis and should be fastened securely
enough to prevent leaking, but not so snugly as to restrict
circulation
•
•
Adhesive material on the inside of the condom allows for a good seal
Or, the condom is secured with elastic tape applied in a spiral fashion to
allow for changes in the size of the penis
• Use of a condom catheter requires good skin care. The penis
must be cleaned, and the condom apparatus changed, daily
Urinary Incontinence: Managing Urinary
Incontinence - Bladder Training
• Bladder training is commonly used to help people re-learn how
to control their urinary elimination patterns
•
For example, a person may be encouraged to use the bedpan,
urinal, or commode at scheduled times. Scheduling of
elimination helps promote regular emptying of the bladder
• The primary goal is for the person to be able to control
involuntary urination. If this is not possible, then the person may
still at least be able to get to the bathroom in time to avoid
accidents
Bowel Elimination
Bowel Elimination: Digestive System
• The digestive tract consists of
the mouth, esophagus, stomach, small
intestine, large intestine, rectum, and
anus
Bowel Elimination: Digestive System
• The rectum is actually part of the large intestine, and together,
•
•
the large and small intestines are sometimes referred to as
“bowels”
The food and fluids that we take in are broken down into smaller
pieces and mixed together in the stomach, forming a partially
digested food and fluid mixture known as chyme
From the stomach, the chyme passes slowly into the small
intestine, where more digestion occurs and nutrients and fluid
are absorbed, and then into the large intestine
Bowel Elimination: Digestive System
• Wave-like muscular movements, called peristalsis, move the
chyme through the intestines
• Finally, the chyme reaches the last part of the large intestine,
called the rectum
• At this point, all of the nutrients have been removed, and what
remains is a semi-solid waste material, called feces
Bowel Elimination: Digestive System
• The presence of feces in the rectum stimulates the urge to
defecate, and the feces leave the body through the anus
• Flatus (or gas) is a natural byproduct of digestion, just as feces
are
Bowel Elimination: Color and Odor
• In healthy people, feces
•
•
Are soft, brown, and moist
Have a distinct odor
• Certain foods and medications can affect the color and odor
of feces
• When helping a patient or resident with defecation, observe the
feces and report any abnormalities to the nurse
• Feces with an unusual odor or appearance could be a sign of
illness or infection
Factors Affecting Bowel Elimination
• The factors that influence a person’s bowel elimination pattern
include
•
•
•
•
•
The amount of fluid the person drinks
The type of food he or she eats
The types of drugs the person takes
The person’s age
The person’s level of activity
• A nursing assistant soon becomes aware of the bowel
elimination pattern that is normal for each person in her care.
This knowledge allows her to recognize any changes that may
occur
Problems With Bowel Elimination
• Problems with bowel elimination that are often seen in the
health care setting include
•
•
•
•
•
Diarrhea
Constipation
Fecal impaction
Flatulence
Fecal (bowel) incontinence
Problems With Bowel Elimination: Diarrhea
• Diarrhea is the passage of liquid, unformed stool
• Diarrhea may occur frequently and can be accompanied by
•
abdominal cramping
If diarrhea is frequent or excessive, the loss of fluid from the
body can quickly cause dehydration, especially in young or
elderly people
Problems With Bowel Elimination: Diarrhea
• When caring for a person with diarrhea
•
•
•
•
Practice good infection control techniques
Answer the call light quickly to provide access to the toilet, commode, or
bedpan
Provide gentle, thorough skin care after each bowel movement to
prevent skin breakdown
Make sure to record and report the frequency and amount of each
incident of diarrhea
Problems With Bowel Elimination:
Constipation
• Constipation occurs when the feces remain in the intestines for
too long
• The delay allows too much fluid to be reabsorbed by the
intestines, resulting in hard, dry feces that are difficult to pass
Problems With Bowel Elimination:
Constipation
• Risk factors for developing constipation include
•
•
•
•
•
Taking medications that slow peristalsis
Not taking in enough dietary fiber or fluids
Not getting enough exercise
Delaying having a bowel movement
Lack of privacy
Problems With Bowel Elimination:
Constipation
• There are many things a nursing assistant can do to help a
patient or resident maintain normal bowel function and prevent
constipation
•
•
•
•
Encouraging fiber-rich foods
Encouraging plenty of fluids
Assisting with exercise
Ensuring privacy
Problems With Bowel Elimination:
Constipation
• If a person is constipated and all other methods of promoting
normal bowel function have failed, a laxative, stool softener, or
fiber supplement may need to be used
•
•
•
A laxative is a medication that chemically stimulates peristalsis so that
material inside the intestines moves through at a faster pace
Stool softeners help to keep fluid in the feces and are used to help
prevent constipation for some people
Fiber supplements, in the form of tablets or drink additives, can add bulk
to the feces, causing it to hold fluid, and preventing constipation
Problems With Bowel Elimination:
Fecal Impaction
• A fecal impaction occurs when constipation is not relieved
• The feces build up in the rectum and become harder and harder
as more and more fluid is absorbed. Eventually, it becomes
almost impossible to pass the feces normally
• The impaction blocks the passage of normal stool, but liquid
stool may go around the impacted mass
Problems With Bowel Elimination:
Fecal Impaction
• A person with an impaction is usually very uncomfortable and
may complain of abdominal or rectal pain or of liquid feces
“seeping” out of the anus
• The person’s abdomen may be swollen
Problems With Bowel Elimination: Fecal Impaction
• If a person is thought to have a
fecal impaction, the nurse will
perform a digital examination
• During the digital examination, a
finger is inserted into the
person’s rectum to feel for the
impacted mass (digital means
“finger”)
Problems With Bowel Elimination:
Fecal Impaction
•
•
•
•
•
The impaction is removed by using the finger to break the impacted feces apart
and scoop it out of the rectum piece by piece
The doctor may also order the use of an oil retention enema or drugs to help
remove the impaction
Digital removal of a fecal impaction is very uncomfortable and embarrassing for
most patients and residents
Many facilities require that a nurse remove an impaction, but your assistance will
be necessary
If you are allowed to remove an impaction, make sure you have been adequately
trained for the procedure and that it is part of your job description
Problems With Bowel Elimination: Flatulence
•
•
•
•
•
Flatulence is the presence of excessive amounts of flatus (gas) in the intestines,
causing abdominal distension (swelling) and discomfort
People have difficulty passing flatus because of a lack of activity or a recent
surgical procedure
Getting out of bed and walking might be all that is needed to help the person to
expel the gas
If walking is not allowed, positioning the person on her left side may help
If the flatulence cannot be relieved with these methods, a nurse may insert a
rectal tube to help the gas escape
Problems With Bowel Elimination: Fecal
Incontinence
• Fecal (bowel) incontinence is the inability to hold one’s feces, or
the involuntary loss of feces from the bowel
• Like urinary incontinence, fecal incontinence can be temporary
or permanent
Problems With Bowel Elimination: Fecal
Incontinence
•
Temporary fecal incontinence may be due to
•
•
•
•
•
•
A severe case of diarrhea
An inability to get to the bathroom quickly enough
Failure to answer call lights promptly
Diseases or injuries that affect the nervous system can also result in temporary or
permanent fecal incontinence
A person who is unconscious will be incontinent of feces
A person who has dementia will develop fecal incontinence as the disease
progresses
Problems With Bowel Elimination:
Fecal Incontinence - Bowel Training
• Bowel training is very similar to bladder training and works to
•
•
promote regular, controlled bowel movements
Offering the commode or bedpan at regular scheduled intervals
is a common method of bowel training
Bowel training is often started by keeping track of when an
incontinent person usually has a bowel movement, then making
sure to provide the appropriate toilet facilities during that time
period
Enemas
•
•
An enema is the introduction of fluid into the large intestine by way of
the anus for the purpose of removing stool from the rectum
Enemas are used to
•
•
•
•
Relieve constipation
Relieve fecal impactions
Empty the intestine of fecal material before surgery or certain diagnostic
tests
Sometimes enemas are used as part of a bowel training program
Enemas: Types of Enemas
• Types of enemas used in the health care setting include
•
•
•
Cleansing enemas
Oil retention enemas
Commercial enemas
Enemas: Cleansing Enemas
•
•
•
•
Cleansing enemas are primarily used to remove feces from the lower
large intestine
Tap water enemas and saline (salt water) enemas help soften the stool
and stimulate peristalsis
Soapsuds enemas consist of water and a small amount of a very gentle
soap called castile soap. The soap solution irritates the lining of the
bowel, stimulating peristalsis
Enemas containing these solutions should not be given repeatedly
because the intestine can absorb the solution, causing a fluid
imbalance in the body
Enemas: Oil Retention Enemas
• An oil retention enema contains mineral, olive, or cottonseed oil
• The oil lubricates the inside of the intestine and any stool that is
present, making the stool easier to pass or remove
• Oil retention enemas are useful for helping to remove fecal
impactions
Enemas: Commercial Enemas
• Commercially prepared and packaged enemas usually contain
120 mL of a solution that irritates the intestinal mucosa to
promote peristalsis
• Some commercial enemas contain a solution that is absorbed
into the stool to make it softer and easier to pass
Enemas: Administering Enemas
• Enemas are ordered by a doctor and usually given by a nurse
• Some facilities allow nursing assistants to administer enemas
after adequate training
• Nursing assistants must make sure that
•
•
•
•
They follow proper procedure and the doctor’s orders closely
The solution is correct for the person
The correct amount of solution is being administered
The solution is at the proper temperature
Enemas: Administering Enemas
• Enema solutions that are too cool can cause abdominal cramping
and pain, while solutions that are too hot can cause serious injury
and possibly even death
• When assisting with the administration of an enema, make sure
that a bed protector and bedpan are in place, or that the path to
the bathroom is clear
Enemas: Administering Enemas
•
•
•
•
An enema is given with the person on her left side in Sims’ position
When a person is lying on her left side in Sims’ position, the intestine is positioned
to take the best advantage of gravity
After the enema has been administered, the person is asked to hold the solution in
the bowel for the specified amount of time, and then to expel the solution
The doctor may order a cleansing enema to be administered “until clear,” which
means that enemas are to be given until the enema return from the person does
not contain any fecal material
Enemas: Administering Enemas
• Ask the nurse how many enemas are allowed to be given during
a particular session
• To make the procedure easier for the person, keep the person
covered as much as possible and ensure that she has as much
privacy as possible
• Having the person take a few slow, deep breaths as the enema
tubing is inserted into the rectum may help to relax the person
and make insertion easier
Rectal Suppositories
• A rectal suppository is a small, wax-like cone or oval that is
•
•
•
inserted into the anus
The wax-like substance dissolves at body temperature,
stimulating peristalsis or lubricating and softening the stool
Glycerin rectal suppositories are often used to help with bowel
elimination before resorting to an enema
Some rectal suppositories also contain medication. These should
only be inserted by a nurse
Stoma
Stoma Care
• Regardless of the type of appliance used, certain principles
•
remain the same regarding the client care
Points to remember include:
•
•
•
•
•
•
•
•
Keeping the skin around the stoma clean and dry to minimize irritation
Attending to the client’s privacy and modesty
Protecting the client and the client’s bed from fecal matter
The wearing of proper personal protection equipment
Proper disposal of fecal waster and used equipment
Proper cleansing and drying of the stoma area
Effective application of the appliance
Appropriate documentation of the procedure
End of Presentation