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Bowel Care

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Bowel Care Yangama Jokwiro BScNS MSc Physiology Certificate IV in Training and Assessment Gastrointestinal System Mouth Esophagus Stomach Small Intestine: Duodenum ... – PowerPoint PPT presentation

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Title: Bowel Care


1
Bowel Care
  • Yangama Jokwiro
  • BScNS
  • MSc Physiology
  • Certificate IV in Training and Assessment

2
Gastrointestinal System
  • Mouth
  • Esophagus
  • Stomach
  • Small Intestine
  • Duodenum
  • Jejunum
  • Ileum
  • Colon
  • Ascending
  • Transverse
  • Descending
  • Sigmoid Colon
  • Rectum

3
Gastrointestinal System
4
Assessment of Gastrointestinal System
  • Note nutritional status as well as condition of
    teeth (denture fit) and mouth
  • Ask client about diet, appetite and bowel
    patterns note date and time of last bowel
    movement
  • Note history of diarrhea or constipation
    (hemorrhoids)
  • Abdomen for bowel sound (passing wind)

5
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

6
Defecation Act of expelling feces
  • Facilitated by peristalsis (wavelike muscular
    contractions of large and small intestine)
  • Movement of food and H2O as well as waste through
    intestines toward sigmoid colon and rectum
  • Rectum distends
  • Anal sphincter (bands of muscle) relaxes
  • Defecation occurs

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Valsalva Maneuver
  • Bearing down by contracting pelvis and abdominal
    muscles facilitates process of defecation
  • Also increases intra-cerebral and intra-ocular
    pressures therefore contraindicated in
  • Client with increased intracranial pressure (ICP)
  • Client with glaucoma
  • Has vagal effect stimulates vagus nerve may
    cause bradycardia therefore contraindicated in
  • Client following Myocardial Infarction (MI)

11
Nausea
  • A sense of wanting to vomit medulla contains
    centre in brain for vomiting
  • Multiple causes
  • Post-operatively takes 24 48 hours for
    peristalsis to return distention of duodenum
  • Medication sensitivities
  • Chemotherapy
  • Migraines
  • Myocardial Infarctions (MI)
  • Bowel obstruction

12
Stool Characteristics
  • Color generally brown but may be black,
    clay-colored, green or yellow
  • Odor foul smelling
  • Consistency soft and formed but may be hard,
    dry, watery, paste-like
  • Shape round/full or may have no shape
  • Other components may include blood, mucous or pus
  • High fat content heavy stool
  • Fiber content right- floating stool

13
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

14
Constipation
  • Dry hard stools that are not easily passed caused
    by
  • Inadequate intake of fluids
  • Diet low in fibre
  • Slow peristalsis
  • Medications i.e. Codeine
  • Signs and symptoms
  • Abdominal distention
  • Pain on defecation
  • Decreased number of bowel movements
  • Inability to pass stool or straining to pass
    stool
  • May have oozing of stool if becoming impacted

15
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

16
Types of Constipation
  • Iatrogenic
  • induced by the administration of drug therapies
    such as
  • anti-inflammatory
  • anticholinergics
  • antidepressants
  • opioids
  • aluminium and calcium antacids
  • diretics

17
Principles of Bowel Care
  • Initial assessment to be performed to identify
    what are normal bowel habits for each individual
    resident.
  • Daily assessment - includes residents treatment
    preferences, history of bowel habits and
    management
  • Ongoing assessment

18
Principles of Bowel Care
  • Prompt and individually tailored treatments
  • Minimization of interventions that can cause loss
    of dignity
  • Comfort for the resident

19
Symptoms of Constipation
  • Nausea and vomiting
  • Straining during defecation
  • Infrequent bowel movement
  • Feelings of incomplete emptying after bowel
    movements
  • Frequent small amounts of diarrhoea

20
Symptoms
  • Rectal pain on defecation
  • Stomach pain, distension or discomfort
  • Hard stools
  • Faecal incontinence

21
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

22
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

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Non-pharmacological approaches
  • Toileting ensuring
  • comfort
  • privacy
  • timeliness - gastric reflux occurs after eating
  • Encourage fluid, fibre intake
  • Low intensity exercise

25
Effective bowel evacuation
  • Diet (meal before hand or hot drink stimulates
    gastro colic reflex)
  • Gravity
  • Massage and straining (Massage abdomen right to
    left and deep breathing and straining)
  • Digital stimulation

26
Digital bowel stimulator
27
Digital Stimulation Gloved hand
  • Inserting a well lubricated gloved finger or
    adaptive device into the rectum
  • With a circular motion, massage the anal muscle
    until it relaxes (15 to 60 seconds)
  • May be needed every 5-10minutes allowing stool to
    pass through the anal muscle

28
Digital Removal of Stool
  • Indications for disimpaction
  • Procedure
  • Explain to client
  • Position client on left side
  • Drape
  • Have bedpan or plastic bag available
  • Apply clean gloves and lubricate index finger
  • Gently insert finger into rectum and advance
    slowly toward umbilicus
  • Gently loosen fecal mass
  • Remove stool and provide perianalcare

29
Diarrhoea
  • Urgent passage of watery or liquid stool may be
    accompanied by abdominal cramping as well as
    nausea and vomitting
  • Causes
  • Diet allergies
  • Emotional stress
  • Laxative abuse
  • Bowel disorders
  • Intestinal pathogens i.e. food poisoning
    gastroenteritis
  • IBS

30
Is it overflow diarrhoea
  • Severe constipation and result in impaction
  • Thin feacal fluid can pass through hard stools
  • Thin fluid with no fibre or solid substances

31
Flatulence (flatus)
  • Excessive accumulation of intestinal gas
  • Caused by
  • Swallowing air while eating
  • Sluggish peristalsis
  • Intolerance to foods i.e. lactose intolerance
  • Ingestion of particular foods i.e. cabbage,
    cucumbers, onions, beans

32
Hemorrhoids
  • Perianal varicose veins
  • Internal inside rectum not visible
  • External protrude outside rectum
  • Pain, itching and bleeding
  • Caused by increased intra-abdominal pressure
  • Pregnancy
  • Constipation prolonged straining
  • Obesity
  • Cirrhosis portal hypertension
  • Prolonged sitting or standing

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Treatment of hemorrhoids
  • Treat constipation high fiber diet, fluids,
    exercise
  • Stool softeners laxatives
  • Topical analgesia
  • Cold packs
  • Sitz baths 3 4 X per day
  • Surgery Hemorroidectomy vein excised surgically

37
Suppositories
  • Oval shaped cone that melts at body temperature
  • May deliver medication i.e. antiemetic,
  • anti-inflammatory, analgesic
  • Useful to soften and lubricate stool i.e.
    glycerin suppository
  • Contact suppositories i.e. Biscodyl (Dulcolax)
    increase fluid and electrolyte volume in colon
    which promotes defecation

38
Enemas
  • Hypotonic less osmotic pressure than fluid in
    surrounding tissue
  • Tap water
  • Isotonic same osmotic pressure as surrounding
    tissue
  • Normal Saline (0.9 NaCl)
  • Hypertonic greater osmotic pressure than fluid in
    surrounding tissue
  • Sodium Phosphate enemas (Fleet)

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Enemas
  • Instillation of a solution into the rectum and
    sigmoid colon to promote defecation stimulates
    peristalsis or to administer medications
  • Large volume enemas
  • Low volume enemas
  • Oil retention enemas
  • Medications

41
Large Volume Enemas
  • Tap Water/Soap Suds (Hypotonic)
  • Normal Saline (Isotonic)
  • Small Volume Enemas
  • NaPhosphate or Fleet (Hypertonic)

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Administration of Enemas
  • Equipment required
  • Clean gloves
  • Water soluble lubricant
  • Waterproof pads
  • Toilet tissue
  • Bedpan or alternative
  • IV pole
  • Enema container with tubing and clamp/rectal tube

44
Administration of Enemas
  • Ensure enema prescribed
  • Assess client (make sure enema not
    contraindicated for individual)
  • Explain procedure to client
  • Ensure privacy
  • Raise bed to an appropriate height
  • Prepare enema
  • Place waterproof pads under buttocks have
    bedpan or commode nearby
  • Position client on left side

45
Low Volume NaPhosphate (Fleet)
  • Prepackaged remove tip cover pre-lubricated
    but requires additional lubricant
  • Proper positioning- left side
  • Separate buttocks, locate rectum, insert tip
    gently toward umbilicus 3-4 inches
  • (7.5 10 cm for an adult)
  • Squeeze bottle until all solution administered
  • Instruct client to hold enema for 2-5 minutes if
    possible

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Large Volume Normal Saline
  • Warm solution check temperature on wrist
  • Raise container prime tubing clamp it
  • Lubricate 7.5-10 cm (3-4 inches) of tip with
    lubricating jelly
  • Proper position left side
  • Separate buttocks visualize rectum
  • Instruct client to breath easily through mouth
  • Gently insert tip in direction of the umbilicus
    7.5-10 cm (3-4 inches)

48
Large Volume Normal Saline
  • Open clamp have container at hip level
  • Raise container slowly to appropriate level above
    rectum (IV pole may be used)
  • High enema 12-18 inches (30-45 cm)
  • Regular enema 12 inches (30 cm)
  • Low enema 3 inches (7.5 cm)
  • Hold tubing in rectum until fluid instillation is
    completed
  • Lower container if client has pain or cramping
  • Clamp tubing gently withdraw
  • Explain that client should hold for as long as
    possible
  • Discard container
  • Inspect color, consistency, amount of stool passed

49
Autonomic dysreflexia
  • Occur in clients with spinal cord injuries
  • Sacral nerves affected 2,3 and 4
  • Range of mild problems to a life threatening
    emergency
  • Caused by a full bladder or Bowel
  • Results in severe hypertention or seizures

50
Signs and symptoms
  • High blood pressure
  • Pounding headache
  • Pulse
  • Sweating
  • Flushing
  • Goose pimples
  • Chills without fever
  • anxiousness

51
First aid
  • Sit client up with legs in a supported position
  • Remove all restrictive clothing
  • Help to evacuate bladder or rectum

52
Rectal prolapse
  • Part of the bowels slides out
  • Partial
  • Complete
  • Internal
  • With a gloved finger gently slide the bowel back
    inside

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Documentation
  • Note on clinical record BM date
  • In narrative notes that an enema was given
  • Type of enema used
  • Results from the enema or lack of results
  • How client tolerated the procedure
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