HLTEN504A - INCP Meeting elimination needs. General guidelines When assisting with elimination...
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Transcript of HLTEN504A - INCP Meeting elimination needs. General guidelines When assisting with elimination...
HLTEN504A - INCP
Meeting elimination needs
General guidelines
When assisting with elimination procedures:• Wear disposable gloves• Wash hands immediately before and after procedure• Provide privacy• Make client as comfortable as possible during
elimination procedures• Ensure safety• Immediately answer call light, as resident may be
finished
Infection control considerations:
Follow standard precautions
Cover bedpans and urinals and close the covers of commodes after use until emptied
Avoid contamination of environmental surfaces with soiled gloves
Encourage client to perform perineal care after toileting or assist as necessary
Restrict use of bedpan or urinal to specific client – store appropriately
Encourage client to wash hands after toileting
Safety Precautions:Be sure client knows how to useEmergency signalEncourage use of grab railsLock wheels of commodeSupervise confused or disoriented clientDo not restrainProvide privacyAnswer call bell promptly
Constipation, diarrhoea, stomas, faecal incontinence
Factors affecting the passage of faeces
Type of foodAmount of foodAmount of fibre in the dietAnxietyPrivacyPositionActivity level - exercise stimulates the large bowel
Factors affecting the passage of faeces (cont)
Medication eg antibiotics, analgesics
Diseases such as • ulcerative colitis, • gastro enteritis, • coeliac disease, • respiratory disease, • heart disease, • spinal cord injuries
Factors affecting the passage of faeces (cont)
Age • control is not established until 2-3 years;• elderly
– lack of muscle tone of smooth muscle of colon, – slowed peristalsis, – decreased ability to evacuate bowel motion; – lack of control of anal sphincter
Post surgical complication - paralytic ileus
Pain ,analgesics
Composition of faecesSemi solid, cylindrical brown mass (adult), soft yellow in infantsWater (60-70%)Indigestible fibrous materialLive bacteria (E Coli)Dead bacteriaBile pigments (give faeces its brown colouring)Epithelial cellsSome fatty acidsSome mucus Inorganic material (calcium, phosphates)
Amount: 100-400 gms/day; varies with diet
Odour: characteristic but varies with individual and dietary intake
Observations of faeces
Amount
Colour
Consistency
Odour
Constituents
And frequency
Record on bowel chart or other document, as per facility
CONSTIPATION
Causes • General • Nutritional • Metabolic• Neurological• Psychological• Pregnancy• Ageing• Colorectal disorders• Medications
The infrequent passage of hard, dry stools, and is often the result of some deficiency in the three elements for normal bowel activity –
1. dietary fibre2. adequate fluid
input, and3. sufficient physical
activity.
Constipation Signs and symptoms• Decreased frequency
of bowel actions• Abdominal discomfort• Increase in flatulence • May experience
anorexia, nausea• Painful defaecation of
hard, dry stools - may be associated with haemorrhoids and anal fissures
• Straining to defaecate - may lead to rectal prolapse
Constipation
Treatment • Adjust diet and fluids – more fibre and fluids• Encourage activity• Develop a bowel regime - don't delay defaecation• Natural posture• Abdominal massage• Avoid anxiety• Giving aperients, or if needed suppositives/enemas
according to assessment
Laxatives
A laxative is a medication used to induce the emptying of the rectumA cathartic is a medication that purges the bowel (it has a stronger effect than a laxative – e.g. Golytley, Fleet)There are four categories of laxatives• Bulk forming• Lubricants• Osmotic agents• Stimulants
Laxatives - types
Bulk-forming laxatives work by softening and increasing the amount of your faeces - the fibre in the bran or isphagula husk "bulks out" the faeces. This then encourages your bowels to move and push the faeces out.
Osmotic laxatives work by increasing the amount of water that stays in the faeces as they pass through your intestines. This makes them softer and easier to pass.
Stimulant laxatives work by speeding up the movements of your intestines.
Generic names Examples of common brand names
Bulk-forming laxatives branispaghula husk Fibrelief, Fybogel, Isogel, Ispagel Orange,
Regulanmethylcellulose Celevacsterculia NormacolStimulant laxativesbisacodyl Dulco-lax tablets and suppositories
docusate sodium Dioctyl, Docusolglycerol Glycerin suppositoriessenna Ex-lax, Senokot, Nylaxsodium picosulfate Laxoberal, Dulco-laxOsmotic laxativeslactulose Regulosemacrogols Idrolax, Movicolmagnesium salts Milk/cream of Magnesia, Epsom Salts, Original
Andrews Salts
phosphates Carbalax, Fleet enema, Fletchers' Phosphate Enema
sodium citrate Microlette, Micralax, Relaxit
Laxative – Types.
Laxatives - types
http://search.chemistdirect.com.au
Suppositories
Suppositories are easily melted medicated masses for insertion into the rectum or vagina (pessary).
Suppositories inserted into the rectum can have • local effect or • systemic effect (Panadol, indocid, stemetil, prolodone)
Evacuant suppositories• Glycerin suppository contains glycerol. • Durolax (Bisacodyl) is used to stimulate the bowel wall and
increase peristalsis.
Enemas Enema – is a solution introduced into the rectum for cleansing or therapeutic purposes.
Retention enema – the solution to be retained in the rectum
Evacuation enema – to promote evacuation of faecal matter• The colon tends to contract when it is distended by
fluid thus promoting evacuation.• The enema is given slowly to avoid sudden
distension that would cause peristalsis or spasm.
Complications of constipation
Abdominal discomfort
Anorexia
Nausea/vomiting
Confusion
Urinary incontinence
Impaction with or without overflow
Development of haemorrhoids, anal fissures, rectal prolapse
Diarrhoea Diarrhoea is the passage of liquid, unformed faeces. The consistency is the primary component not just the frequencyCauses of diarrhoeaEmotional stress (anxiety)Intestinal infection (streptococcal or staphylococcal enteritis)Food allergiesFood intolerance (greasy foods, coffee, alcohol, spicy foods)Tube feedings
Causes of diarrhoea (cont)
Medications • Iron • Antibiotics • Laxatives (short term)
Impactions Colon disease (colitis, Crohn’s disease)Surgical alterations • Gastrectomy• Colon resection
Nursing care
Hygiene - wash area if required, protective creams
Fluid and electrolyte replacement - IV fluids, gastrolyte• Reduce peristalsis by withholding food• Clear fluids only (no milk until diarrhoea has subsided
24/24)• FBC• Elderly and young are more at risk of complications
Nursing care (cont)
Remove the cause if possible - laboratory specimens and investigative procedures may be neededAnti-diarrhoeals - eg lomitil, codeine phosphateEnsure access to toilet/utensilsEnsure privacyRemoval of odour - deodorise, open windows, remove soiled linen immediately