Maintaining Proper Bowel Elimination

Transcription

1 Peak Development Resources, LLC P.O. Box Richmond, VA Phone: (804) Fax: (804) After reading the newsletter, the nursing assistant should be able to: 1. Describe the normal process of bowel elimination. 2. Define constipation, fecal impaction and diarrhea. 3. List three causes of constipation and diarrhea. 4. List two signs of dehydration. 5. Discuss measures to promote good bowel function in the elderly. Peak Development for Long- Term Care Nursing Assistants and Competency Assessment Tool for Long-Term Care Nursing Assistants are components of a site license for the Peak Development Resources Competency Assessment System for Long-Term Care Nursing Assistants and may be reproduced for this individual facility only. Sharing of these components with any other freestanding facility within or outside the licensee s corporate entity is expressly prohibited. The information contained in Peak Development for Long-Term Care Nursing Assistants is intended only as a guide for the practice of long-term care nursing assistants supervised by licensed personnel. It is the responsibility of the reader to understand and adhere to policies and procedures set forth by the employing institution. The editor and publisher of this newsletter disclaim any liability resulting from use or misuse of information contained herein. Professional guidance from licensed personnel should be sought. Copyright 2007 Mr. Coffey is an 82-year old resident who has been living in the long-term care facility for the past two months. Ever since he arrived, he has complained about not being able to have a BM. His chart shows a pattern of bowel movements every 2-3 days. They are usually small, hard pieces of stool. Then Mr. Coffey began having small amounts of liquid stool once or twice per day. One of the staff members said, Well, I guess Mr. Coffey s constipation is fixed. Maybe he won t complain about it so much any more. But Sara, Mr. Coffey s nursing assistant, knew that something was wrong. She notified the nurse of Mr. Coffey s diarrhea. When the nurse checked Mr. Coffey, she found and removed a very large amount of hard stool from his bowel. Mr. Coffey had a fecal impaction. Sara s excellent observation and reporting skills helped Mr. Coffey to feel better and regain normal bowel function. This newsletter will discuss a very important body function bowel elimination. It will cover how the bowel normally works, as well as some common bowel problems. You will also learn how to help your residents to have good bowel function. Bowel Elimination Normal bowel function allows us to eliminate, or get rid of, solid waste from our body. This process is very important to our health. When food is eaten, it passes from the stomach into the small intestine, or small bowel. This is where nutrients from the food are absorbed into the body. The remaining food (waste) moves on into the large intestine, also called the large bowel or colon. As the waste moves through the intestines, water is removed and the waste becomes a solid mass. It then enters the last part of the bowel, called the rectum. This causes an urge to have a bowel movement, and the solid waste is then eliminated from the body. This solid waste has many names bowel movement, BM, stool, or feces. The food moves through the gastrointestinal (GI) tract because of rhythmic contractions of the intestines. This action is called peristalsis. It allows the food to move from the stomach, through the intestines, and out of the body. Common Bowel Problems Two common bowel problems are constipation and diarrhea. Both

2 of these problems can be very upsetting for elderly residents. They can also cause serious health problems. Constipation A resident who is constipated has hard, dry stools that are difficult to expel, or push out. Bowel movements do not occur very often, sometimes only once or twice a week. The resident may complain of feeling bloated, and may lose his appetite. One cause of constipation is slow peristalsis. When the waste moves through the bowels slowly, too much water is removed. This leads to hard, dry stools. Peristalsis slows down as we get older. That is one reason why constipation is so common in the elderly. Constipation may also be caused by not drinking enough fluids or not getting enough physical activity. Many medications can also cause constipation. Treatment of constipation may include the use of laxatives, enemas or suppositories. If nothing is done to treat the constipation, a more serious condition may result. Hard stool may collect in the rectum, forming a large mass called a fecal impaction. This mass may become too big for the resident to expel, causing nausea, pain, or an enlarged abdomen. Peristalsis increases in an effort to expel the mass, resulting in liquid stool being forced out around the mass. This can easily be mistaken for diarrhea. An enema may be needed to relieve the impaction, or the nurse may have to remove it. Any time you see liquid stools in an elderly person, suspect fecal impaction and report it immediately! Diarrhea When peristalsis is too fast, waste moves through the intestines too quickly. More water than usual stays in the waste, since the intestines do not have time to remove it. This results in frequent, liquid stools. There are many causes of diarrhea, including infection, medications, tube feeding or certain foods. The cause must be checked out right away so that the diarrhea can be treated. Diarrhea can be very dangerous, especially in the elderly. A great deal of body fluid may be lost, resulting in dehydration and serious heart or kidney problems. Report diarrhea to the charge nurse right away. The resident with diarrhea needs your frequent attention. Answer the call light immediately, since the resident may have very frequent bowel movements that are difficult to control. She may even have fecal incontinence. Clean the area gently after each bowel movement, since diarrhea is very irritating to the skin. Applying ointment may help to protect the skin from further irritation. As always, follow Standard Precautions by using gloves any time you may come in contact with urine or feces. Watch the resident for signs of dehydration dry mouth, dark urine, increased pulse and respiration, or decreased blood pressure. Report any changes to the charge nurse immediately. Promoting Good Bowel Function Many residents want to take laxatives or enemas to help their bowels move. It is much better for them to improve their bowel function in other ways. There are many ways that you can help with this. Remember these words: water, fiber and activity! Water is a very important part of good bowel function. Without enough water, stools become hard and dry, causing constipation. The average adult needs at least 8 glasses of water or other fluids every day. Each time you see your residents, encourage them to drink a glass of fluid. Explain to them that this will help keep their bowels regular. Fiber helps to provide bulk to the stool so that it travels well through the GI tract. Fiber is found in many of the normal foods we eat, such as fruits, vegetables and whole grains like oatmeal and whole wheat bread. Suggest that your residents have an apple or some raw carrots when they want a snack, if they are able to eat these foods. Activity helps to stimulate peristalsis. People who are active tend to have more regular bowel function than people who sit or lie down a lot. If the resident is able, have him walk in the halls once or twice each day. For residents who cannot walk, ask the nurse or physical therapist about exercises that can be done in the bed or chair. You know from working with your residents that they are often very concerned about their bowel function. You have also seen how uncomfortable they can be when they have constipation or diarrhea. Your help with diet and activity, as well as your good observation and reporting skills, will help them to get the care they need to maintain good bowel function. Peak Development for Long-Term Care Nursing Assistants Page 2

3 Monthly Staff Development Resource Learning Objectives: After reading the newsletter, the nursing assistant should be able to: 1. Describe the normal process of bowel elimination. 2. Define constipation, fecal impaction and diarrhea. 3. List three causes of constipation and diarrhea. 4. List two signs of dehydration. 5. Discuss measures to promote good bowel function in the elderly. Suggested Adjunct Activities 1. Hold a conference to discuss care of a resident with bowel elimination problems. 2. Have the nursing assistants report on measures they are using to promote good bowel function with their residents. Competency Assessment Tool Answer Key: 1. D. stomach > small intestine > large intestine > rectum 2. C. rhythmic contractions of the intestines. 3. B. False 4. A. not drinking enough water. 5. B. False 6. D. a mass of hard stool in the rectum. 7. A. Mr. Lampe, who is having small amounts of liquid stool. 8. C. increased pulse 9. B. celery 10.C. take two walks per day.

4 Competency Assessment Tool NAME: DATE: Directions: Write the letter of the one best answer in the space provided. 1. Which of the following best describes the path that food takes through the GI tract? A. stomach > large intestine > small intestine > rectum B. small intestine > stomach > rectum > large intestine C. stomach > small intestine > rectum > large intestine D. stomach > small intestine > large intestine >rectum 2. Peristalsis is the: A. solid mass of waste that moves through the intestines. B. process of absorbing nutrients from the intestines. C. rhythmic contractions of the intestines. D. elimination of solid waste from the body. 3. As waste moves through the intestines, water is normally added to it as it moves along. A. True B. False 4. Constipation may be caused by: A. not drinking enough water. B. eating too much. C. fast peristalsis. D. too much physical activity. 5. Diarrhea is often upsetting to the elderly, but it cannot harm them physically. A. True B. False

5 6. A fecal impaction is: A. an infection of the bowel. B. stool that stays in the small intestine. C. a weakening in the wall of the intestine. D. a mass of hard stool in the rectum. 7. The nursing assistant should most strongly suspect a fecal impaction in which one of the following cases? A. Mr. Lampe, who is having small amounts of liquid stool. B. Mrs. Pett, who has a temperature of orally. C. Mrs. Bibb, who is complaining of weakness. D. Mr. Lock, who didn t eat dinner because his stomach was upset. 8. Which of the following is a sign of dehydration? A. pale urine B. decreased respirations C. increased pulse D. increased blood pressure 9. Which of the following foods is a good source of fiber? A. cheese B. celery C. eggs D. hamburger 10. Mr. Brown sometimes complains of constipation. To promote his bowel function, the nursing assistant suggests that Mr. Brown: A. drink three glasses of water per day. B. eat more meat at dinner. C. take two walks per day. D. ask the nurse for an enema. Competency Assessment Tool Page 2