Factors affecting bowel elimination
Bowel routine is important so...
- Daily time clock
- Hot drinks (sometimes with lemon)
- Stool softeners
- Position and abdominal pressure
- Bearing down
- What else?
- Encourage fluids – fiber pill without water = cement blockage in the intestine
- Proper diet – fresh fruits, vegetables, whole grains, fiber
- Exercise – 3-5 times a week; range of motion for clients on bed rest
- What can the nurse do to facilitate? – this would be the intervention portion of your Nursing Care Plan
- What are some questions you would ask?
- Subjective versus Objective
- What are the assessments you would do?
- What patient education would you provide?
- Monitor stools to quantify diarrhea
- Assess and monitor for fluid imbalance – how?
- Monitor for alterations in perineal skin integrity – why?
- Increase fiber intake.
- BRAT diet: Bananas, Rice, Apple sauce, Toast.
- Increase exercise
- Increase intake of high-fiber foods – like what and why?
- Increase fluid intake
- Increase activity/exercise
- Provide privacy
- Help client in a position that facilitates defecation
- Allow uninterrupted time
- Laxatives when lifestyle changes are ineffective
Managing fecal impaciton
- Prevention is the best treatment
- Determine presence: digital examination (finger exam)
- Manual/digital removal: disimpacting (work it out with your fingers. Yay.)
- Establish bowel program to prevent recurrence
- Main purpose is the promotion of defecation, stimulate peristalsis
- Fluid breaks up fecal mass, stretches the rectal wall and initiates defecation reflex
- Position patient in left lateral position because fluid flow is best in this position.
- Physician order
- Equipment: Protect the bed.
- Have client lie on left side.
- Warm the solution to 105 – 110 degrees
- Insert tube, lubricated, gently, 3-4 inches. Hold 12–18 inches above client – the average adult can accommodate 350-500mL.
- Listen to your patient and encourage to hold 15-20 min.
- Monitor for adverse affects
- Document results!