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