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Slide 1 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Textbook For Nursing.

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Presentation on theme: "Slide 1 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Textbook For Nursing."— Presentation transcript:

1 Slide 1 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Textbook For Nursing Assistants Chapter 20 – Assisting with Urinary and Bowel Elimination

2 Slide 2 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Assisting with Elimination

3 Slide 3 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Some patients or residents may only need a steady arm to lean on during their trip to the bathroom; others will need more help The bathrooms in many health care facilities have special features that make them easier for people with physical disabilities to use Assisting with Elimination

4 Slide 4 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Modifications allow many patients or residents to use the toilet in the bathroom with very little assistance from a nursing assistant Assisting with Elimination

5 Slide 5 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Some patients or residents may not be able to get out of bed at all, or they may be too weak or ill to walk to the bathroom. These people may need to use: Bedside commodes Bedpans Urinals Assisting with Elimination - Elimination Equipment

6 Slide 6 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The bedside commode consists of a chair frame with a toilet seat and a removable collection bucket Elimination Equipment - Bedside Commodes For a person who is able to get out of bed, but who is not able to walk to the bathroom, a bedside commode can make toileting easier

7 Slide 7 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A bedpan is used for elimination when a person is unable to get out of bed at all A woman who cannot get out of bed uses a bedpan to urinate, and for bowel movements. A man who cannot get out of bed uses a bedpan for bowel movements, and a urinal to urinate. Elimination Equipment - Bedpans

8 Slide 8 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Arthritis can make using a bedpan very painful, as can fractures of the back or legs In such cases, when using a bedpan is uncomfortable or dangerous, a special bedpan called a fracture pan is used Elimination Equipment - Fracture Pans

9 Slide 9 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The fracture pan, which is wedge- shaped, is placed underneath the person’s buttocks with the thin edge toward the person’s back Elimination Equipment - Fracture Pans

10 Slide 10 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Warm a metal bedpan before offering it to the patient or resident by wrapping the bedpan in a warm towel, or running warm water over the seat area and then drying it before use Provide as much privacy as safely possible Fracture Pans and Bedpans - Useful Tips

11 Slide 11 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. If the person’s condition allows, raise the head of the bed to promote a more natural elimination position Fracture Pans and Bedpans - Useful Tips

12 Slide 12 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A man uses a urinal to urinate when he cannot get out of bed Elimination Equipment - Urinals

13 Slide 13 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. To urinate, the man puts his penis in the opening of the urinal If the man is very weak or disabled, you may need to place his penis inside the opening of the urinal for him Elimination Equipment - Urinals

14 Slide 14 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A patient or a resident may have difficulty with elimination, if elimination occurs under conditions that are not as private as the person would like. In a health care facility, people may share a bathroom or use a bedpan while only being separated from other people in the room by a curtain Difficulty with Normal Elimination

15 Slide 15 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Feelings of embarrassment and shame are made worse when patients or residents accidentally soil themselves, their bed linens, or their clothing with urine or feces. This might be due to: The effects of medications Being in a strange place Reluctance to ask for help Physical or mental disabilities Difficulty with Normal Elimination

16 Slide 16 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Kindness, empathy, and a professional attitude can go a long way toward easing the patient’s or resident’s embarrassment Promoting Normal Elimination

17 Slide 17 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Being in a health care facility can change a person’s normal elimination patterns, which can cause health problems The most effective method of treating urinary and bowel problems is to prevent them from happening in the first place Promoting Normal Elimination

18 Slide 18 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Encourage plenty of fluids, unless the doctor has ordered against it Answer call lights promptly Encourage the person to call when he first feels the urge to void Offer people the chance to eliminate frequently Provide for privacy and comfort The sound of running water may help some people to urinate If a person is having difficulty moving his bowels, do not rush the person Regular exercise and foods containing insoluble fiber help promote regular bowel movements Promoting Normal Elimination

19 Slide 19 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The contents of a person’s urine or feces can provide a doctor with clues about the person’s overall health status A nursing assistant may be asked to obtain a urine or stool specimen (sample) for laboratory study Obtaining Urine and Stool Specimens

20 Slide 20 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Before collecting any specimen—of urine, feces, or any other body fluid—ask yourself the following questions: Do I have the right person? Do I have the right laboratory requisition slip? What method is to be used to collect the specimen? Do I have the right type of specimen cup? Is the specimen cup properly labeled? What is the correct date and time? What storage and delivery method must I use? Obtaining Urine and Stool Specimens

21 Slide 21 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Always remember to wear gloves when assisting with specimen collection and when handling the specimen cups Obtaining Urine and Stool Specimens

22 Slide 22 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Urinalysis, or examination of the urine under a microscope and by chemical means, is a commonly used diagnostic tool in the health care setting Substances found in urine during urinalysis can help doctors diagnose kidney disease, certain metabolic diseases, and infections To perform urinalysis, a urine specimen must be obtained Obtaining Urine and Stool Specimens - Urinalysis

23 Slide 23 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. For routine urinalysis, the person is asked to urinate directly into the specimen cup, if possible. If difficult, the person can urinate into a specimen collection device. The person must not have a bowel movement at the same time the urine is being collected. Do not place toilet paper in the collection device. Either of these actions will change the urinalysis results. Obtaining Urine Specimens - Routine Urinalysis

24 Slide 24 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. This method of collecting urine prevents contamination of the urine by the bacteria that normally live in and around the urethra A midstream (“clean catch”) urine specimen is usually ordered when the doctor suspects a urinary tract infection When a midstream (“clean catch”) urine specimen is requested, the person is asked to clean the area around the urethral opening with a special cleansing wipe The urine flow is started, then stopped, then started again The urine sample is collected from the restarted flow Obtaining Urine Specimens- Midstream (“Clean Catch”) Urine Specimen

25 Slide 25 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A type of routine urine testing involves dipping chemically treated paper strips into a urine sample Obtaining Urine Specimens - Testing Chemicals on the paper react with certain substances that may be found in the urine, causing the chemical blocks on the paper to change color if these substances are present in the urine The paper is then compared with a color chart that comes with the strips

26 Slide 26 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Stool is analyzed for the presence of blood, pathogens (such as parasites or bacteria), fat, and other things that are not normally found in feces If a stool sample is needed, the person should be notified well in advance so that the specimen can be collected when it becomes available Ask the nurse if there are any particular collection methods that should be used Obtaining Stool Specimens

27 Slide 27 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Stool can be collected in a bedpan, bedside commode, or in a collection device placed into a regular toilet. The person must not urinate at the same time the stool sample is being collected. Toilet paper must not be placed in the collection device. Both of these actions will change the test results. Obtaining Stool Specimens

28 Slide 28 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Urinary Elimination

29 Slide 29 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The urinary system consists of the kidneys, urinary bladder, ureters, and urethra Blood is filtered by the kidneys, forming urine The urine is stored in the urinary bladder As the bladder fills, we begin to feel the urge to urinate Urine leaves the body through the urethra Urinary Elimination - Urinary System

30 Slide 30 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The process of passing urine from the body is known by several terms, including Urination Voiding Micturition Patients or residents will have their own terms for urinating, such as “peeing” or “passing water” When talking about urination, use words that the person is familiar with. This is especially important when talking with children. Urinary Elimination - Expressions

31 Slide 31 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. In healthy people, urine is: Clear, without cloudiness or particles Pale yellow, straw-colored, or dark gold (amber) in color, with a slight odor Urinary Elimination - Color and Odor

32 Slide 32 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Foods and drugs can affect the color and odor of urine When you are helping a patient or resident with urination, observe the urine and report any abnormalities to the nurse Urine with an unusual odor or appearance could be a sign of illness or infection Urinary Elimination - Color and Odor

33 Slide 33 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A slight red tinge to the urine may indicate hematuria, or the presence of blood in the urine Sometimes hematuria is occult and must be detected using urinalysis Urinary Elimination - Hematuria

34 Slide 34 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Many factors influence a person’s urinary pattern, including: The amount of fluids the person drinks The types of medications the person takes The person’s age The person’s lifelong elimination habits A nursing assistant soon becomes aware of the urinary pattern that is normal for each person in her care This knowledge allows her to recognize any changes that may occur Factors Affecting Urinary Elimination

35 Slide 35 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Frequency is the term used to describe voiding that occurs more often than usual Frequency is often accompanied by a feeling of urgency, or the need to urinate immediately Nocturia is the need to get up more than once or twice during the night to urinate, to the point where sleep is disrupted Urination - Frequency and Nocturia

36 Slide 36 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Dysuria is difficulty voiding that may or may not be associated with pain Some people describe the discomfort they feel during urination as a “burning” or “cramping” sensation Dysuria is often associated with bladder infections, prostate problems, and some sexually transmitted diseases (STDs) Urination - Dysuria

37 Slide 37 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. In a person maintaining a good fluid balance, urine output is neither too high nor too low. Complications associated with urine output are: Oliguria (the state of voiding a very small amount of urine over a given period of time) Polyuria (the state of excessive urine output) Anuria (the state of voiding less than 100 ml of urine over the course of 24 hours) Measuring Urine Output

38 Slide 38 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. People who have illnesses or take medications that may alter their body’s ability to maintain a healthy fluid balance will need to have their urine output measured regularly Some people who are critically ill will have their urine output measured and recorded every hour, but most people in the health care setting have routine orders for their urine output to be measured and recorded each shift Measuring Urine Output

39 Slide 39 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. If a person uses a regular toilet, you will need to remind the person: To void into a specimen collection device (“commode hat”) To call you after he or she has finished voiding so that you can measure and record the amount of urine Specimen collection devices, urinals, and the drainage bags used with urinary catheters often have markings that make measuring urine output easy Measuring Urine Output - Process

40 Slide 40 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Urine output can also be measured by pouring it into a graduate Measuring Urine Output - Process

41 Slide 41 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. If the urine output of one of your residents or patients is being monitored, you will need to keep a record of the amount of urine passed at each voiding This can be done using an intake and output (I&O) flow sheet, which has spaces to record the amount of each individual voiding To obtain the end-of-shift amount, simply add the individual amounts and record the total in the appropriate space Measuring Urine Output - Process

42 Slide 42 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Urinary catheterization is done when a person is unable to urinate using a toilet, bedpan, urinal, or bedside commode A urinary catheter is a tube that is inserted into the bladder through the urethra to allow the urine in the bladder to drain out Urinary Catheterization

43 Slide 43 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A urinary catheter is used in many different situations: A urinary catheter may be inserted to drain the bladder before or during a surgical procedure, during recovery from a serious illness or injury, or to collect urine for testing A urinary catheter may be used for a person who is incontinent of urine, if the person has wounds or pressure ulcers that would be made worse by contact with urine A urinary catheter is necessary when a person is unable to urinate because of an obstruction in the urethra Urinary Catheterization - Situations When a Urinary Catheter is Used

44 Slide 44 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Inserting a catheter is a procedure that requires sterile technique because it involves putting a foreign object (that is, the catheter) into a person’s body. Inserting a urinary catheter is usually beyond the scope of practice for a nursing assistant, although in some facilities, nursing assistants are provided with additional training that allows them to catheterize residents or patients. Regardless of whether or not you are trained to actually insert urinary catheters, caring for people who have urinary catheters in place will almost certainly be a part of your daily duties. Urinary Catheterization - Insertion of Urinary Catheter

45 Slide 45 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. You will see many different types of urinary catheters in use A straight catheter, also known as a Robinson, Rob- Nel, or Red Rubber catheter, is used when the catheter is to be inserted and removed immediately. An indwelling catheter, also known as a retention or Foley catheter, is left inside the bladder to provide continuous urine drainage. A suprapubic catheter is a type of indwelling catheter. The suprapubic catheter is inserted into the bladder through a surgical incision made in the abdominal wall, right above the pubic bone. Urinary Catheterization - Types of Urinary Catheters

46 Slide 46 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Catheters Straight Suprapubic Indwelling

47 Slide 47 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Indwelling urinary catheters are connected by a length of tubing to a urine drainage bag The tubing is secured loosely to the person’s body near the insertion site using a catheter strap or adhesive tape Securing the tubing to the person’s body prevents the catheter from being accidentally pulled out during repositioning Urinary Catheterization - Caring for a Person with an Indwelling Urinary Catheter

48 Slide 48 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A little bit of slack is left in the tubing to prevent the catheter from pulling against the bladder outlet and the urethral opening The remaining length of tubing is then gently coiled and secured to the bed linens using a plastic clip or safety pin Urinary Catheterization - Caring for a Person with an Indwelling Urinary Catheter

49 Slide 49 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Coiling the tubing prevents the tubing from becoming bent or kinked, which would stop the free flow of urine into the drainage bag. Coiling the tubing and securing it to the bed linens also keeps the weight of the tubing from pulling against the person’s body. The drainage bag is then secured to the bed frame or the back of the person’s wheelchair, at a level lower than the person’s bladder. Urinary Catheterization - Caring for a Person with an Indwelling Urinary Catheter

50 Slide 50 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. If the drainage bag and tubing are higher than the person’s bladder, then gravity could cause old, contaminated urine to run back down the tubing and into the person’s bladder, causing an infection. Urinary Catheterization - Caring for a Person with an Indwelling Urinary Catheter

51 Slide 51 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Nursing assistants are usually responsible for providing catheter care. Catheter care involves thorough cleaning of the perineal area and the catheter tubing that extends outside of the body, to prevent infection. Urinary Catheterization - Providing Catheter Care

52 Slide 52 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Providing good catheter care is important because the presence of the catheter in the urethra provides a pathway for bacteria to travel up from the perineum into the bladder, where they can cause infection. In addition, having a catheter in place eliminates the “flushing” action of normal urination, which helps to remove bacteria from the urinary tract naturally. Urinary Catheterization - Providing Catheter Care

53 Slide 53 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Because bacteria can be introduced into the body both when a urinary catheter is inserted and after it is in place, urinary tract infections in catheterized people are one of the most common nosocomial infections. In an effort to reduce the risk of nosocomial infection in people who are catheterized, many facilities require catheter care to be provided routinely. Urinary Catheterization - Providing Catheter Care

54 Slide 54 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Urine drainage bags are routinely emptied and the urine measured at the end of each shift. Urine drainage bags should also be emptied if they are full. Leg bags need to be emptied frequently because they are smaller, and hold less urine. Urinary Catheterization - Emptying Urine Drainage Bags

55 Slide 55 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Use of an indwelling catheter can lead to temporary urinary incontinence when the catheter is removed, because the lack of activity can decrease the muscle tone of the bladder. To prepare the bladder for removal of the catheter, it is common to clamp the tubing of the catheter for a period of time to allow the urine to fill the bladder. The tubing is then unclamped and the urine is allowed to drain from the bladder. The procedure is repeated over a period of time, with the time intervals between clamping and emptying becoming increasingly longer. Then the catheter is removed and the person is allowed to void normally. Urinary Catheterization - Preparing for Removal of an Indwelling Catheter

56 Slide 56 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Urinary incontinence is the inability to hold one’s urine, or the involuntary loss of urine from the bladder. Urinary incontinence may be temporary or permanent. Temporary urinary incontinence can occur as a result of bladder infection, or after an indwelling catheter that has been in place for a long time is removed. Permanent urinary incontinence can be caused by many things, including: Decreased muscle tone in the bladder or the muscles that support the bladder, such as occurs after childbirth or from obesity Injuries or illnesses that affect the spinal cord, the brain, or the nerves that control bladder function Dementia Urinary Incontinence

57 Slide 57 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Urinary incontinence can be emotionally devastating for both the incontinent person and the person’s caregivers. For the person who is incontinent, having wet clothes or smelling like urine can be very embarrassing. In addition, being incontinent of urine places a person at risk for developing skin problems and for falling. For the caregiver, caring for a person who is incontinent of urine can be frustrating and emotionally draining. Because caring for an incontinent person can be so emotionally trying and time consuming, incontinence is the factor that most often leads family members to have a relative admitted to a long-term care facility. Urinary Incontinence

58 Slide 58 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. There are many types of urinary incontinence Stress incontinence is the involuntary release of urine from the bladder when the person coughs, sneezes, or exerts herself. Urge incontinence is the involuntary release of urine right after feeling a strong urge to void. Functional incontinence occurs in the absence of physical or nervous system problems affecting the urinary tract. Overflow incontinence occurs when the bladder is too full of urine. Reflex incontinence occurs when there is damage to the nerves that enable the person to control urination. Urinary Incontinence - Types

59 Slide 59 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Products available to help manage urinary incontinence include: Incontinence pads Incontinence briefs Condom catheters In addition, techniques such as bladder training may be used to help a person overcome certain types of incontinence For some people, temporary or permanent catheterization may be necessary to manage incontinence Urinary Incontinence - Managing Urinary Incontinence

60 Slide 60 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Incontinence pads and briefs are specially made to absorb urine and hold it away from the person’s skin. Incontinence pads are placed inside the person’s underpants to prevent wetting of the clothes and to draw the moisture away from the person’s body. For a person who is confined to bed, bed protectors are used to help to keep the bed linens and mattress dry and to wick urine away from the person’s skin. Incontinence briefs tend to fit closely, which makes it difficult for air to reach the skin. Switching between briefs and bed protectors helps expose the skin to air at night. A nursing assistant must make sure that these incontinence products are changed frequently and that urine is cleaned from the skin whenever the change occurs. Urinary Incontinence - Managing Urinary Incontinence - Incontinence Pads and Briefs

61 Slide 61 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A condom catheter consists of a soft plastic or rubber sheath, tubing, and a collection bag for the urine. The sheath is placed over the penis and the collection bag is attached to the leg. Urinary Incontinence - Managing Urinary Incontinence - Condom Catheters

62 Slide 62 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The urine flows through the tubing into the collection bag, allowing the man to urinate at will. The condom must fit the penis and should be fastened securely enough to prevent leaking, but not so snugly as to restrict circulation. Adhesive material on the inside of the condom allows for a good seal Or, the condom is secured with elastic tape applied in a spiral fashion to allow for changes in the size of the penis Use of a condom catheter requires good skin care. The penis must be cleaned, and the condom apparatus changed, daily. Urinary Incontinence - Managing Urinary Incontinence - Condom Catheters

63 Slide 63 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Bladder training is commonly used to help people re- learn how to control their urinary elimination patterns. For example, a person may be encouraged to use the bedpan, urinal, or commode at scheduled times. Scheduling of elimination helps promote regular emptying of the bladder. The primary goal is for the person to be able to control involuntary urination. If this is not possible, then the person may still at least be able to get to the bathroom in time to avoid accidents. Urinary Incontinence - Managing Urinary Incontinence - Bladder Training

64 Slide 64 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Bowel Elimination

65 Slide 65 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The digestive tract consists of the mouth, esophagus, stomach, small intestine, large intestine, rectum, and anus Bowel Elimination - Digestive System

66 Slide 66 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The rectum is actually part of the large intestine, and together, the large and small intestines are sometimes referred to as “bowels.” The food and fluids that we take in are broken down into smaller pieces and mixed together in the stomach, forming a partially digested food and fluid mixture known as chyme. From the stomach, the chyme passes slowly into the small intestine, where more digestion occurs and nutrients and fluid are absorbed, and then into the large intestine. Bowel Elimination - Digestive System

67 Slide 67 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Wave-like muscular movements, called peristalsis, move the chyme through the intestines. Finally, the chyme reaches the last part of the large intestine, called the rectum. At this point, all of the nutrients have been removed, and what remains is a semi-solid waste material, called feces. Bowel Elimination - Digestive System

68 Slide 68 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The presence of feces in the rectum stimulates the urge to defecate and the feces leave the body through the anus. Flatus (or gas) is a natural byproduct of digestion, just as feces are. Bowel Elimination - Digestive System

69 Slide 69 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. In healthy people, feces: Are soft, brown, and moist Have a distinct odor Certain foods and medications can affect the color and odor of feces When helping a patient or resident with defecation, observe the feces and report any abnormalities to the nurse Feces with an unusual odor or appearance could be a sign of illness or infection Bowel Elimination - Color and Odor

70 Slide 70 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The factors that influence a person’s bowel elimination pattern include: The amount of fluid the person drinks The type of food he or she eats The types of drugs the person takes The person’s age The person’s level of activity A nursing assistant soon becomes aware of the bowel elimination pattern that is normal for each person in her care. This knowledge allows her to recognize any changes that may occur. Factors Affecting Bowel Elimination

71 Slide 71 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Problems with bowel elimination that are often seen in the health care setting include: Diarrhea Constipation Fecal impaction Flatulence Fecal (bowel) incontinence Problems with Bowel Elimination

72 Slide 72 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Diarrhea is the passage of liquid, unformed stool. Diarrhea may occur frequently and can be accompanied by abdominal cramping. If diarrhea is frequent or excessive, the loss of fluid from the body can quickly cause dehydration, especially in young or elderly people. Problems with Bowel Elimination - Diarrhea

73 Slide 73 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. When caring for a person with diarrhea: Practice good infection control techniques Answer the call light quickly to provide access to the toilet, commode, or bedpan Provide gentle, thorough skin care after each bowel movement to prevent skin breakdown Make sure to record and report the frequency and amount of each incident of diarrhea Problems with Bowel Elimination - Diarrhea

74 Slide 74 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Constipation occurs when the feces remain in the intestines for too long The delay allows too much fluid to be reabsorbed by the intestines, resulting in hard, dry feces that are difficult to pass Problems with Bowel Elimination - Constipation

75 Slide 75 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Risk factors for developing constipation include: Taking medications that slow peristalsis Not taking in enough dietary fiber or fluids Not getting enough exercise Delaying having a bowel movement Lack of privacy Problems with Bowel Elimination - Constipation

76 Slide 76 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. There are many things a nursing assistant can do to help a patient or resident maintain normal bowel function and prevent constipation Encouraging fiber-rich foods Encouraging plenty of fluids Assisting with exercise Ensuring privacy Problems with Bowel Elimination - Constipation

77 Slide 77 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. If a person is constipated and all other methods of promoting normal bowel function have failed, a laxative, stool softener, or fiber supplement may need to be used A laxative is a medication that chemically stimulates peristalsis so that material inside the intestines moves through at a faster pace Stool softeners help to keep fluid in the feces and are used to help prevent constipation for some people Fiber supplements, in the form of tablets or drink additives, can add bulk to the feces, causing it to hold fluid, and preventing constipation Problems with Bowel Elimination - Constipation

78 Slide 78 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A fecal impaction occurs when constipation is not relieved. The feces build up in the rectum and become harder and harder as more and more fluid is absorbed. Eventually, it becomes almost impossible to pass the feces normally. The impaction blocks the passage of normal stool, but liquid stool may go around the impacted mass. Problems with Bowel Elimination - Fecal Impaction

79 Slide 79 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A person with an impaction is usually very uncomfortable, and may complain of abdominal or rectal pain or of liquid feces “seeping” out of the anus. The person’s abdomen may be swollen. Problems with Bowel Elimination - Fecal Impaction

80 Slide 80 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. If a person is thought to have a fecal impaction, the nurse will perform a digital examination. During the digital examination, a finger is inserted into the person’s rectum to feel for the impacted mass (digital means “finger”). Problems with Bowel Elimination - Fecal Impaction

81 Slide 81 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The impaction is removed by using the finger to break the impacted feces apart and scoop it out of the rectum piece by piece. The doctor may also order the use of an oil retention enema or drugs to help remove the impaction. Digital removal of a fecal impaction is very uncomfortable and embarrassing for most patients and residents. Many facilities require that a nurse remove an impaction, but your assistance will be necessary. If you are allowed to remove an impaction, make sure you have been adequately trained for the procedure and that it is part of your job description. Problems with Bowel Elimination - Fecal Impaction

82 Slide 82 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Flatulence is the presence of excessive amounts of flatus (gas) in the intestines, causing abdominal distension (swelling) and discomfort. People have difficulty passing flatus because of a lack of activity or a recent surgical procedure. Getting out of bed and walking might be all that is needed to help the person to expel the gas. If walking is not allowed, positioning the person on her left side may help. If the flatulence cannot be relieved with these methods, a nurse may insert a rectal tube to help the gas escape. Problems with Bowel Elimination - Flatulence

83 Slide 83 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Fecal (bowel) incontinence is the inability to hold one’s feces, or the involuntary loss of feces from the bowel Like urinary incontinence, fecal incontinence can be temporary or permanent Problems with Bowel Elimination - Fecal Incontinence

84 Slide 84 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Temporary fecal incontinence may be due to: A severe case of diarrhea An inability to get to the bathroom quickly enough Failure to answer call lights promptly Diseases or injuries that affect the nervous system can also result in temporary or permanent fecal incontinence A person who is unconscious will be incontinent of feces A person who has dementia will develop fecal incontinence as the disease progresses Problems with Bowel Elimination - Fecal Incontinence

85 Slide 85 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Bowel training is very similar to bladder training and works to promote regular, controlled bowel movements Offering the commode or bedpan at regular scheduled intervals is a common method of bowel training Bowel training is often started by keeping track of when an incontinent person usually has a bowel movement, then making sure to provide the appropriate toilet facilities during that time period Problems with Bowel Elimination - Fecal Incontinence - Bowel Training

86 Slide 86 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. An enema is the introduction of fluid into the large intestine by way of the anus for the purpose of removing stool from the rectum Enemas are used to Relieve constipation Relieve fecal impactions Empty the intestine of fecal material before surgery or certain diagnostic tests Sometimes enemas are used as part of a bowel training program Enemas

87 Slide 87 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Types of enemas used in the health care setting include: Cleansing enemas Oil retention enemas Commercial enemas Enemas - Types of enemas

88 Slide 88 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Cleansing enemas are primarily used to remove feces from the lower large intestine. Tap water enemas and saline (salt water) enemas help soften the stool and stimulate peristalsis. Soapsuds enemas consist of water and a small amount of a very gentle soap called castile soap. The soap solution irritates the lining of the bowel, stimulating peristalsis. Enemas containing these solutions should not be given repeatedly because the intestine can absorb the solution, causing a fluid imbalance in the body. Enemas - Cleansing Enemas

89 Slide 89 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. An oil retention enema contains mineral, olive, or cottonseed oil. The oil lubricates the inside of the intestine and any stool that is present, making the stool easier to pass or remove. Oil retention enemas are useful for helping to remove fecal impactions. Enemas - Oil Retention Enemas

90 Slide 90 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Commercially prepared and packaged enemas usually contain 120 ml of a solution that irritates the intestinal mucosa to promote peristalsis. Some commercial enemas contain a solution that is absorbed into the stool to make it softer and easier to pass. Enemas - Commercial Enemas

91 Slide 91 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Enemas are ordered by a doctor and usually given by a nurse. Some facilities allow nursing assistants to administer enemas after adequate training. Nursing assistants must make sure that They follow proper procedure and the doctor’s orders closely The solution is correct for the person The correct amount of solution is being administered The solution is at the proper temperature Enemas - Administering Enemas

92 Slide 92 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Enema solutions that are too cool can cause abdominal cramping and pain, while solutions that are too hot can cause serious injury and possibly even death When assisting with the administration of an enema, make sure that a bed protector and bedpan are in place, or that the path to the bathroom is clear Enemas - Administering Enemas

93 Slide 93 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. An enema is given with the person on her left side in Sims’ position When a person is lying on her left side in Sims’ position, the intestine is positioned to take the best advantage of gravity After the enema has been administered, the person is asked to hold the solution in the bowel for the specified amount of time, and then to expel the solution The doctor may order a cleansing enema to be administered “until clear,” which means that enemas are to be given until the enema return from the person does not contain any fecal material Enemas - Administering Enemas

94 Slide 94 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Ask the nurse how many enemas are allowed to be given during a particular session To make the procedure easier for the person, keep the person covered as much as possible and ensure that she has as much privacy as possible Having the person take a few slow, deep breaths as the enema tubing is inserted into the rectum may help to relax the person and make insertion easier Enemas - Administering Enemas

95 Slide 95 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A rectal suppository is a small, wax-like cone or oval that is inserted into the anus. The wax-like substance dissolves at body temperature, stimulating peristalsis or lubricating and softening the stool. Glycerin rectal suppositories are often used to help with bowel elimination before resorting to an enema. Some rectal suppositories also contain medication. These should only be inserted by a nurse. Rectal Suppositories

96 Slide 96 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. End of Presentation


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