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 use Emergency signal Encourage use of grab rails Lock wheels of commode Supervise confused or disoriented client Do not restrain Provide privacy Answer call bell promptly

Constipation, diarrhoea, stomas, faecal incontinence

Factors affecting the passage of faeces Type of food Amount of food Amount of fibre in the diet Anxiety Privacy Position Activity 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 faeces Semi solid, cylindrical brown mass (adult), soft yellow in infants Water (60-70%) Indigestible fibrous material Live bacteria (E Coli) Dead bacteria Bile pigments (give faeces its brown colouring) Epithelial cells Some fatty acids Some mucus Inorganic material (calcium, phosphates) Amount: 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 fibre 2. adequate fluid input, and 3. 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 rectum A 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 namesExamples of common brand names Bulk-forming laxatives bran ispaghula huskFibrelief, Fybogel, Isogel, Ispagel Orange, Regulan methylcelluloseCelevac sterculiaNormacol Stimulant laxatives bisacodylDulco-lax tablets and suppositories docusate sodiumDioctyl, Docusol glycerolGlycerin suppositories sennaEx-lax, Senokot, Nylax sodium picosulfateLaxoberal, Dulco-lax Osmotic laxatives lactuloseRegulose macrogolsIdrolax, Movicol magnesium saltsMilk/cream of Magnesia, Epsom Salts, Original Andrews Salts phosphatesCarbalax, Fleet enema, Fletchers' Phosphate Enema sodium citrateMicrolette, Micralax, Relaxit Laxative – Types.

Laxatives - types

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 frequency Causes of diarrhoea Emotional stress (anxiety) Intestinal infection (streptococcal or staphylococcal enteritis) Food allergies Food 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 needed Anti-diarrhoeals - eg lomitil, codeine phosphate Ensure access to toilet/utensils Ensure privacy Removal of odour - deodorise, open windows, remove soiled linen immediately