Textbook for Nursing Assistants Chapter 21: Assisting With Urinary and Bowel Elimination

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Assisting With Elimination

Fluid Imbalance Water is lost from skin, lungs, and GI tract Dehydration- diarrhea, vomiting, bleeding, diaphoresis, poor PO intake Symptoms= fever?, decreased urine output, concentrated urine, decreased weight, mucous membranes dry Edema- infections, increased sodium intake, kidney diseases, heart disease, sitting for too long in one position, Symptoms= decreased output, weight gain, swelling, SOB

Assisting With Elimination 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 Modifications allow many patients or residents to use the toilet in the bathroom with very little assistance from a nursing assistant

Assisting with Elimination - Elimination Equipment 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

Elimination Equipment: Bedside Commodes The bedside commode consists of a chair frame with a toilet seat and a removable collection bucket 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

Elimination Equipment: Bedpans 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 : Fracture Pans 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 The fracture pan, which is wedge-shaped, is placed underneath the person’s buttocks with the thin edge toward the person’s back

Fracture Pans and Bedpans: Useful Tips 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 Apply a small amount of powder to the rim of the bedpan to make it easier to slide under the person Provide as much privacy as safely possible

Fracture Pans and Bedpans: Useful Tips If the person’s condition allows, raise the head of the bed to promote a more natural elimination position

Elimination Equipment: Urinals A man uses a urinal to urinate when he cannot get out of bed

Elimination Equipment: Urinals 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

Difficulty With Normal Elimination 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 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

Promoting Normal Elimination Kindness, empathy, and a professional attitude can go a long way toward easing the patient’s or resident’s embarrassment

Promoting Normal Elimination 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 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

Obtaining Urine and Stool Specimens 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 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 container? Is the specimen container properly labeled? What is the correct date and time? What storage and delivery method must I use?

Obtaining Urine and Stool Specimens Always remember to wear gloves when assisting with specimen collection and when handling the specimen containerss

Obtaining Urine and Stool Specimens: Urinalysis 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 Specimens: Routine Urinalysis 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: Midstream (“Clean Catch”) Urine Specimen 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 in a sterile specimen cup

Obtaining Urine Specimens: Testing A type of routine urine testing involves dipping chemically treated paper strips into a urine sample 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

Obtaining Stool Specimens 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 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.

Urinary Elimination

Urinary Elimination: Urinary System 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: Expressions 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: Color and Odor 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 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: Hematuria 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

Factors Affecting Urinary Elimination 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

Urination: Frequency and Nocturia 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: Dysuria 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)

Measuring Urine Output 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 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: Process 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 Urine output can also be measured by pouring it into a graduate

Measuring Urine Output: Process 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

Urinary Catheterization 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: Situations When a Urinary Catheter Is Used 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: Insertion of Urinary Catheter 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: Types of Urinary Catheters 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

Catheters Straight Indwelling Suprapubic

Urinary Catheterization: Caring for a Person With an Indwelling Urinary Catheter 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 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

Urinary Catheterization: Caring for a Person With an Indwelling Urinary Catheter 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 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: Providing Catheter Care 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 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 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: Emptying Urine Drainage Bags 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: Preparing for Removal of an Indwelling Catheter 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 Incontinence 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 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: Managing Urinary Incontinence 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 - Incontinence Pads and Briefs 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 - Condom Catheters 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 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 - Bladder Training 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

Bowel Elimination

Bowel Elimination: Digestive System The digestive tract consists of the mouth, esophagus, stomach, small intestine, large intestine, rectum, and anus

Bowel Elimination: Digestive System 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 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 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: Color and Odor 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

Factors Affecting Bowel Elimination 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

Problems With Bowel Elimination 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: Diarrhea 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 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: Constipation 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 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 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 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: Fecal Impaction 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 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 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 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: Flatulence 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: Fecal Incontinence 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 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 - Bowel Training 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

Enemas 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: Types of Enemas Types of enemas used in the health care setting include Cleansing enemas Oil retention enemas Commercial enemas

Enemas: Cleansing Enemas 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: Oil Retention Enemas 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: Commercial Enemas 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: Administering Enemas 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 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 An enema is given with the person on her left side in Sims’ position (or Lateral) 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 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

Rectal Suppositories 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

Tell the Nurse Urine is cloudy or contain particles, has abnormal color, or abnormal odor Patient c/o difficulty or pain when passing urine Patient c/o frequency, urgency, or both Patient needs to use bathroom more frequently than usual during the night Patient is having incontinence accidents or more frequent incontinence accidents

Tell the Nurse- When caring for catheterized patient Changes in color, clarity, or odor Failure of urine to flow freely through the tubing c/o pain and discomfort from catheter Redness, swelling or discharge from catheter site Leaking around catheter insertion site

Tell the Nurse Patient has diarrhea or constipation Blood or mucus in the stool Stool is black or green Foul-smelling stool Painful defecation Bleeding at defecation Swollen abdomen or c/o of and pain Liquid feces “seeping” from the anus Excessive flatus or gas

Stoma

Stoma Care Regardless of the type of appliance used, certain principles remain the same regarding the client care Points to remember include: Keeping the skin around the stoma clean and dry to minimize irritation Attending to the client’s privacy and modesty Protecting the client and the client’s bed from fecal matter The wearing of proper personal protection equipment Proper disposal of fecal waster and used equipment Proper cleansing and drying of the stoma area Effective application of the appliance Appropriate documentation of the procedure

End of Presentation