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Patients may be embarrassed to talk about it, but bowel problems affect quality of life. Advice on how to help patients, how to broach the subject, and options for addressing the problem Bowel care is of great importance for a patient’s quality of life, yet many people are too embarrassed to discuss the subject. It’s a conversation that arguably needs to be had whatever the clinical setting: £168 million was spent by NHS England on treating constipation in 2018-19, the equivalent of funding 7,304 newly qualified nurses for a year. Nursing Standard. 35, 9, 54-57. doi: 10.7748/ns.35.9.54.s19 Want to read more?Already subscribed? Log inORUnlock full access to RCNi Plus todaySave over 50% on your first 3 monthsYour subscription package includes:
Subscribe RCN student member? Try Nursing Standard StudentAlternatively, you can purchase access to this article for the next seven days. Buy now Or Caring for patients who have or are at risk for elimination problems because of emotional stress (anxiety or depression), physiological changes in the GI tract such as surgical alteration of intestinal structures, inflammatory diseases, prescribed therapy, or disorders impairing defecation is common in the practice of nursing. DiarrheaDiarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration (Gray, 2007). Excess loss of colonic fluid results in serious fluid and electrolyte or acid-base imbalances. Infants and older adults are particularly susceptible to associated complications (see Chapter 41). Because repeated passage of diarrhea stools also exposes the skin of the perineum and buttocks to irritating intestinal contents, meticulous skin care and containment of fecal drainage is necessary to prevent skin breakdown (see Chapter 48). Many conditions cause diarrhea. Antibiotic use via any route of administration alters the normal flora in the GI tract (Vonberg et al., 2008). Patients receiving enteral nutrition are also at risk for diarrhea. Consult a dietitian when diarrhea occurs (Tabloski, 2009). See Chapter 44 for interventions to decrease diarrhea caused by enteral feedings. Food allergies and intolerances increase peristalsis and cause diarrhea. Surgeries or diagnostic testing of the lower GI tract also cause diarrhea. The aim of treatment is to remove precipitating conditions and slow peristalsis. Another common causative agent of diarrhea is Clostridium difficile (C. difficile), in which symptoms range from mild diarrhea to severe colitis. C. difficile infection is acquired in one of two ways: by factors that cause an overgrowth of C. difficile, and by contact with the C. difficile organism. A new strain of C. difficile has been identified that is more virulent with more toxic effects (Grossman, 2010). Antibiotics (cephalosporins, ampicillin, amoxicillin, and clindamycin (Calfee, 2008), chemotherapy, and invasive bowel procedures such as surgery or colonoscopy disrupt normal bowel flora and may cause an overgrowth of C. difficile. Some patients acquire the organism from a health care worker’s hands or direct contact with the environmental surfaces contaminated with it. Only hand hygiene with soap and water is effective to physically remove C. difficile spores from the hands. In addition, evidence supports the use of diluted bleach (1 : 10) as an environmental disinfectant to decrease the incidence of C. difficile (Calfee, 2008; Vonberg, 2008). The most common diagnostic test for the bacteria is the enzyme-linked immunosorbent assay (ELISA) test, which detects C. difficile A and B in the stool. Communicable foodborne pathogens also cause diarrhea. Hand hygiene following the use of the bathroom, before and after preparing foods, and when cleaning and storing fresh produce and meats greatly reduces the risk of foodborne illnesses. When diarrhea is the result of a foodborne virus, the goal usually is to rid the GI system of the pathogen rather than slow peristalsis. When a patient constantly ignores the urge to defecate Which of the following can develop?Ignoring an urge to have a bowel movement can lead to constipation. Some people prefer to have bowel movements at home. But holding in a bowel movement can cause constipation if the delay is too long. Medical conditions.
Which risk factor places patients and residents at the greatest risk for falls?Age. Age is one of the key risk factors for falls. Older people have the highest risk of death or serious injury arising from a fall and the risk increases with age.
Which chronic disease is most likely to affect the thinking and reasoning processes of residents?Dementia is the loss of cognitive functioning — thinking, remembering, and reasoning — to such an extent that it interferes with a person's daily life and activities.
How can the nursing assistant best help a resident who is not accepting a loss?How can the nurse aide best help a client who is not accepting a loss? Encourage the client to talk.
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