NATCEP Day 22

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NATCEP Day 22

  1. 1. B OWEL AND B LADDER T RAINING P ROGRAM
  2. 2. O BJECTIVES  List the goals of a bowel and/or bladder training program  Discuss the preparation factors for establishing a bowel/bladder training program  Identify the steps involved in implementing a bowel and/or bladder training program for a person
  3. 3. G OALS OF A BOWEL AND / OR BLADDER TRAINING PROGRAM  Establish a regular pattern of elimination  Decrease number of times a resident is incontinent  Increase resident’s self-esteem by gaining control of elimination  Decrease range of other problems (such as skin breakdown from incontinence  Preserve the integrity and function of the elimination systems
  4. 4. P REPARATION FACTORS E STABLISHING B OWEL AND / OR B LADDER T RAINING  Past elimination patterns are reviewed, as well as the entire medical history  Routine for elimination is established by the nurse and placed into plan of care. All staff must then carry out the plan
  5. 5. S TEPS : B OWEL T RAINING  High-Fiber diet  Daily laxative may be ordered by the physician  Scheduled elimination: place resident on a toilet or commode at regular, scheduled times  Exercise!  Positive reinforcement  Hydration: 2000 cc daily unless stated otherwise on plan of care  Recorded output
  6. 6. S TEPS : B LADDER T RAINING  Supply adequate hydration  Schedule voiding according to plan of care  Toilet or commode instead of bedpan  Promote relaxation and provide privacy during voiding  Use voiding triggering techniques if needed  Record intake and output  Give positive reinforcement
  7. 7. B OWEL E LIMINATION
  8. 8. O BJECTIVES  Describe characteristics of normal and abnormal elimination  Discuss the effects of aging on the lower intestinal tract  Identify the signs that may indicate constipation  List the measures to help alleviate constipation  Discuss the STNA role in helping to prevent impaction  Describe and demonstrate the care of the person incontinent of feces
  9. 9. S TRUCTURE
  10. 10. F UNCTION  Remove solid waste from the body  Terms used for bowel elimination:  Stool  Feces  Bowel Movement (BM)
  11. 11. N ORMAL S TOOL  Brown  Formed  Not necessarily each day
  12. 12. A BNORMAL S TOOL  Containing blood, mucous or undigested food  Tarry (black and sticky)  Gray  Liquid  Very dry and hard  No movement for 4 or 5 days
  13. 13. E FFECTS OF  GI tract slows down  Loss of control  Incomplete emptying of rectum  Increased concern regarding bowel movements  Increased risk for intestinal disorders A GING
  14. 14. S IGNS  No record of recent BM  Abdominal distension, flatus  Abdominal discomfort  Agitation and/or irritability OF C ONSTIPATION
  15. 15. M ETHODS TO P REVENT OR R ELIEVE C ONSTIPATION  Increased fluids  Diet with bulk and fiber  Exercise  Prompt response to natural urge
  16. 16. F ECAL I MPACTION  Hard stool in the lower bowel usually found on exam with the finger (digital exam)  FYI: Person can have a fecal impaction and have daily bowel movements
  17. 17. S YMPTOMS  No normal stool  Liquid stool seeping from the anus as small amounts of fluid are able to go around the impacted mass  Constant feeling of need to have a BM  Rectal pain, abdominal discomfort and nausea
  18. 18. C AUSES  Decreased muscle tone or nerve block to the lower bowel  Inadequate activity  Inadequate fluid intake  Insufficient bulk in the diet  Uncorrected constipation
  19. 19. R OLE  OF THE Observe   Consistency: firm. formed, liquid, hard?   Note amount Frequency Report  Changes in pattern  Person constipated suddenly develops diarrhea STNA
  20. 20. C ARE OF THE I NCONTINENT  Skin care  Assist with toileting as needed  Answer call light promptly

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