Nursing Study Guide/Care of Gastrointestinal Needs

Nurse attending oral toilet

Assisting Dependant Client With Meal

Prepare for meal

1. Perform hand hygiene
2. Clear the patients table in their room and ensure patient is pain free/comfortable
3. Position patient upright
4. Confirm the name on food tray that is delivered corresponds to the patents name band
5. Check the patients care plan to ensure patients food is correct (e.g. Patients with dysphasia, depending on the seriousness of the condition they may need thickened water or puree)
6. Take opportunity to change diet if appropriate
7. Always consider if the hot food is too hot or if the cold foods are too cold.
8. The fluids that are sent such as tea or coffee are within the care plan requirements
9. Make sure the size of the meal is appropriate for the size of the patient
10. Gain consent and explain to the patient what your going to do if assistance is required
11. If no assistance is required let them continue to eat
12. Observe how much food is eaten and document observations/concerns
13. Report any dysphasia, nausea or vomiting associated with meals
14. Clean up spills and change linen if required
15. Ask the patient if they would like oral hygiene to be performed

Assisting with feeding

• Perform hand hygiene
• Position patient upright
• Place napkin to protect clothing
• Position food and utensils close to patient on table
• Always encourage any independence if possible
• Never leave the patient through procedure
• Gain consent and explain procedure
• Never rush procedure
• Allow time for chewing and swallowing so the patient doesn't choke
• Offer fluids to the patient during the feeding
• Have supportive conversation so the patient feels comfortable
• If the person is visionally impaired describe meal to them (e.g. temperature, flavour, size)
• If the patient is able to feed themselves but only very slowly, let them because its better than nurses feeding them
• Clean and change linen or clothes if appropriate
• Document observations

Procedure for feeding

• Perform hand hygiene
• Gain consent and explain the procedure
• Patient should sit upright if possible
• Food should be put in front of patient to encourage good posture
• Only collect small amounts of food on appropriate utensil
• When food is on spoon ensure solid foods are towards the front so that's the first part entering the mouth to help swallow
• Ensure the previous mouthful is swallowed before putting more food in their moth or they may choke
• Between mouthfuls encourage coughing to clear throat to prevent choking
• The patient needs to remain upright for roughly half an hour after the meal
• Encourage swallowing
• Once procedure is finished clean linen or clothes if appropriate
• Offer oral hygiene
• Liquids are the most difficult substance for patients with impaired swallow to manage. Always refer to Speech Pathology and Dietician assessment.

Student Nurse Editors Kirsten Jackson, Leon Tye, Zoe Wright

Assist Client With Toileting

Preparation Equipment

• Disposable gloves
• Clean bedpan
• Bedpan cover
• Toilet tissue
• Specimen bag clearly labelled with patient's name, date being collected and patient identification number
• Wash basin
• Wash cloth, towels and soap
• Waterproof absorbent pads
• Clean drawsheet (optional)

Cultural Considerations

• Obtain consent
• Accommodate the need for gender congruent care amongst culture emphasizing different gender roles and female modesty (such as African, Hispanic, Asian, Islamic, Arabi, Hindu, Jewish Orthodox, Amish and Aboriginal cultures)
• Provide for hygiene needs of patients
• Distinct hygiene practices are observed by certain cultures that designate the left hand to perform unclean procedures such as bowel elimination. Wash your hands before touching patient and use your right hand to touch the patient. Use left hand to handle the bedpan and to assist the patient in cleansing after bowel movement.

BOWEL ELIMINATION USING BEDPAN PROCEDURE

N.B: The optimal time to take a patient to the toilet is 10 minutes after a meal

• Assess patient's normal elimination habits, routine patterns, character of stool, effects of certain foods, current medications and normal fluid intake
• Assess patient for mobility
• Assess patient for comfort (i.e., pain and/or irritation)
• Determine if specimen is needed
• Place metal bedpan under warm water to warm it and ensure it is dry afterwards
• Raise rail on opposite side of the bed
• Raise bed horizontally to nurse's height
• Have patient assume supine position
• Raise patient's head to 30-60 degrees
• Remove bed linen out of the way but do not expose patient
• If patient has mobility: Instruct patient how to flex knees and lift hips to place the bedpan underneath them
• Be sure the open rim of bedpan is facing the foot of the bed
• If patient is immobile: Roll them to one side and place bedpan firmly against buttocks and roll back onto the bedpan
• Keep call bell in easy reach of patient
• Discard gloves
• Allow patient privacy but monitor them
• Determine if patient can wipe themselves. If not, the nurse should use several layers of tissues or disposable wipes.
• Dispose of tissue in bedpan
• If patient is mobile: ask them to flex knees and lift buttocks. Slide bedpan out from underneath them
• If patient is immobile: Roll them onto their side, hold bedpan flat and steady
• Place bedpan on beside chair and cover
• Change soiled linens, remove gloves and return patient to comfortable position

CLINICAL SKILLS COMPETENCIES

• Identify indication (constipation, diarrhoea, etc.)
• Assess patient's ability to be independent
• Evidence of therapeutic interaction between nurse and patient (i.e., nurse explains procedure)
• Gathers all necessary equipment
• Displays problem solving (positions patient appropriately and provides privacy)
• Washes hands
• Assists patients to use commode
• Giving a urinal and bedpan
• Provide perineal care
• Disposing of excreta properly
• Cleans, replaces, and disposes of equipment appropriately
• Documents relevant info
• Can link theory to practice

PERINEAL CARE

• Is the cleansing of perineal area for hygiene and comfort
• If left untreated the soiled skin with macerate and skin integrity will be lost. This makes skin more susceptible to infection and discomfort

CONSTIPATION

• Infrequent passage of dry, hard stools which results in painful defecation

PREVENTION

• sufficient dietary fibre, adequate fluid intake, respond to desire to defecate, maintain regular time for defecation, exercise and relaxation helps to prevent, avoid undue anxiety about bowel habits

TREATMENT:

• Laxatives given orally, available over the counter at pharmacy or supermarket. Given to increase bulk, soften or lubricate faeces
• Suppositories inserted into rectum. Solid glycerine capsule that melts inside rectum due to body temperature. Promotes faecal evacuation.
• Panadol administered rectally
• Enemas: similar to a suppository but is fluid in a tube which is also inserted via the rectum. An enema distends the bowel and stimulates peristalsis which is the involuntary constriction and relaxation of the muscles of the intestines which creates wave like movements to push the faeces forwards

SYMPTOMS

• Stomach pain
• Pallor, sweating, changes in pulse rate

IMACTED FAECES

• Large dry mass of faeces in the rectum
• Symptoms include small, frequent bowel actions and treatment includes manual removal

DIARRHAEA

• Dangerous because can cause dehydration and exhaustion in the patient

TREATMENT

• Maintain hydration, hygiene and anti-spasmodic medications
• Workout cause of diarrhoea

Editors Natalie Robinson, Chandrice Orebanwo, Jeff Garrett

Collecting Adult stool Specimen

EQUIPMENT

• Complete Signed Laboratory Request Form
• Biohazard Bag
• Disposable gloves
• CONTAINER WITH COVER & TONGUE BLADE
• client addressograph LABEL FOR CONTAINER
• CLEAN BED PAN OR BEDSIDE
• COMMODE chair

PROCEDURE

• 1. CHECK THE PATIENTS IDENTITY BAND AND EXPLAIN THE PROCEDURE TO THE PATIENT.
• 2. BEFORE COLLECTING STOOL SPECIMEN ASK THE PATIENT TO VOID. TELL PATIENT TO NOT VOID ON THE SPECIMEN.
• 3. CLEAN OUT ALL URINE FROM THE BED PAN OR BEDSIDE COMMODE.
• 4. depending on client mobility, roll client onto the pan, RAISE THE HEAD OF THE BED SO THAT THE PATIENT CAN ASSUME A SQUATTING POSITION ON THE BEDPAN, OR HELP THE PATIENT SIT ON THE BEDSIDE COMMODE.
• 5. PROVIDE PRIVACY UNTIL THE PATIENT HAS PASSED THE STOOL.
• 6. REMOVE THE BEDPAN OR BEDSIDE COMMODE. IF NECESSARY, HELP THE PATIENT CLEAN THE PERINEUM.
• 7. USE TONGUE BLADE TO OBTAIN AND PLACE THE SMALL PORTION OF THE FORMED STOOL IN A CONTAINER. (FOR SOME TESTS YOU

MAY NEED TO COLLECT ENTIRE SPECIMEN)

• 8. CLEAN BED PAN OR BEDSIDE COMMODE
• 9. WASH YOUR HANDS
• 10. LABEL CONTAINER WITH PATIENT'S NAME .
• 11. FILL OUT LABORATORY REQUEST FOR APPROPRIATE TEST
• 12. TAKE SPECIMEN TO THE LABORATORY IMMEDIATELY

Student Nurse Editors: Leneth Cartagina, Danelle Calitz, Bonnie Malycha