Helping patients who have bowel problems
Helping patients who have bowel problems
5-step plan starts with their diet
No one really cares to discuss it — not even the nurses who have patients relying on their help. But at some point, you may have to teach your nurses how to set up a bowel management plan for patients who, either because of their age or disability, have problems with regular bowel movements.
"Most of the diets of the elderly don’t have enough fluids, and that’s how they get impacted," says Mary Ellen Green, RN, case manager with Medical Innovations of Woodbridge, VA. The Houston-based company’s Virginia offices handle only Medicare patients and serve patients from coastal Virginia to the suburbs of Washington, DC.
"They also rely heavily on laxatives, and after a while they don’t work. So the patients just keep taking more and more, and they don’t work," Green adds.
Green suggests nurses assess patients’ bowel movement status by being direct and asking them when the last time they had a bowel movement was. The next question is to ask how many bowel movements they typically have in a week. "Some people don’t go every day," she explains. "But if they go every day, and they haven’t had a bowel movement for a week, then they’re in trouble."
At this point, the nurse might inquire as to what medication the patient is on because sometimes these will cause the patient to either become constipated or have diarrhea.
If a patient’s bowel problems are left untreated, it could result in the fecal material backing up into the intestines, causing stomach swelling, Green explains. "This presents with small watery stools; the water gets around the blockage, but you can’t get the stool out."
When the problem becomes this bad, nurses might try using suppositories and enemas. If those fail to discharge the stool, then surgery might be necessary in extreme cases.
However, Green emphasizes that patients’ bowel problems won’t become that severe if they follow this simple five-step bowel management plan:
• Stress diet, diet, diet.
Have the patients add roughage to their meals such as vegetables and fruits. Also, encourage the patient to drink more fluids, including fruit juices.
Green recommends that nurses talk with patients about their diet and not simply hand them a list of foods to eat. "Lots of people won’t read what you hand them," she says.
"The one thing you will run into with the elderly is that they can’t chew as much, so they’ll stick to stuff that’s soft, and it doesn’t give you the bulk you need in your diet," Green adds.
Likewise, Green says that people with bowel problems should cut down on eating rice, cheese, pasta, and other starchy foods.
• Encourage use of a stool softener.
An over-the-counter stool softener, such as Metamucil, could be taken once a day or as needed to supplement the diet, Green says. The stool softener keeps the fecal material from hardening in the bowels.
"The patient can take it with a glass of water and juice in the morning," she adds.
• Teach that staying active is important.
"Older people sometimes sit around too much," Green says. "Many have underlying conditions of arthritis and osteoporosis, and they don’t move around enough."
Instead, they need to be active, walking each day or participating in gentler exercises, such as tai chi or aerobics for the elderly, Green advises.
• Have them use a suppository if problems persist.
The nurse could notify the physician of the problem at this point. But the patient also could buy a suppository over the counter.
"The main thing you have to instruct patients is that no matter how many suppositories you give them, they will have to maintain adequate hydration and a proper diet," Green says.
Nurses should follow a plan of care for inserting suppositories. First, Green says, wait for the bowels to move, and make sure the patient is cleaned out. Then, roll the patient over, and insert the suppository with a water-based lubricant.
• Make it clear to the patient that this program will have to be followed the rest of his or her life.
"We have one 96-year-old woman patient who gets impacted every year or so," Green says. "We set her up on the bowel management plan, and she follows it for awhile."
But because of her age, she sometimes becomes too tired to stay active, and Green’s agency typically is called to take care of her after a major hospitalization.
Nurses might not be able to convince every patient to follow this plan continually, but Green suggests they show patients how the same steps will improve their other health problems as well.
"Sometimes, if they increase their activity, it’ll be good for their hearts too," she says. "So they’ll start feeling better."
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