Unit 19
Diarrhea
Diarrhea is semi-solid, liquid, or watery feces often expelled with force with abdominal cramping. This is a results from digestive waste moving too rapidly through the intestines. It may be caused by food, medication, infection, or other disease. The intestines normally remove needed water from digestive waste as it passes through the large intestine. Muscle movement that propels food and liquid through the GI tract is called peristalsis. Continuing diarrhea can cause dehydration and other health problems. Treatment usually involves medication, an increase in certain fluids and a change of diet.
CNA's responsibilities:
Understand elimination goals that are part of care plan.
Respond promptly to resident’s request for assistance.
Cleanse skin well after diarrhea stools; apply protective cream if ordered.
Encourage increased fluid intake.
Document bowel movements, whether normal, diarrhea, or constipation. Document amount.
Observations
Notify nurse promptly of any potential problem:
Observe resident’s defecation. Normal stool (feces) is soft-formed, brown-colored. Report
color, consistency, and amount. Save for nurse if feces appear other than normal.Observe for signs of dehydration, such as concentrated urine and dry mouth.
Constipation
Constipation is the inability to eliminate stool (have a bowel movement) or the infrequent, difficult, and often painful elimination of a hard, dry stool. Constipation occurs when feces moves too slowly through the intestine. This can result from decreased fluid intake, poor diet, inactivity, medications,, aging, disease, or ignoring the urge to eliminate. Signs of constipation include abdominal swelling, gas, irritability, and a record of no recent bowel movement.
Treatment often includes increasing fiber and fluid intake, increasing activity level, and possibly medication. Accurate documentation of bowel movements is important. An enema or rectal suppository may be ordered to help. An enema is a specific amount of water, with or without an additive, that is introduced into the colon to eliminate stool. A rectal suppository is a medication given rectally to cause a bowel movement.
CNA's responsibilities:
The CNA has a critical role in identifying and preventing constipation.
Understand elimination goals and approaches that are part of care plan.
Respond promptly to resident’s request for assistance. Peristalsis stimulated by eating can
produce the urge to defecate.Assist the resident to a comfortable position for defecating, seated on toilet or commode if
possible.Allow time for resident to defecate.
Encourage activity and exercise.
Encourage resident to choose and eat foods that are high in fiber.
Encourage increased fluid intake.
Place the resident in the Sim's position (left side with right knee pulled up to waist) if asked to by nurse in order to facilitate the administration of an enema.
Assist with administration of enema if procedure is ordered by resident’s physician.
Document bowel movements, whether normal, diarrhea, or constipation.
Enema Administration:
A cleansing enema is the introduction of liquid into lower intestine to soften and stimulate emptying feces. CNA’s role with this type of enema may be to assist the nurse.
Commercially prepared and oil retention enemas is to stimulate emptying feces from lower intestine. Oil retention softens hard feces.
CNA’s role with these enemas may be to assist or administer.
Read package instructions
Preparing equipment
Resident’s position
Depth to insert enema tip
Emptying bottle or bag slowly
Instructions to resident about retaining/expelling enema liquid
Observing and reporting results
Observations
Notify nurse promptly of any potential problem!
Observe resident’s defecation. Report color, consistency, and amount. Save for nurse if feces
appear other than normal. Observe for signs of continuing constipation such as:
Abdominal distention and flatus (gas)
Resident complains of discomfort, restless, or irritable
Fecal Impaction
A fecal impaction is a hard stool that is stuck in the rectum and cannot be expelled. It results from unrelieved constipation. Symptoms include no stool for several days, oozing of liquid stool, cramping, abdominal swelling, and rectal pain. When an impaction occurs, a nurse or doctor will insert one or two gloved fingers into the rectum and break the mass into fragments so that it can be passed. Prevention of fecal impactions includes a high-fiber diet, plenty of fluids, an increase in activity level, and possibly medication. Early assessments of constipation may also help prevent impactions.
CNA's responsibilities:
The CNA has a critical role in identifying and preventing fecal impaction.
Assist with administration of enema if procedure is ordered by resident’s physician.
Understand that manually removing fecal impaction is the responsibility of the nurse.
Impaction is manually removed from the rectum with gloved fingers.
Damage to bowel wall is a hazard of impaction removal.
The CNA can provide support and reassurance to resident during impaction removal.
Observations:
Observe for signs of constipation. The CNA has a critical role in identifying constipation that
could lead to an impaction.Liquid feces seeping from anus. CNA may see smearing on sheets or resident’s
underclothing.Resident may report rectal pressure or pain.
Following treatment of impaction, observe for return of normal bowel function.
Hemorrhoids
Hemorrhoids are enlarged veins in the rectum. They may also be visible outside the anus. Chronic constipation, obesity, pregnancy, chronic diarrhea, overuse of laxatives and enemas, and straining during bowel movements are common causes. Rectal itching, burning, pain, and bleeding during bowel elimination are signs and symptoms of hemorrhoids. Treatment includes increasing fiber and fluid intake. Medications, compresses, and sitz baths are also used for treatment. Surgery may be necessary. When cleaning the anal area the CNA should be careful to avoid causing pain and bleeding.