Faecal incontinence – how to reduce this occurring in - Careinfo.orgкод для вставки
Faecal incontinence вЂ“ how to reduce this occurring in care home residents Bose Adegbola & Bernadette Donnelly, Older PeopleвЂ™s Specialist Nurses, Care Homes Support Team Outline пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ Definition Causes Staff skills Assessment Management Good Practice tips Faecal incontinence пЃ¬ пЃ¬ пЃ¬ Faecal incontinence is defined as involuntary loss of faeces including staining or smearing. The prevalence rises in older age groups, particularly in advanced old age. Higher rate of faecal incontinence in institutions than in general population. Impact of faecal incontinence пЃ¬ пЃ¬ пЃ¬ Distressing and socially isolating Increases risk to skin integrity Time consuming for carers and costly to manage Causes of faecal incontinence пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ Overflow due to faecal impaction Loose stools Ano-sphincter weakness Neurological disease Functional Functional incontinence What skills do care home staff need to reduce the incidence of faecal incontinence пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ Awareness Knowledge Familiarity with assessment tools, Bristol stool chart Risk Assessment Record keeping Positive attitude Onward referral. Assessment of faecal incontinence пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ Medical and obstetric history General examination,abdominal palpation, possible stool specimen Anorectal examination Cognitive Assessment Identify normal bowel habit Assessment of diet and fluid intake Assessment of mobility and dexterity Life style Medication review Initial Management of Faecal Incontinence пЃ¬ пЃ¬ пЃ¬ пЃ¬ Treat Faecal loading Treat causes of diarrhoea Look out for warning signs for colorectal cancer Identify rectal prolapse or third degree haemorrhoids Definition of Constipation пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ Two or fewer bowel movements per week Or Two or more of the following symptoms Straining on one in four occasions Hard stools on one in four occasions Feeling of incomplete evacuation on one in four occasions Contributing factors associated with constipation пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ Inadequate fluid intake Lack of exercise and/or immobility Insufficient dietary fibre Toileting facilities Polypharmacy Some medical conditions MONITORING OF BOWEL ACTIONS пЃ¬ пЃ¬ пЃ¬ Bowel activity should be documented at the end of each nursing shift. Systematic monitoring is required using a chart Tools such as the Bristol stools chart can aid monitoring of bowel actions. Bristol stool chart Types 1 and 2 indicate constipation, commence on laxatives Types 3 and 4 are the easiest to pass, maintain laxative dose Type 5 slightly too soft, decrease laxative dose Type 6 too soft, decrease laxative dose Type 7 too soft, stop taking laxatives for a day or so Bowel chart Date Time Stool type Did you reach the toilet on time? Did you mark your underwear or pad? Any other comments Long Term Management of Faecal Incontinence пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ Monitoring and care planning Continued management of diarrhoea and constipation Individualised toileting routine Skin care Psychological and Emotional Support Provision of continence product if necessary 6 monthly review of symptoms Possible Specialist referral Scenario пЃ¬ пЃ¬ пЃ¬ пЃ¬ Mrs M has history of long term constipation and urinary incontinence as well as occasional faecal incontinence. She has other medical conditions such as atrial fibrillation, neoplasm of lung, reduced mobility and poor hearing She is able to mobilise with Zimmer frame to the toilet but needs assistance of one staff She has episodes of urinary and faecal incontinence while mobilising to the toilet Problems пЃ¬ пЃ¬ пЃ¬ пЃ¬ Staff not responding quickly to call bell Lack of routine toileting Lack of record of bowel action No care plan for constipation Action plan пЃ¬ пЃ¬ пЃ¬ пЃ¬ Staff educated on need for timely response to call bell and assisting with toileting Routine toileting regime Care plan for constipation and occasional faecal incontinence Review of laxatives by the GP Outcome пЃ¬ пЃ¬ Reduction in incidence of faecal incontinence (once in 5 weeks) Daily/alternate bowel actions, stool type 4 or 5 Good practice tips пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ пЃ¬ Focus on the individual вЂ“ what is normal for them? Plan toilet visits according to each individuals needs Remember about Signage Look for signs of full bowel вЂ“ fidgeting, aggression, discomfort Use mechanisms such as the gastro-colic reflex to increase success with bowel continence Foot stool Do not be tempted to put pads on those that do not have a problem!! Conclusion Continence promotion is enabling and supporting people in your care to keep dry and clean. Staff should aim to prevent or reduce incontinence wherever and whenever possible.