NATCEP Day Twenty-Two

BOWEL AND BLADDER TRAINING PROGRAM

OBJECTIVES

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

GOALS 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

PREPARATION FACTORS ESTABLISHING BOWEL AND/OR

BLADDER TRAINING

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

STEPS: BOWEL TRAINING

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

STEPS: BLADDER TRAINING

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

BOWEL ELIMINATIONNATCEP Day Twenty-Two

OBJECTIVES

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

STRUCTURE

FUNCTION

Remove solid waste from the body

Terms used for bowel elimination:

Stool

Feces

Bowel Movement (BM)

NORMAL STOOL

Brown

Formed

Not necessarily each day

ABNORMAL STOOL

Containing blood, mucous or undigested food

Tarry (black and sticky)

Gray

Liquid

Very dry and hard

No movement for 4 or 5 days

EFFECTS OF AGING

GI tract slows down

Loss of control

Incomplete emptying of rectum

Increased concern regarding bowel movements

Increased risk for intestinal disorders

SIGNS OF CONSTIPATION

No record of recent BM

Abdominal distension, flatus

Abdominal discomfort

Agitation and/or irritability

METHODS TO PREVENT OR RELIEVE CONSTIPATION

Increased fluids

Diet with bulk and fiber

Exercise

Prompt response to natural urge

FECAL IMPACTION

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

SYMPTOMS

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

CAUSES

Decreased muscle tone or nerve block to the lower bowel

Inadequate activity

Inadequate fluid intake

Insufficient bulk in the diet

Uncorrected constipation

ROLE OF THE STNA

Observe

Note amount

Consistency: firm. formed, liquid, hard?

Frequency

Report

Changes in pattern

Person constipated suddenly develops diarrhea

CARE OF THE INCONTINENT

Skin care

Assist with toileting as needed

Answer call light promptly