O explain the procedure including the position to

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o Explain the procedure, including the position to assume, precautions to take to avoid discomfort, and length of time necessary to retain the solution before defecation. If a patient needs to take the enema at home, explain the procedure to a family member. o Giving an enema to a patient who is unable to contract the external sphincter poses difficulties. Give the enema with the patient positioned on the bedpan. Giving the enema with a patient sitting on the toilet is unsafe because the position of the rectal tubing could injure the rectal wall. Skill 47-1 on pp. 1170–1173 outlines the steps for an enema administration. Bowel training program
o A patient with chronic constipation or fecal incontinence secondary to cognitive impairment may benefit from bowel training, also called habit training. The training program involves setting up a daily routine. By attempting to defecate at the same time each day and using measures that promote defecation, a patient may establish a normal defecation pattern. The program requires time, patience, and consistency. A patient with cognitive impairment needs to have a caregiver able to devote the time to the training program. A successful program includes the following: Assessing the normal elimination pattern and recording times when a patient is incontinent Incorporating principles of gerontological nursing when providing bowel retraining programs for an older adult. Examples for an older adult include: o Older age is a risk factor for having constipation. o Increase fiber in diet with whole grains, legumes, fruits, and vegetables. o A minimum of 1500 mL of fluid per day reduces the risk of constipation, with increased fluid needs during summer months and for those on diuretics with stable cardiovascular status. o If holding a drinking cup is a problem, consider using a lighter plastic cup and filling half full, refilling frequently. o Encourage regular exercise within the limitations imposed by other conditions. o Patients need to feel at ease during elimination. Lack of privacy leads a patient to ignore the urge to defecate. o Review all medications with a patient's health care provider to substitute medications that are less likely to cause constipation whenever possible. o Behavioral interventions such as timed toileting helps establish a scheduled time for bowel elimination. Try to maintain the same schedule each day for toileting. Choosing a time based on the patient's pattern to initiate defecation- control measures Offering a hot drink (hot tea) or fruit juice (prune juice) (or whatever fluids normally stimulate peristalsis for the patient) before the defecation time Helping the patient to the toilet at the designated time Providing privacy
Instructing the patient to lean forward at the hips while sitting on the toilet, apply manual pressure with the hands over the abdomen, and bear down but not strain to stimulate colon emptying An unhurried environment and a nonjudgmental caregiver Maintaining normal exercise within the patient's physical ability

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