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oExplain 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.oGiving 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
oA 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 thefollowing:Assessing the normal elimination pattern and recording times when a patient is incontinentIncorporating principles of gerontological nursing when providing bowel retraining programs for an older adult. Examples for an older adult include:oOlder age is a risk factor for having constipation.oIncrease fiber in diet with whole grains, legumes, fruits, and vegetables.oA 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.oIf holding a drinking cup is a problem, consider using a lighter plastic cup and filling half full, refilling frequently.oEncourage regular exercise within the limitations imposed by other conditions.oPatients need to feel at ease during elimination. Lack of privacy leads a patient to ignore the urge to defecate.oReview all medications with a patient's health care providerto substitute medications that are less likely to cause constipation whenever possible.oBehavioral 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 measuresOffering a hot drink (hot tea) or fruit juice (prune juice) (or whatever fluids normally stimulate peristalsis for the patient) before the defecation timeHelping the patient to the toilet at the designated timeProviding 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 emptyingAn unhurried environment and a nonjudgmental caregiverMaintaining normal exercise within the patient's physical ability