Question

PLEASE READ THE CASE STUDY AND ANSWER THE QUESTIONS TO THE BEST OF YOUR ABILITY:

Mr. Jackson is 86 years old. He is admitted to HUMC for congested heart failure. He also has a history of renal failure and goes for dialysis on Mondays, Wednesdays and Friday. He has an AV fistula in his right hand. He also has a history of diabetes, hypertension and depression.

He is allergic to shrimp. He is a nonsmoker. He lives with his wife and two sons.

He is on a renal, low sodium, low cholesterol diet.

He is positive for clostridium difficile.

He suffered a stroke while he was in the hospital and now has left sided weakness.

10. Mr. Jackson is incontinent of stool. As a student nurse what would you do to address his bowel elimination needs?

Answer 1

Patient is having cardiac failure , renal failure and stroke. Patient is having bowel incontinence due to stroke so management of incontinence of stroke patient is important. Major points are

1) Reassuring the patient and gave emotional support to patient and ask about his bowel movements.

2) Use simple cloths to patient because it can be easily removed during bowel incontinence.

3)Use adult diapers if needed, teach care givers about patient condition and help them if they need help.

4)Teach patient small pernial exercises to strengthen the muscles that will help to control bowel movements.

5) Dietary management give fiber containing foods that will help to regulate bowel movements. But keep in mind that foods didn't contain high sodium or cholesterol levels because he is cardiac and renal patient.

6)Gave sufficient amounts of water as per order of physician.

7)Avoid foods that exacerbate diarrhea such as caffeine, artificial sweeteners, cured meat etc.

8)planned defecation timing, that would help to manage bowel movements by gatrocolic reflux(while entering food in to body organ colon release hormone that will help to contract colon)

9)Gave enema if needed beacuse enema will help for complete emptying of bowel and reduce incontinence.

10)pharmacological intervention like bulk forming medications or motility agents that will help for normal bowel movements however, his renal and cardiac condition should be considered.

11) Proper position should be given to patient, provide small excercises practice that will help patient remain active and help in bowel elimination properly.

12) Understand the pathology behind the bowel incontinence in stroke (Nerve damage and muscle weakness from stroke) .That will help to stand emotionally stable and manage effectively.

These are important points keep in mind while caring that patient.