Continence Care Part 5: Management of Bowel Dysfunction
Presented by Christine Cave
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After completing a comprehensive assessment of a patient’s bowel function and capturing at least 3 to 7 days of bowel patterns, the rehabilitation nurse can initiate interventions to address the predominant symptom of either constipation or loose stool with or without fecal incontinence. This course will describe the various presentations of bowel dysfunction as it relates to underlying gastrointestinal, musculoskeletal or neurological deficits. Evidence based nursing care recommendations that are the least invasive and least expensive will be discussed. Pharmacologic treatment will be presented and the use of these interventions as they impact the functional independence measure. The symptoms of neurogenic bowel, constipation and loose stool (with or without diarrhea/fecal incontinence) will be presented in association to various underlying pathologies and options for management will be presented. Prevention strategies that avoid constipation and diarrhea through natural and behavioral interventions will be presented, with emphasis on the rehabilitation nurse’s role to education patients and their caregivers.
Meet your instructor
Christine Cave
Christine Cave is an advocate for the profession of nursing and the science of caring for rehabilitation patients across post-acute settings. Now in pursuit of an advanced degree as a doctorate prepared, family nurse practitioner at the University of San Francisco. Her specialty areas include bowel and bladder management and…
Chapters & learning objectives
1. Introduction to Bowel Dysfunction and Symptom Recognition
This chapter expands on the final section of the previous assessment of bowel module. Evidence based definitions (using the ROME IV criteria) will be introduced for constipation, diarrhea and fecal incontinence. The various underlying causes of these will be discussed. A more detailed description of the neurogastrointestinal functions that drive digestion and defecation will be described.
2. Check for/Resolve Fecal Impaction
This brief chapter addresses the proper procedure for identifying a fecal impact. The procedure to manually clear the rectum will be introduced using graphics and animation. Disimpaction care will be described. Prevention of recurrence will be emphasized.
3. Stabilize Dietary Routines
This brief chapter emphasizes the need for proper dietary intake to optimize healthy digestion and defecation. Basic interventions here include optimizing fiber intake, maintaining a consistent daily meal schedule and avoiding constipating foods.
4. No Bowel Movement in 3 Days
This chapter introduces the underlying causes of constipation and the various presentations (obstructed constipation, chronic constipation including normal transit and slow-transit forms) that may occur for the rehabilitation patient. Management techniques will be introduced with emphasis on natural remedies that can improve stool consistencies (fiber, fluids, prune juice, mobility, abdominal massage). The proper selection of laxatives will then be discussed.
5. Diarrhea: Definition and Classifications
This chapter addresses the various etiologies of diarrhea by appearance of output (water, bloody, mucous/fatty/foamy) and how the nurse can conclude underlying cause. A description of chronic diarrhea will also be presented with varying underlying etiologies as well: Crohn’s Disease, Diverticulitis, Irritable Bowel Syndrome, Ulcerative Colitis, Neoplasia (Colon Cancer), Radiation colitis. Management recommendations are introduced.
6. Fecal Urgency and Fecal Incontinence
This chapter addresses two aspects of fecal incontinence: fecal urgency (with sensation) and passive fecal incontinence (no sensation). Both may be related to neurogenic bowel, and clinical features with management recommendations will be explained. Emphasis is placed on achieving outcomes that promote controlled stooling, establishing a once or twice daily bowel program, optimizing dietary fiber, and promoting good skin care.
7. Neurogenic Bowel Dysfunction
This chapter introduces neurogenic bowel and clarifies lower motor neuron and upper motor neuron symptoms. Specific interventions for each are introduced using the least invasive and least expensive approach first.
More courses in this series
Continence Care Part 1: Introduction for Practice Improvement
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Continence Care Part 2: Evidence Based Bladder Assessment
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Continence Care Part 3: Evidence Based Bowel Assessment
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Continence Care Part 4: Management of Urinary Dysfunction
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Continence Care Part 5: Management of Bowel Dysfunction
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