Clear the patients table in their room and ensure patient is pain free/comfortable
Position patient upright
Confirm the name on food tray that is delivered corresponds to the patents name band
Check the patients care plan to ensure patients food is correct (e.g. Patients with dysphasia, depending on the seriousness of the condition they may need thickened water or puree)
Take opportunity to change diet if appropriate
Always consider if the hot food is too hot or if the cold foods are too cold.
The fluids that are sent such as tea or coffee are within the care plan requirements
Make sure the size of the meal is appropriate for the size of the patient
Gain consent and explain to the patient what your going to do if assistance is required
If no assistance is required let them continue to eat
Observe how much food is eaten and document observations/concerns
Report any dysphasia, nausea or vomiting associated with meals
Clean up spills and change linen if required
Ask the patient if they would like oral hygiene to be performed
Assisting with feeding
Perform hand hygiene
Position patient upright
Place napkin to protect clothing
Position food and utensils close to patient on table
Always encourage any independence if possible
Never leave the patient through procedure
Gain consent and explain procedure
Never rush procedure
Allow time for chewing and swallowing so the patient doesn't choke
Offer fluids to the patient during the feeding
Have supportive conversation so the patient feels comfortable
If the person is visionally impaired describe meal to them (e.g. temperature, flavour, size)
If the patient is able to feed themselves but only very slowly, let them because its better than nurses feeding them
Clean and change linen or clothes if appropriate
Document observations
Procedure for feeding
Perform hand hygiene
Gain consent and explain the procedure
Patient should sit upright if possible
Food should be put in front of patient to encourage good posture
Only collect small amounts of food on appropriate utensil
When food is on spoon ensure solid foods are towards the front so that's the first part entering the mouth to help swallow
Ensure the previous mouthful is swallowed before putting more food in their moth or they may choke
Between mouthfuls encourage coughing to clear throat to prevent choking
The patient needs to remain upright for roughly half an hour after the meal
Encourage swallowing
Once procedure is finished clean linen or clothes if appropriate
Offer oral hygiene
Liquids are the most difficult substance for patients with impaired swallow to manage. Always refer to Speech Pathology and Dietician assessment.
Student Nurse Editors Kirsten Jackson, Leon Tye, Zoe Wright
Specimen bag clearly labelled with patient's name, date being collected and patient identification number
Wash basin
Wash cloth, towels and soap
Waterproof absorbent pads
Clean drawsheet (optional)
Cultural Considerations
Obtain consent
Accommodate the need for gender congruent care amongst culture emphasizing different gender roles and female modesty (such as African, Hispanic, Asian, Islamic, Arabi, Hindu, Jewish Orthodox, Amish and Aboriginal cultures)
Provide for hygiene needs of patients
Distinct hygiene practices are observed by certain cultures that designate the left hand to perform unclean procedures such as bowel elimination. Wash your hands before touching patient and use your right hand to touch the patient. Use left hand to handle the bedpan and to assist the patient in cleansing after bowel movement.
BOWEL ELIMINATION USING BEDPAN PROCEDURE
N.B: The optimal time to take a patient to the toilet is 10 minutes after a meal
Assess patient's normal elimination habits, routine patterns, character of stool, effects of certain foods, current medications and normal fluid intake
Assess patient for mobility
Assess patient for comfort (i.e., pain and/or irritation)
Determine if specimen is needed
Place metal bedpan under warm water to warm it and ensure it is dry afterwards
Raise rail on opposite side of the bed
Raise bed horizontally to nurse's height
Have patient assume supine position
Raise patient's head to 30-60 degrees
Remove bed linen out of the way but do not expose patient
If patient has mobility: Instruct patient how to flex knees and lift hips to place the bedpan underneath them
Be sure the open rim of bedpan is facing the foot of the bed
If patient is immobile: Roll them to one side and place bedpan firmly against buttocks and roll back onto the bedpan
Keep call bell in easy reach of patient
Discard gloves
Allow patient privacy but monitor them
Determine if patient can wipe themselves. If not, the nurse should use several layers of tissues or disposable wipes.
Dispose of tissue in bedpan
If patient is mobile: ask them to flex knees and lift buttocks. Slide bedpan out from underneath them
If patient is immobile: Roll them onto their side, hold bedpan flat and steady
Place bedpan on beside chair and cover
Change soiled linens, remove gloves and return patient to comfortable position
Evidence of therapeutic interaction between nurse and patient (i.e., nurse explains procedure)
Gathers all necessary equipment
Displays problem solving (positions patient appropriately and provides privacy)
Washes hands
Assists patients to use commode
Giving a urinal and bedpan
Provide perineal care
Disposing of excreta properly
Cleans, replaces, and disposes of equipment appropriately
Documents relevant info
Can link theory to practice
PERINEAL CARE
Is the cleansing of perineal area for hygiene and comfort
If left untreated the soiled skin with macerate and skin integrity will be lost. This makes skin more susceptible to infection and discomfort
CONSTIPATION
Infrequent passage of dry, hard stools which results in painful defecation
PREVENTION
sufficient dietary fibre, adequate fluid intake, respond to desire to defecate, maintain regular time for defecation, exercise and relaxation helps to prevent, avoid undue anxiety about bowel habits
TREATMENT:
Laxatives given orally, available over the counter at pharmacy or supermarket. Given to increase bulk, soften or lubricate faeces
Suppositories inserted into rectum. Solid glycerine capsule that melts inside rectum due to body temperature. Promotes faecal evacuation.
Panadol administered rectally
Enemas: similar to a suppository but is fluid in a tube which is also inserted via the rectum. An enema distends the bowel and stimulates peristalsis which is the involuntary constriction and relaxation of the muscles of the intestines which creates wave like movements to push the faeces forwards
SYMPTOMS
Stomach pain
Pallor, sweating, changes in pulse rate
IMACTED FAECES
Large dry mass of faeces in the rectum
Symptoms include small, frequent bowel actions and treatment includes manual removal
DIARRHAEA
Dangerous because can cause dehydration and exhaustion in the patient
TREATMENT
Maintain hydration, hygiene and anti-spasmodic medications
Workout cause of diarrhoea
Editors Natalie Robinson, Chandrice Orebanwo, Jeff Garrett
1. CHECK THE PATIENTS IDENTITY BAND AND EXPLAIN THE PROCEDURE TO THE PATIENT.
2. BEFORE COLLECTING STOOL SPECIMEN ASK THE PATIENT TO VOID. TELL PATIENT TO NOT VOID ON THE SPECIMEN.
3. CLEAN OUT ALL URINE FROM THE BED PAN OR BEDSIDE COMMODE.
4. depending on client mobility, roll client onto the pan, RAISE THE HEAD OF THE BED SO THAT THE PATIENT CAN ASSUME A SQUATTING POSITION ON THE BEDPAN, OR HELP THE PATIENT SIT ON THE BEDSIDE COMMODE.
5. PROVIDE PRIVACY UNTIL THE PATIENT HAS PASSED THE STOOL.
6. REMOVE THE BEDPAN OR BEDSIDE COMMODE. IF NECESSARY, HELP THE PATIENT CLEAN THE PERINEUM.
7. USE TONGUE BLADE TO OBTAIN AND PLACE THE SMALL PORTION OF THE FORMED STOOL IN A CONTAINER. (FOR SOME TESTS YOU
MAY NEED TO COLLECT ENTIRE SPECIMEN)
8. CLEAN BED PAN OR BEDSIDE COMMODE
9. WASH YOUR HANDS
10. LABEL CONTAINER WITH PATIENT'S NAME .
11. FILL OUT LABORATORY REQUEST FOR APPROPRIATE TEST