Infection Control Worksheet

Bowel Care Worksheet – For Spinal Injured People

Name: ______

Date: ______

Name of Trainer: ______

Name of Company: Clinical Update (NZ) Ltd

Segment 1

Normal bowel function is when the rectum gets full the anal sphincter will relax and release the stools in the bowel

What are the 2 types of bowel dysfunction and where does the spinal cord lesion occur?

1 Reflex Bowel Dysfunction Above T 12

2 Flaccid Bowel Dysfunction Below T12

What is the other name for reflex bowel dysfunction? Upper neurone bowel dysfunction

What happens for a person who has reflex bowel dysfunction? They lose the ability to recognize when the bowel is full

What happens to the anal sphincter? It remains tight

What do they have to rely on to empty the bowel? Defaecation reflext action

What does this type of dysfunction respond to to empty the bowel

1. digtial stimulation

2. Stimulants

What is the other name for flaccid bowel dysfunction? Lower motor neurone bowel dysfunction

In this type of bowel dysfunction the bowel had no tone or strength to contract or expand

In flaccid bowel dysfunction the anal sphincter remains opem

Faeces are likely to remain hard and will require aperients to soften the bowel motion

What is dysreflexia? Syndrome affecting persons with a spinal cord lesion above the midthoracic level

Why does dysreflexia occur? Impaired autonomic nervous system has a massive power surge that is dangerous to the body

What happens to the body when dysreflexia occurs? A whole range of signs and symptoms

What will happen to the skin that may alert you to dydreflexia?

Pale skin below spinal cord lesion and flushed above the cord lesions

What else may happen to the person?

• High blood pressure (hypertension)

• Slow pulse rate (bradycardia)

• Severe headaches

• Convulsions

• Stroke

• Death

Dysreflexia is a medical emergency and you need to dial 111because a person may have a stroke or even die in an attack.

Segment 2

List the 3 reasons why bowel management plan is important

• Regular consistent bowel care is essential for normal life

• Promotes comfort and good health

• Prevents spontaneous unplanned bowel evacuations

Spinal inured people can become very unwell if a bowel management plan is not in place

What are the 2 conditions lack of a bowel management plan can predispose a person to?

· Diverticulitus

· Stretch the bowel

A high fibre diet helps to stimulate the nerve endings in the bowel and trigger bowel movement which will reduce the chance of haemarrhoids, varicouse veins or diverticulitis

Spinal injured people need to drink a lot of water and need to avoid medications that slow the bowel.

Aperients must not be overused

List the 4 methods used to assist bowel evacuation and describe what happens:

1. Manual bowel removal

2. Digital Stimulation Removal

3. Suppositories

4. Enemas

There are two common types of suppositories used. dulcolax stimulates nerve endings in the bowel so it is important when inserting it that it touches the rectal wall and glycerine that draws water into the stool to soften it so it needs to be inserted into the faeces

Mini enemas soften, lubricate and draws water into the stool to stimulate evacuation

When administering aperients it is important that you

• Always give on an empty stomach

• Give with a full glass of water

• Preferably at night

• Use only what is prescribed

What side should the person lie on when inserting an enema or suppository and why?

On the left side as the descending colon, rectum and anus are on the left side (or some answer that is acceptable to you)

How long do you leave a suppository or enema in for the bowel to work? 20 mins

When performing digital stimulation, what must you make sure your gloved finger does? Touches he inside of he rectal wall

How long do you stimulate the bowel for? 10-20 secs

How often do you repeat it? Every 5-10 mins

What do you do after you have done the digital removal of faeces? Check the bowel I empty and if not remove what is left

List 5 things that can influence bowel evacuation (any 5 of these)

• Past history

• Over use of aperients & stimulants

• Timing

• Privacy & Comfort

• Positioning

• Fluid

• Food

• Medication

• Illness

• Activity Level

• Weather

• External Massage

• Bearing down (avoid for people with heart problems)

List 4 things to avoid? (any 4 of these)

• Regular use of stimulant laxatives

• Full Size enemas

• Skipping or changing bowel regime times

• Rushing

• More than 4 digital stimulations at a time

• Long finger nails

List 4 things that could help? (any 4 of these)

• Hot drink prior to bowel care and something to eat

• Fibre in the diet

• Gravity

• Use mild laxatives first

• Keep to the bowel regime

• Discuss with the person

List 5 important things to report about a client’s bowels(any 5 of these)

• Constipation

• Diarrhoea

• Frequent accidents

• Mucus accidents

• No bowel movement for 3 days

• Rectal bleeding

• Excessive gas

• Bowel programme takes long time to complete

• Autonomic dysreflexia during bowel programme

Bowel evacuation is the method of choice for spinal injured people

When is it used for older frail people? As a last resort

What are the two important factors in maintaining good bowel function?

1. Aperients

2. Diet

Who must train you? Registered Nurse

What must you record and report? Any changes to bowel habits or complications

What must you do if you are in doubt? Call for help