Constipation is a condition when the evacuation of hard stools less frequently than necessary. The rate for each particular Pacicient individual, since, even in healthy people defecating are not always carried DAILYbut, allowing the chair to a delay of three days.
Constipation can cause secondary symptoms, urinary retention, ileus. When intestinal obstruction feces filled straight, thick and sometimes cecum. As long as the stool are in contact with the mucous membraneintestinal membrane, liquid obsorbiruetsya of them, with the result that they become hard. Bypower of the mass of feces builds up so much that it removed becomes physically impossible. Timezhizhenie upper faeces as a result of bacteria can cause diarrhea and leakage fepotassium, when a patient complains of the appearance of a liquidth chair in small amounts after defecation absence for a long time. This may be accompanied by spasmodic rectal pain, tenesmus (prolonged false urge to defecate), abdominal distention, nausea, vomiting. Inelderly patients with advanced stages disease may develop urinary retention.
A patient who is near death, in need of care, whose purpose – to eliminate symptoms whenrepairing inconvenience or suffering. active lechenie may include changing the diet of the patient’s power: the consumption of large amounts of fluid, fibrous food (fruits, ZeleGOVERNMENTAL vegetables), laxatives.
Laxatives are divided into stimulatingSuitable (increasing motility), stool softeners and osmotic. By means of that increase peristalsis, are:
- bisacodyl (tablets, suppositories or orally);
- sodium picosulphate, Senade.
By means softening the chair include:
- sodium dozukat (norgalaks).
By osmotic agents include:
- lactulose;
- magnesium hydroxide (Milk magnesia);
- magnesium sulfate.
Exercising care of a patient suffering from constipation, you should immediately respond to requests for assistance in the act of defecation:
- to seat the patient on a special boat-chair (or put a vessel under the patient) to posture it was the most convenient and contributed to tension of the abdominal muscles;
- ensure patient privacy and full time
to perform the act of defecation.
If these measures do not help the patient, you must enter into the rectum with bisacodyl candle or put a cleansing enema, or oil, preferably overnight.
The sequence of manipulations suppository when administered to a patient (candle) with the laxative effect:
- Take from the fridge pack with suppozithorium, read the name of the drug carefully;
- help the patient to lie on his left side and bend
knees; - Wear rubber gloves;
- Open the envelope, which is packed suppozitory without removing the suppositories from the shell;
- Ask the patient to relax;
- Dilute patient fingers of his left buttock hand, right hand, type, squeezing suppozitory of the shell into the anus (sheath dolzhna remain in your hand);
- ask the patient to take a comfortable position for him lying;
- remove gloves;
- Monitor the act of defecation.
Staging a cleansing enema.
If the patient is bleeding from pischevariTel’nykh tract, malignancies of the rectum, he recommended that in the absence of chair for three days to deliver a cleansing enema (Fig. 43).
To put a cleansing enema reqDimo:
- cook: mug douches, oilcloth, salfetKu, container with water in an amount of 1.5 – 2 liters,
ship, water thermometer, Vaseline, with ste package-sterile gauze; - pour into a mug Esmarch 1.5 – 2 liters of water (theperature water 20-25 ° C, if the patient suffers atonic constipation – water temperature 12 – 14 ° C,
spasticconstipation Water temperature 37 – 40 ° C); - hang on a nail mug douches or shtaTIV to a height of 1.5 meters;
- enema tip Vaseline grease coated on sterile cloth;
- fill system: open the valve on the system, let the air out, close the valve;
- put the patient on the left side: the legs bent at the knees and slightly reduced to the stomach;
Note: if the patient lay on his side can not be put in the position of an enema patient “lying on his back.”
- placed under the patient’s buttocks oilcloth covered with a large cloth;
- push the buttocks first and second fingers of his left hand;
- right hand to gently introduce the tip into the anus, first toward the navelku (3 – 4 cm), then – parallel to the spine,
to a depth of 8 – 10 cm; - open the valve on the system;
- ask the patient to breathe stomach;
- system to close the valve after the introduction of water into the intestine (all the water can not enter, or assair children in the intestines of the patient);
- carefully remove the tip of the rectum; ask the patient for 10 minutes atlying on the back, holding the water in the intestine;
- ask the patient to lift the pelvis, remove fatsfetku, substitute the vessel;
- disconnect napkin enema tip from the system;
- wash with soap under running water;
- dry cloth;
- reset wipes in a plastic bag.
The procedure for setting an oil enema: - Prepare: pear-shaped rubber balloon
capacity of 200 ml, petrolatum, vegetable or vaseLinova oil (200 ml), a spatula; - heat the oil in a water bath until evapry 37 – 38 ° C;
- type in the pear-shaped balloon preheated oil;
- pear-shaped balloon tip lubricate vaseline;
- Wear rubber gloves;
- sheet under the patient and napkin oilcloth;
- help the patient to lie on the left side and pull up the knees to the abdomen;
- Extend the patient’s buttocks and enter Naconechnik pyriform cylinder toward the navel to 3 – 4 cm and more along the spine to the depth 10 – 12 cm;
- slowly squeeze the pear-shaped balloon and enterthose of its contents into the rectum;
- extract compressed pear-shaped cylinder;
- treat anal region of the sanitary napkin patient port;
- oilcloth and remove the diaper;
- help the patient to take a comfortable position lying down;
- Treat tip pyriform balloon;
- remove gloves;
- explain the patient need to be in, the bed after setting an oil enema in thosechenie 3 – 4 hours to prevent leakage of oil introduced into the intestine.
The patient should be advised this morning NATOschak drinking glass of cold water, adjustVat menu, including foods containing highNiemi fibers (boiled meat and fish, wholemeal grinding, friable porridge: buckwheat, barley, fruits and vegetables in large quantities), there are often small portions.
To prevent re-lock, you should continue taking laxatives.
Diarrhea – increased frequency of defecation or dilution of feces. If this process Institutetensiven, it can be described as fecesNoah incontinence. It is necessary to carry out observationdenie chair for the state: whether there is deviation from the rules (presence of blood, pus, mucus, undigested food); also important to monitor the nutritional Pacicient. Exclude products that contribute to the efforts ofNIJ diarrhea: fresh and dried fruit, nuts, CBEGiez vegetables, beans, lentils, onions, salads with Majorana nezom, spicy dishes with condiments, alcohol, coffee, fresh fruit juice.
care of the patient suffering from diarrhea, has its own characteristics and demands of attending, care, participation and patience. It is important to carefully slaughteringtitsya of patient health:
- put a vessel under the patient;
- wash the anal area with warm water using a soft cloth;
- wipe dry with a soft cloth;
- lubricate the skin in the anal area with a protective cream or Vaseline;
- put on the patient’s soft cotton underwear.
Not recommended:
- use toilet paper after defecation;
- podmyvanii use with soap (it sushield the skin).
When caring for patients is very important to do everything possible so that the patient does not feel fear and anxiety, I felt relaxed and comfortable. It is necessary to regularly monitor the condition of the patient, to persuade him to accept more liquid diet number 4, eat 5 – 6 times a day, to familiarize with an assortment of basic products for its food. The patient re dietmended include: crackers of white bread, soups with fat-free broth, decoctions of cereals (semolina or rice), boiled or steam meat and fish, juice of blueberries, broth hips, tea, jelly, boiled egg (no more than two pieces day), butter (40 – 50 g daily).