Nursing Practices

Nursing Practices

Introduction

From the complaints received from Mabel Hetherington and the other patient, there is a common symptom that relates the two conditions. Speculations arise in the two cases about the possible disease or condition which affects the two patients. One of the speculations is that of Irritable Bowel Syndrome, Bowel Cancer, Crohn’s disease and Faecal or Bowel incontinence. Even in the inherent consideration of these symptoms prior to diagnosis, the highest probability is that these aged patients are suffering from faecal incontinence. This therefore becomes the core issue of treatment and prevention in this study. It is almost obvious because this condition is common among the adult patients of the age bracket involved. There appears to be an outbreak of the disease, prompting the dire need of a quick response to prevent the spread of the disease among the patients and clinical staff.

Evidence from research to support your clinical decisions and care implementation

From the researches on Faecal incontinence by Hara et al (2005), also referred to as bowel or anal incontinence the condition requires special attention including regular attendance to the environment around the entire clinical institution and its environs. The researches by Manheimer et al (2012) reveal intriguing and fascinating details about its causes and the consequences of improper treatment. Since it leads to inability to control defecation, the aged patient’s involuntary release their bowel contents. There is a risk of imbalance between the fluids and the electrolyte in the body. Since Faecal incontinence is a symptom in itself but not a diagnosis, patients who do not exhibit all the symptoms can proceed to the step of diagnosis for exclusive verification of its presence (Paul.et al, 2009). The bowel contents of the patients can be confirmed to be including mucus, diarrhea and flatus. The causes of faecal are largely attributed to poor hygiene, constipation and diarrhea. Studies by Jafri et al (2007) have shown that incontinence is rarely caused by a single factor. It is generally ascertained that it requires more than one factor to facilitate its emergence. The clinical decisions in this case are to practice preventive mechanisms to minimize the probability of it occurring (Shah, Chokhavatia & Rose, 2012). The disease commonly is caused by the permanent effects of damage from the birth of an individual. Others in their old age suddenly realize that their sphincter muscles have become weak due to old age physiological challenges and hence cannot hold the contents of their bowels (Rodrigues & Motta, 2012). Still, this condition has also proved to be as a result of other related issues such as irritable bowel syndrome, food intolerance, Crohn’s condition and ulcerative colitis. It therefore means that the condition is majorly irreversible and as such, the patients require constant assistance to live with an almost permanent condition.

Describe how this type of infection can be spread within healthcare facilities and outline the possible risks to residents and / or nurses

From the research about the causes of the disease, it is evident that the disease is not communicable. It does not pose the risk of spreading to other resident patients or even the nurses themselves directly, but through a sequence of other infections (Romano et al, 2007). However, nurses and the residents of the clinical environment have the responsibility of ensuring high standards of hygiene since the contents that the patients release has the enormous potential of causing other equally disastrous conditions. These include diarrhea, dysentery, cholera, typhoid and amoebic disease. The same diseases weaken the sphincter muscles and end up causing Faecal Incontinent. As long as the patients are present within the healthcare environment, the spread of the bowel contents is inevitable (Printz, 2010). One cannot predict when and where the patients will release the filth. Given the nature of the contents, it is a great concern; how the attendants react to the wastes. The possibility of picking such wastes without proper hand glove protection is so high. Worse still, in areas prone to water shortages, the environmental hygiene is at stake, owing to the chances of contamination of surfaces and high mobility rates. It can thus spread the contents of such waste products to both nurses and other patients. The more the number of patients in the health care centre the higher the risks of infections. Patients’ vulnerability is equally high since the effect of faecal incontinent exposes them to stigma and lack of self esteem. Patients ought to live with the acceptance of their conditions and the willingness to overcome its effects.

Identify best practice for preventing the spread of this infection

In order to prevent the infection, there has to be a critical consideration of how to maintain the highest level of hygiene and cleanliness. Perhaps the most suitable strategy is to provide diapers for adult patients to enable them hold the waste products from spreading uncontrollably. To accommodate the necessity of high mobility, everyone who interacts with the patients must practice the strict rule of hand washing with disinfectant soaps. It is not ethical to discriminate or to stigmatize against such patients. Best practice demands that very patient receive equal treatment (Bliss & Norton, 2010). At the same time to prevent house flies from spreading the contents of the filths. Nurses and other attendants have to disinfect every surface that is exposed. Ultimately, awareness of the disease is critical in preventing the disease since the society has to be proactive enough to participate in its prevention. Through counseling and awareness, nurses can reduce the burdens of their works by simply educating the patients concerning the risks of spreading the disease further to others.

Discuss hygiene maintenance and manual handling risks for both clients and staff

As it emerges in the studies, the chances of the disease spreading are high in dirty environment. The hygiene maintenance standards are very essential for controlling the spread of the disease because there is absolutely no substitute to manual handling of the patients. The risks are approximately 97 percent sure to occur and that translates into a perpetual chain of spreading the contamination and infection. Staffs that do not use hand protection such as hand gloves are at great risks (Barrett et al, 2008). Cleaning of the patient clothes without sufficient disinfection and hot water is equally as disastrous as having direct contact with the bowl wastes them. It may be difficult for the patients to disclose to the attendants about their conditions due to fear of stigmatization. Consequently, the risk of patients attempting to help themselves end up spreading contamination to more surfaces and this worsens the situation.

Outline nutritional management including monitoring and maintaining fluid and electrolyte balance for Mrs Hetherington during your shift

Even though medication is possible for faecal incontinent, it ought to be supplemented by massive consumption of fluids such as warm water and fruit juice and regulated contents of salt. The more the intake of salt and juices, the more the amount of water the patients have to consume is to ensure the balance between the water and the electrolytes (salt solutions). As water intake monitors and mitigates the risks of dehydration, electrolytes serve the purpose of maintaining sensitivity and response of the body to external forces. During the visit to Mrs Hetherington, it is vital to confirm that he consumes the recommended measures and that the environment is hygienic to fight the spread of Faecal incontinent. The medication has to be favorable for her condition. In this perspective, it is important to change medication whenever they appear to cause more vomiting and diarrhea. The dietary balance assists in managing the risks of constipating and diarrhea. For obvious reasons, it is necessary for Mrs Hetherington to practice dietary modification to fight constipation, in order to maintain the strength of rectal muscles. Electrolytes are the mineral composition of the patient’s consumption. They include Caffeine which plays the role of causing diarrhea whenever there is need to clean the alimentary canal. There has to be a balance between calcium, magnesium, potassium and sodium components of electrolyte to increase the chances of diarrhea and unblock constipation.

Conclusion

As much, most causes of Faecal Incontinent are psychological, they are medically and nutritionally treatable. Once there is a possibility of it having occurred, it is important to exercise best practice among the staff of the clinical services institutions to maintain hygiene and assist the affected patients in overcoming the challenges they face such as discrimination and stigma. Prevention is better than cure, so goes the saying and rightly so. The dedication of the staff in preventing the disease is a service not only to the patients but also themselves as health experts and the entire society. Any slight mistake can plunge the vast community into the dilemma of a chain of infection. The best practice on the part of the patients is to practice hygiene and dietary modification and balance.

References

Barrett, J. C., Hansoul, S., Nicolae, D. L., Cho, J. H., Duerr, R. H., Rioux, J. D., Brant, S. R., Silverberg, M. S. et al. (2008). “Genome-wide association defines more than 30 distinct susceptibility loci for Crohn’s disease”. Nature Genetics 40 (8): 95.

Bliss, D. Z. & Norton, C (2010). “Conservative management of fecal incontinence.”. The American journal of nursing 110 (9): 33.

Hara, A. K., Leighton, J. A., Heigh, R. I., Sharma, V. K., Silva, A. C., De Petris, G., Hentz, J. G., Fleischer, D. E. (2005). “Crohn Disease of the Small Bowel: Preliminary Comparison among CT Enterography, Capsule Endoscopy, Small-Bowel Follow-through, and Ileoscopy”. Radiology 238 (1): 14.

Jafri, W., Yakoob, J., Jafri, N., Islam, M., Ali, Q. M. (2007). “Irritable bowel syndrome and health seeking behaviour in different communities of Pakistan”. J Pak Med Assoc 57 (6): 28.

Manheimer E., Cheng, K., Wieland LS, et al. (2012). “Acupuncture for treatment of irritable bowel syndrome”. Cochrane Database Syst Rev 5 (5).

Paul, A. et al., ed. (2009). “Pathophysiology of Urinary Incontinence, Faecal Incontinence and Pelvic Organ Prolapse”. Incontinence: 4th International Consultation on Incontinence, Paris, July 5-8, 2008 (4th ed. ed.). Paris: Health Publications.

Printz, C. (2010). “A “natural” in the hunt for anticancer compounds. Researcher spans the globe in quest for cancer-fighting plants”. Cancer 116 (23): 541–542.

Rodrigues, M. L., Motta, M. E. (2012). “Mechanisms and factors associated with gastrointestinal symptoms in patients with diabetes mellitus.”. Jornal de pediatria 88 (1): 17.

Romano, C. R., Giovanni B. D., Lowry, A. C., Paahlman, L. G. (2007). Fecal incontinence : diagnosis and treatment (1. Ed. ed.). Milan: Springer.

Shah, B. J., Chokhavatia, S., Rose, S. (2012). “Fecal Incontinence in the Elderly: FAQ.”. The American journal of gastroenterology 107 (11): 35.