Nursing standard

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june 1 :: vol 30 no 40 :: 2016 37 if pain persists or if the patient asks you to stop, you must discontinue the procedure and inform a senior clinician. Monitor the patient’s pulse. This can be done manually or electronically, depending on the setting and circumstances. If the heart rate drops or the rhythm changes, cease digital removal of faeces.
22. If there are any signs of autonomic dysreflexia,
8. Undertake a bowel assessment to determine the need for digital removal of faeces Figure 1).
9. Assist the patient if there are no contraindications, such as the presence of any musculoskeletal disorders to assume the left lateral position with the knees drawn up towards the chest (Figure 2).
10. Place a protective bed cover beneath the patient’s hips and buttocks. Wash and dry your hands. Put on the apron and non-latex gloves. Observe the perianal area. Check for rectal prolapse, haemorrhoids, anal skin tags, wounds, discharge, anal lesions, bleeding, infestation and foreign bodies. Document and record any irregularities. In the presence of any of these irregularities, do not continue with the procedure. Document any findings and seek appropriate advice. Lubricate your gloved index finger with lubricating gel. If an anaesthetic gel has been prescribed, apply this topically to the anal area. Do not use the gel if there is documented evidence of anal trauma or bleeding. Explain the procedure to the patient as you perform each action. Gently and slowly insert your gloved, lubricated index finger into the rectum Figure 3). Determine the type of faeces in the rectum using the Bristol Stool Chart Lewis and Heaton 1997).
17. If the stool is type 1 (scybala – faecal pellets, slowly and gently remove one lump at a time until no more faecal matter is felt, placing it in a suitable receiver. If a solid faecal mass is felt, gently push the gloved finger into the middle of the mass, split it and remove pieces using a hooked finger until no faecal matter is felt, placing it in a suitable receiver. Care is required to avoid causing trauma. On examination, if the faecal mass is more than cm across and it is difficult to break it up, discontinue the procedure. Refer the patient to the medical team who may consider digital removal of faeces under general anaesthesia. Provide a rest period for the patient, if needed. If appropriate, ask the patient to perform the
Valsalva manoeuvre – the patient is asked to breathe in and then try to force air outwith the mouth and nose closed – this can assist with the passage of faeces into the rectum. Observe the patient during the procedure, noting signs of pain, distress, bleeding or general discomfort. If the anal area bleeds,

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