Caregivers Guide

A Guide for Family Caregivers of Older New Jersey Residents

Section 4 - Personal Skills Development

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4.6 Dealing With Body Wastes

Body wastes are eliminated through perspiration, evaporation from the lungs, bowel movements and urination. The bedbound person may be concerned about how he can eliminate through his kidneys and bowels. This is particularly true of the elderly. Be aware of his concerns and respond quickly to his needs. In giving the bedpan or urinal to a person, consider his privacy and the importance of making him feel comfortable.

Procedure for use of bedpan:

• Warm the bedpan with warm tap water and dry it.
• Cover the bedpan with a newspaper or washcloth when carrying it to the person.
• Add extra protection to the bed, even if a plastic or rubber sheet is used on the mattress; an extra cloth or newspaper may be placed under the person's hips.
• Sprinkle talcum powder or cornstarch on the bedpan seat to make it easier to get on or off; if the person is thin, add a small pad to cushion the seat. (A sanitary pad or soft cloth may be used.)
• Place the bedpan on the bed near the person's hips with the open end towards the foot of the bed.
• Fold the top covers to one side to avoid soiling and partially drape the sheet or blanket to prevent chilling and provide privacy.
• If the person needs help in raising the hips, have him flex his knees. Place one hand under the small of the back and, on signal,push his hips up is he pushes down with his hands and heels. With the other hand, place the bedpan under his hips and adjust the pan for comfort.
• Help the person to a sitting position, if possible. Provide toilet paper and a call signal. Then leave the room to allow for privacy. Remind the female to wipe from front to back to avoid bringing germs into the vagina and bladder.
• Assist with thorough wiping.
• Apply talc sparingly.
• To remove the bedpan, have the person flex his knees and push down with his heels.
• Remove the bed protector, cover the pan, and take it to the bathroom.
• Help the person wash his hands.
• Position him comfortably.
• Inspect the contents of the bedpan.
• Rinse the bedpan with cold water to prevent coagulation of proteins.
• Clean the bedpan with soap and water, cover and store.

Procedure for use of urinal:

• Use a protector under the person's hips.
• Give the person the urinal. If he is helpless, place it between his legs in a position to collect the urine.
• Provide for privacy by replacing covers, leaving the room if safe to do so.
• Rinse the urinal with cold water.
• Wash urinal, cover and store.

Re-establishing Bowel and Bladder Routine

The following steps may help to reestablish bowel and bladder routine. Good bowel and bladder function may also be maintained by the same procedure. The doctor may recommend a suppository or enema to help stimulate the bowel.

Procedure:

• Establish the normal pattern for elimination by maintaining a record for several days.
• Give urinal and bedpan at regular intervals based upon observations and when a desire is expressed.
• Encourage drinking plenty of fluids during the day, but fewer in the evening; strong urine resulting from too few fluids is irritating and can cause incontinence.
• Encourage the person to eat high-fiber foods.
• Instruct the person in other signs of a full bladder - sweating, chills, headache, restlessness.

Ostomy Care

A surgical opening in the skin following the removal of part of the large intestine (colon) is called a colostomy. The removal of all of the colon is called an ilesotomy. The removal of the urinary bladder is called a urinary bypass or ureterostomy.

The care of the ostomy depends on where the surgery occurs. The further down the colon it is, the more closely the bowel contents will resemble the normal bowel movements before surgery. The higher up the bowel the more fluid the bowel contents will be.

Persons who have had any of the surgical procedures creating an ostomy will be using a bag or device for collecting body waste. There are various types of ostomy bags. The individual will use the type of bag best suited to his needs and lifestyle.

The types of bag, include:

• A disposable, temporary bag with an end opening to discard contents.
• A one-piece bag with an attached piece of adhesive around the opening of the stoma.
• A one-piece bag, with an attached mounting piece which is supported by a lightweight belt and requires no adhesive.

The person with an ostomy is usually taught to care for it before leaving the hospital. If a caregiver is to provide ostomy care, he should be taught the procedure by an ostomy registered nurse.

The informal caregiver may be asked to help the person clean the skin or to dispose of the contents of the bag. Some points to remember are:

A bag with an end opening can be rinsed out with an asepto syringe and does not need to be changed as often.

Persons will need two bags, so one airs out while the other is worn.

Some people with colostomies have good bowel regulation and prefer to wear only a gauze dressing over the stoma.

Clean and dry skin around the stoma and cover it with a 4" X 4" dressing held in place by tape.

Men may wear an elastic supporter or a homemade muslin binder to keep the dressing in place.

The ileostomy bag requires a tight fit because of liquid bowel contents and constant drainage. The appliance or bag must be emptied every 3 to 4 hours and changed every 5 to 7 days.

Skin condition around the ostomy must be frequently assessed.

Before skin problems become acute, seek medical intervention. The diet needs careful consideration. Experiment with foods, particularly those that are gas-forming, such as nuts, beans, onions, melons, vegetables of the cabbage family, sugar and sweets. Gas escaping from the ostomy cannot be controlled, since there are no muscles present to close the opening. The tight-fitting rubber or plastic bag helps control odors, but the dressing offers no odor protection.

Foods such as nuts, raisins, or prunes which cause diarrhea should be avoided. Prevention of diarrhea is even more important for the person with an ileostomy because of the loss of important electrolytes. A person with an ileostomy should never eat coconut, as it tends to ball up and cause an obstruction. Remind the person to chew food well. After approximately six weeks, the person will be able to determine the foods he can tolerate.

Contact your doctor or home health nurse if the person has diarrhea. The person should not irrigate the ostomy when diarrhea is present. The person who has a colostomy should never take a laxative.

The emotional reaction to the loss of bowel control requires a great deal of support and understanding. It is important to be a good listener. Another person who has successfully adjusted to his colostomy often provides great assistance in demonstrating how well one can manage. Local contacts may be made through the American Cancer Society or the United Ostomy Association. Part of the grief process felt by the person over the loss of a body part might have occurred before leaving the hospital. It is important to help him express his emotions, as he still may not accept the surgery and feel repulsed by the stoma. Try to help him feel as calm as possible. Help him understand that adverse emotions affect the bowel motion and the regulation of the bowel. The informal caregiver must be very careful to show no distasteful reaction to the stoma. The person needs to feel accepted by those around him, particularly those caring for him.

Infection and Contamination

Bodily wastes may carry infection and must be disposed of carefully to reduce the spread of infection. Wastes may include used paper tissues, sputum, dirty dressings, uneaten food, excrement and vomit. To dispose of solid wastes, use tongs or a spring clothespin. If these utensils are not available, carefully grasp the cleanest part of the material or pick it up with a paper towel. The soiled material should be put into a paper or plastic bag and disposed. In using a paper or plastic bag for disposal, turn down a cuff on the bag. The cuff protects the hands when closing the bag.

When a bag is not available, it is important to improvise one from a newspaper.

Liquid wastes should be poured into a container that has a lid and then poured into the toilet. The container holding the liquid should be washed with soap and water. Hands can carry germs and transmit infections and disease. When providing personal care, hand washing is important to protect both the caregiver and care-receiver.

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