Clinical Nurse Educator. Special thanks to Vanessa Davey (PCC)

Transcription

1 Clinical Nurse Educatr Special thanks t Vanessa Davey (PCC)

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3 Definitin f cnstipatin Explre the likely causes f cnstipatin and cntributing factrs Discuss the assessment f cnstipatin Discuss the management f cnstipatin

4 Difficulty passing faeces r decrease in frequency f defecatin (Sykes, 1998). Infrequent and difficult bwel evacuatin, resulting in pain, and discmfrt (Cnnlly & Larkin, 2012). Prevalence in palliative care is between 50-95% (Lentz, McMillan, 2010).

5 Inhibited bwel activity (reduced activity) Reductin f peristalsis (reduced appetite) Increased reabsrptin f fluid frm gut (reduced fluid intake) Opiids binds t piid receptrs in GIT, interfering with tne and cntractin Suppressin f frward peristalsis, and increase f smth muscle tne delaying passage f faeces Reductin f sensitivity t rectal distentin

6 Inactivity/weakness Other medical prblems (hypthyridism, diabetes) Intestinal bstructin Dehydratin DRUGS! (always have a laxative charted cncurrently with piids) Pr nutritin, lw fibre Pr fluid intake Cnfusin vs cnstipatin

7 Hypercalcaemia Drug therapy, such as anti-chlinergics, TCAs, irn, antihistamines, ndansetrn, antacids, neurleptics, anti parkinsnian drugs GI/ varian cancers Spinal crd cmpressin Depressin Haemrrhids, anal fissures, endcrine disrders (diabetes, hypthyridism)

8 Anrexia Vmiting/ nausea Abdminal discmfrt r cramping Diarrhea/Overflw Cnfusin Anxiety Pain

9 Accurate and meticulus assessment Assess & address physical & nn-physical issues Different appraches t difficult symptms Aim fr the highest pssible QOL Use a risk burden verses benefit assessment Keep patient and the carer(s) infrmed Use a multi-disciplinary apprach Reassess cntinuusly

10 Requires preventin and management DETAILED HISTORY - Medicatins - Descriptin f stl - Frequency - Pain - Blating - Aware f pssible cnstipatin with verflw when diarrhea is a cnstant symptm

11 Histry, frequency and cnsistency f bwel mvements Histry, include: pain, nausea, vmiting, cnfusin, distentin, diet, mbility, fluid intake, malaise, urinary incntinence, drug changes, disease status. Palpatin- cln may have mbile faecal mass, tenderness Auscultatin- bwel sunds Digital examinatin-essential (Andrews & Mrgan, 2012) Assessment tls (Bristl stl chart) AXR

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15 PREVENTION: crrect the crrectable! Assessment includes diet, fluids exercise etc Regular Laxsl and titrate dse as needed (up t 4 TDS)(stimulates nerve endings in the clnic mucsa t induce peristalsis) Avid lactulse in palliative patients Add in Mvicl ( Lax sachets) if inadequate r if faecal lading. Nte: Mvicl requires a special authrity If rectum is empty and dilated cnsider abdminal xray (supps wn t wrk) as may mean impacted faeces higher up in bwel Faeces cnsists f 50% water, 25% bacteria and 25% fd residue s if yur patient is nt eating it is likely there will be faeces in their bwel (McLed, Vella-Brincat and McLed, 2012)

16 Taken frm Palliative Care Partnership Manual, 2016

17 Type Actin Example Hints Stimulant Stimulate peristaltic mvement Senna (in laxsl) Bisacdyl Fleet Dulclax Can increase abdminal pain, and cntraindicated in bstructin Must be inserted at least 4cm, in cntact with bwel wall, nt int faeces. BLUNT END FIRST Lubricant Lubricates the anrectum and has a stimulant effect Glycerine Insert int faeces-pinted end first Sfteners Changes cnsistency f faeces. Nt the laxative f chice where peristaltic actin impaired: Parkinsns, impactin, bwel bstructin, CVA Lactulse- needs t be taken with adequate water. Lax sachets- similar t an smtic as it draws water but n effect in electrlytes. Clxyl At least 125mls f water required at time f administratin Bulk frming agent Prved fibre which adds bulk int the stl Psyllium husk (knsyl-d) Must be taken with significant amunt f water Tends t be used t maintain regularity (nt as treatment)

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19 Andrews, A., Mrgan, G. (2012). Cnstipatin management in palliative care: treatments and the ptential f independent nurse prescribing. Internatinal Jurnal f Palliative Nursing. 18 (1), Arhanui Hspice, Palmerstn Nrth. (2016). Palliative Care Partnership Prgram. Clark, K., Currw, D. (2011). Assessing cnstipatin in palliative care within a gastrenterlgy framewrk. Palliative Medicine. 26(6), 1-8. Cnnlly, M., Larkin, P. (2012). Managing cnstipatin: a fcus n care and treatment in the palliative setting. British Jurnal f Cmmunity Nursing. 17(2), Davis, M.P. (2008). Cancer cnstipatin: are piids really the culprit. Supprt Cancer Care. 16, Dhingra, L., Shuk, E., Grssman, B., Strada, A., Wald, E., Prteny, A., Kntkva, H., Prteny, R. (2012). A qualitative study t explre psychlgical distress and illness burden assciated with piid induced cnstipatin in cancer patients with advanced cancer. Palliative Medicine. 26(4), Sykes, N.P. (1998). The relatinship between piid use and laxative use in terminally ill cancer patients. Palliative Medicine. 18(1),