Bowel Incontinence - Home Care Interventions and Client / Family Teaching

Home Care Interventions

1. Assess and teach a bowel management program to support continence.

2. Provide clothing that is nonrestrictive, can be manipulated easily for toileting, and can be changed with ease.
R/ : Avoidance of complicated maneuvers increases the chance of success in toileting programs and decreases the client's risk for embarrassing incontinent episodes.

3. Assist the family in arranging care in a way that allows the client to participate in family or favorite activities without embarrassment.
R/ : Careful planning can both help client retain dignity and maintain integrity of family patterns.

4. If the client is limited to bed (or bed and chair), provide a commode or bedpan that can be easily accessed. If necessary, refer the client to physical therapy services to learn side transfers and to build strength for transfers.

5. If the client is frequently incontinent, refer for home health aide services to assist with hygiene and skin care.


Client / Family Teaching

1. Teach the client and family to perform a bowel reeducation program; scheduled, stimulated program; or other strategies to manage fecal incontinence.

2. Teach the client and family about common dietary sources of fiber, as well as supplemental fiber or bulking agents as indicated.

3. Refer the family to support services to assist with in-home management of fecal incontinence as indicated.

4. Teach nursing colleagues and nonprofessional care providers the importance of providing toileting opportunities and adequate privacy for the patient in an acute or long term care facility.

Refer to nursing diagnoses Diarrhea and Constipation for detailed management of these related conditions.

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Ineffective Airway Clearance - Home Care Interventions and Client / Family Teaching

Home Care Interventions

1. Assess home environment for factors that exacerbate airway clearance problems (e.g., presence of allergens, lack of adequate humidity in air, stressful family relationships).

2. Limit client exposure to persons with upper respiratory infections.

3. Provide/teach percussion and postural drainage per physician orders. Teach adaptive breathing techniques.
R/ : Adaptive breathing, percussion, and postural drainage loosen secretions and allow more effective oxygenation.

4. Determine client compliance with medical regimen.

5. Teach client when and how to use inhalant or nebulizer treatments at home.

6. Teach client/family importance of maintaining regimen and having prn drugs easily accessible at all times.
R/ : Success in avoiding emergency or institutional care may rest solely on medication compliance or availability.

7. Identify an emergency plan, including criteria for use.
R/ : Ineffective airway clearance can be life threatening.

8. Refer for home health aide services for assist with ADLs.
R/ : Clients with decreased oxygenation and copious respiratory secretions are often unable to maintain energy for ADLs.

9. Assess family for role changes and coping skills. Refer to medical social services as necessary.
R/ : Clients with decreased oxygenation are unable to maintain role activities and therefore experience frustration and anger, which may pose a threat to family integrity.

10. Provide family with support for care of a client with a chronic or terminal illness.
R/ : Severe compromise to respiratory function creates fear in clients and caregivers. Fear inhibits effective coping.


Client/Family Teaching

1. Teach importance of not smoking. Be aggressive in approach, ask to set a date for smoking cessation, and recommend nicotine replacement therapy (nicotine patch or gum). Refer to smoking cessation programs, and encourage clients who relapse to keep trying to quit.
R/ : All health care clinicians should be aggressive in helping smokers quit (AHCPR Guidelines, 1996).

2. Teach client how to use a flutter clearance device if ordered, which vibrates to loosen mucus and gives positive pressure to keep airways open. R/ : This device has been shown to effectively decrease mucous viscosity and elasticity (App et al, 1998), increase amount of sputum expectorated (Langenderfer, 1998; Bellone et al, 2000), and increase peak expiratory flow rate (Burioka et al, 1998).

3. Teach client how to use peak expiratory flow rate (PEFR) meter if ordered and when to seek medical attention if PEFR reading drops. Also teach how to use metered dose inhalers and self-administer inhaled corticosteroids following precautions to decrease side effects (Owen, 1999).

4. Teach client how to deep breathe and cough effectively. Teach how to use the ELTGOL method-an airway clearance method that uses lateral posture and diferent lung volumes to control expiratory flow of air to avoid airway compression.
R/ : Controlled coughing uses the diaphragmatic muscles, making the cough more forceful and effective. The ELTGOL method was shown to be more effective in secretion removal in chronic bronchitis than postural drainage (Bellone et al, 2000).

5. Teach client/family to identify and avoid specific factors that exacerbate ineffective airway clearance, including known allergens and especially smoking (if relevant) or exposure to second-hand smoke.

6. Educate client and family about the significance of changes in sputum characteristics, including color, character, amount, and odor.
R/ : With this knowledge the client and family can identify early the signs of infection and seek treatment before acute illness occurs.

7. Teach client/family need to take antibiotics until prescription has run out.
R/ : Taking the entire course of antibiotics helps to eradicate bacterial infection, which decreases lingering, chronic infection.

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