Restricted Activities

1. Restricted Activities Annual compulsory education Revised April 2013

2. Learning Objectives: Increase your understanding of constipation and fecal impaction Learn the correct procedure to perform a rectal check Learn the correct procedure to administer a glycerin suppository Learn the correct procedure to administer an enema Revised April 2013

3. Constipation - Constipation is a problem for many residents - It is caused by food passing along more slowly in the digestive tract - The feces instead of being soft and easy to expel become dry hard and difficult to expel - Some major causes of constipation include: • Inadequate fluid intake • Lack of exercise • Inadequate fiber intake - Other causes can include depression, disease and certain medications Revised April 2013

4. Constipation A resident with constipation may: Not have an appetite Complain of abdominal discomfort Have a distended (stretched) abdomen Suffer from delirium Revised April 2013

5. Fecal Impaction Most serious form of constipation Results when the fecal mass loses so much water that it becomes dry, hard and impossible to eliminate The dried feces act as an irritant to the bowel Mucus tends to dissolve the outer part of the mass, which then drains from the bowel as oozing diarrhea Whenever there are frequent small amounts of diarrhea, report this to the charge nurse who will further assess for fecal impaction Revised April 2013

6. Rectal Check This procedure allows you to determine if there are feces in the rectum and whether they are hard or soft This procedure must be delegated to an HCA by an RN/LPN Rectal checks should always be done prior to administering suppositories or enemas Revised April 2013

7. Rectal Check - procedure - Explain procedure to the resident and provide privacy - Wash hands and put on gloves • The resident must be in bed on the left side with the right leg flexed • Use your index finger; lubricant well (your nails should be clean and short) • Insert finger approximately 1 – 1.5 inches into the rectum and ask the resident to take a deep breath - Move finger in a circular motion • If bleeding or hemorrhoids stop the procedure, notify the nurse - Report findings to Supervisor Revised April 2013

8. Glycerin Suppositories Glycerin Suppositories are used to stimulate bowel evacuation The suppository must be placed beyond the rectal sphincter and against the bowel wall • This ensures that it will melt and lubricate the rectum This procedure must be delegated to an HCA by an RN/LPN Revised April 2013

9. Glycerin SuppositoriesProcedure Explain the procedure to the resident and provide privacy Help resident turn to left side with right leg flexed Wash your hands and put on gloves Adjust bed linen to expose only the resident’s buttocks Separate buttocks exposing anus Remove suppository from foil Use lubricant on fingers and insert suppository about 1-2 inches against the rectum wall, not directly into the feces Check resident frequently and assist resident with toileting Revised April 2013

10. Glycerin Suppositoriesprocedure (cont.) If resident is using a bedpan, raise the head of the bed to a comfortable height Keep call bell and toilet paper within easy reach Observe contents of bedpan or toilet Clean resident and wash hands Give resident soap, water and a towel to wash and dry their hands. Assist as needed Report results to the Supervisor and document on PCA flow sheet Revised April 2013

11. Enemas An enema is the placing of fluid into the rectum through the anal sphincter to remove feces Prepackaged commercial enema solution may be used This procedure must be delegated to and HCA by an RN/LPN Revised April 2013

12. Enema Considerations Before giving an Enema, consider: When possible, an enema should be given before breakfast or morning care Do not give an enema an hour after a meal Ensure that a bathroom/commode is free before giving an enema Revised April 2013

13. Commercially Prepared Enema Assemble equipment, enema, gloves, bed protector pan or bedside commode, toilet paper, soap and wash cloths Explain the procedure to the resident and provide privacy Wash your hands Help resident to turn to the left side with right leg flexed Place bed protector pan under buttocks Put on gloves Revised April 2013

14. Commercially Prepared Enema Adjust bed linen to expose only the resident’s buttocks Separate buttocks exposing anus Ask resident to breath deeply Insert the pre-lubricated tip into anus as the resident takes a deep breath Squeeze container slowly until all the solution has entered into the rectum Remove container and place in package box to be discarded Revised April 2013

15. Commercially Prepared Enema - Encourage resident to remain on their side - Remove gloves and wash hands - Check resident frequently and assist resident to the bathroom or commode • If resident is on the bedpan, raise head of bed to comfortable height - Place call bell and toilet tissue within easy reach - Observe contents of bedpan or toilet/commode. - Clean resident and wash hands • Give resident soap, water and towel to wash and dry hands. Assist as needed • Report results to the nurse and document on PCA flow sheet Revised April 2013

16. BSF requirements All HCAs must complete the Annual On-line In-service Annual Restricted Activity – Rectal Interventions Competency must be completed by all HCAs before they are able to perform this task. Revised April 2013