Back, Bladder and Bowel Care

Back, Bladder and Bowel Care

BACK CARE

Patients in Orthopedics are usually bed ridden so they have problems in proper bladder and bowel care. These makes them prone to development of pressure sores and poor function of bladder and bowel.

BACK CARE

Spinal injury patients especially with neurological deficit are more prone to develop various bladder and bowel dysfunctions, which affects their physical and mental wellbeing leading to poor recovery of functions.

Why back care???

  

PROLONGED BED RIDDEN

1Multiple fractures.

2Spinal injury with neurological involvement.

3Poor general condition.

4Secondary complication like muscle weakness, deformity and muscle contractures etc.

 Back care 

AIMS-

1.Avoid pressure sores.

2.To prevent secondary complication.

3.Maximize functional recovery.

The EPUAP Guide to Pressure Ulcer Grading

Pressure sore

     Found during autopsies on Egyptian mummies, pressure sores are an ancient medical problem.

The sites of occurrence include the

1.ischium (28%),

2.sacrum (17-27%),

3.trochanter (12-19%), and

4.heel (9-18%).

Pressure sore

HIGH RISK GROUP

1.Patients with fractures treated by conventional method like prolonged traction.

2.Elderly patients.

3.Patients with spinal cord injury.

Pressure sore - Management

Remove all clothing.

Use pressure relieving mattress ( Water bed, Air mattress)

Lift or log roll the body hourly

Examine skin for marking or damage

Posturing

Support injured spine in alignment

Maintains limbs and joints in functional position to avoid contractures.

In paraplegic patients sleeping in prone position with pillows bridging the bony prominences

Relieve pressure

Avoid wetting

Choice of bed

Stryker bed

Profiling bed with multiple layers of varying density foam

Dry

Wrinkle free

Skin Care

Examine and relieve pressure regularly

Keep clean

Avoid damage

Frequent posture change

Treat minor abrasions

Log Rolling

Needed for nursing care of paraplegic and quadriplegic patients.

Avoids further damage to spinal cord & detioriation of neurology.

Log rolling

Log rolling

BLADDER MANAGEMENNT

AIMS –

1.Preservation of renal function

2.Continence

3.Prevention of infection

4.Achieve fluid balance

Catheterization

TYPES

1.Indwelling catheterization.

2.Intermittent catheterization.

3.Condom catheterization.

4.Suprapubic catheterization.

Indwelling catheterization

Catheter is left in place

urethra / SPC

no touch technique under strict aseptic precaution.

Intermittent catheterization

Prereqisites:

1.Strict aseptic techniques.

2.Catheterize 6 hourly initially

3.Restrict fluids to 1500 ml/24 hrs

4.Culture regular urine samples and treat significant UTI

Disadvantages

Calculi

Weekly or biweekly bladder wash

Frequent blockages

Infection

periurethral abscess, urethral diverticulum, fistula formation and epididymoorchitis

Self Intermittent Catheterization

Optimum requirements

1.Absent or minimal detrusor activity

2.Large bladder capacity

3.Sufficient manual dextrity

4.Pain free cathterisation

5.Patient motivation

●

Condom Catheterisation

Used in spastic bladder which empties on its own leading to soiling of clothes.

Allergic reaction.

Negates disadvantage  of urethral catheterization.

Suprapubic Catheterization

Avoids urethral instrumentation and attendant problems.

Permits high fluid intake

No fluid restriction

Disadvantages :-

1.Catheter blockage.

2.Surgical site infection

3.Technical demanding

Long term prevention of UTI

High fluid intake

effective bladder training

urinary antiseptics

Biweekly catheter change

Regular bladder wash

Bowel Care

Stretching >>>signals to spinal cord>>

Reflexive emptying

OR

Stretching>>spinal cord>>brain>>

Voluntary emptying or holding

Why Bowel Care ?????

To prevent:-

Constipation

Hemorhoids

Malnutrition

Fluid imbalance

Bowel Care Program

1.Avoiding constipation.

2.Maintaining a good consistency in stool.

When feces becomes too dry and firm, more difficulty in emptying , allowing bacteria to remain in body for a longer period ,cause of infections and other problems.

Firm stool  irritates the colon and cause hemorrhoids

.

Bowels Management

Diet- a high rich fiber diet.

Avoid caffeine

laxatives, stool softeners

enemas

Manual removal of fecoliths

 Take Home Message

   Back, bladder and bowel care is a very important aspect in orthopedic patient care because these…

Have a profound impact on the overall recovery of the patient.

Hamper rehabilitation.

Lead to additional morbidity.