Gastrointestinal Interventions – Stroke Nursing Care in Med-Surg

00:01 Okay. Again, not the most glamorous system, but it needs attention.

00:06 We're going to talk about the GI system after a stroke, and what you need to be looking for.

00:11 Okay. So, you want normal bowel function.

00:13 Again, this isn't what everyone likes to talk about, but it's super important because our job is to minimize the risk of constipation and impaction.

00:24 Now, impaction is when the patient is unable to pass the stool on their own, and you have to end up getting real personal with the patient.

00:32 It's uncomfortable for you and the patient. So that's what we're going to avoid, because constipation is the most common bowel problem.

00:41 Now, if you've never personally experienced constipation, it is no fun for the patient. It's extremely uncomfortable.

00:49 So, there's no reason for the patient to have to go through that if we're on our A game.

00:53 So we're going to prophylactically put them on stool softeners or fiber.

00:57 So prophylactic means before they have the actual constipation problem, we're going to put them on stool softeners or fiber, because we're going to be attentive to knowing that they're at risk for developing this problem.

01:09 If they don't have swallowing problems, we're going to make sure they stay very well hydrated, while at the same time, we're watching them closely for fluid volume overload.

01:18 Now, physical activity is good gut health.

01:20 So that's another reason why walking doesn't just help your lungs, it also helps your gut move and be more active, because we need that gut to be active so it can move the waste through the body.

01:31 Now, sometimes, patients need bowel retraining. And so we will have to work closely with a patient if we need to retrain their bowel.

01:39 Just like sometimes we need to help people learn how to walk again, we also need to help their gut learn how to empty out again.

01:46 Okay. So, I want to give you a little bit of a breakdown of how bowel retraining works.

01:51 So, essentially, what we'll do is offer regular opportunities for Mr. Johnson to go to the bathroom.

01:57 Now, usually, we do that about every 2 hours throughout the shift, right? You always offer the opportunity for the patient to use the bathroom, whether it's for eliminating their bladder or emptying their bowel.

02:07 But so there's some other key times.

02:10 There's something called a gastrocolic reflex that happens about 30-40 minutes after somebody eat.

02:16 Their gut really kicks in. You're starting to process more food, the gut is really moving, so about 30-40 minutes after a meal is a key time to offer the bathroom to Mr. Johnson.

02:27 That will help to start the bowel retraining program.

02:30 Now that may be enough. If it needs to be more complex, you'll sit down with the interdisciplinary team and develop a plan.

02:37 But just as a general rule, that's what we try with bowel training.

02:41 Offer them regular attempts to use the restroom, usually about 30-40 minutes after a meal is the appropriate time.

02:49 Now if his immobility is severe, we might have to add some extra suppositories or other stimulation, but we're not going to get into that here.

02:56 Just know that we have those options.

03:00 So, we've got adequate and safe nutrition, right? We're going to work with the clinical dietician and the health care provider to give them complete nutritional needs, right? We want to make sure that we look at it from both angles.

03:12 Now, health care providers are experts, but dieticians bring a special set of skills to the table.

03:18 Ha! To the table -- pun intended.

03:20 So, the clinical dietician is going to look very in depth at Mr. Johnson's needs and how we can meet those with his diet.

03:29 We'll also work with the speech therapist. Remember, we talked about if he's having any problems with swallowing, they'll work together, the healthcare provider, the clinical dietician, the speech therapist, and you to make sure he gets adequate and safe nutrition.

03:44 So we're talking about Mr. Johnson.

03:46 So we're going to make sure that we put him in a High Fowler's position for feeding.

03:50 That means he's sitting up right.

03:52 Now, it would be better if we got Mr. Johnson up to a chair rather than feeding him in bed, if at all possible, which he's doing pretty well. I'll just let you know that. He's doing pretty well, so if I get him up to the chair, I'm helping him be mobile, and I'm putting him in a more normal setting for eating.

04:11 Now, before the first feeding, we will have assessed his gag reflex.

04:16 This is not a fun experience for the patient.

04:19 Essentially, to assess a gag reflex, you stick them in the back of their throat -- and you look for them to do that.

04:26 Now there's no need to do this repeatedly unless there's some type of change.

04:30 If he's had the speech therapist in there, then we know, for sure, how he does with swallowing.

04:35 If we've noted that the gag reflex is inadequate we don't feed him until a specialist takes a look at him and a safe plan is written.

04:44 So, if Mr. Johnson had not seen a speech therapist yet, you can just try that on gently on the back of his throat.

04:50 If you don't notice a good gag reflex, don't feed them.

04:54 Usually, we'll even wait to see how they're doing and let a speech therapist evaluate them before we start the meals.

05:01 So, also watch them for chewing and pocketing before you start oral feeding.

05:05 When we say chewing, that makes sense to you.

05:08 Well, how you normally would chew your bites of food.

05:10 But pocketing means sometimes, like a little squirrel, you'll notice they chew, but they don't swallow it. They just kind of stuff it into the pockets of their cheek, and that's no good because they are going to choke when we finally do get to swallowing.

05:23 So, there's a sign to watch for that a patient is having a difficult time with swallowing, they'll start pocketing their food.

05:31 So, follow every meal with good oral hygiene.

05:35 So you want them to properly brush their teeth, rinse their mouth, and make sure they've had good oral hygiene because we don't want them developing any type of infection.