Okay. Again, not the most glamorous
system, but it needs attention.
We're going to talk about the GI system
after a stroke, and what you
need to be looking for.
Okay. So, you want normal bowel function.
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.
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.
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.
Now, if you've never personally
it is no fun for the patient. It's
So, there's no reason for the patient to have
to go through that if we're on our A game.
So we're going to prophylactically put
them on stool softeners or fiber.
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.
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.
Now, physical activity is good gut health.
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.
Now, sometimes, patients need bowel
retraining. And so we will have to work
closely with a patient if we need
to retrain their bowel.
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.
Okay. So, I want to give you a little bit of
a breakdown of how bowel retraining works.
So, essentially, what we'll do
is offer regular
opportunities for Mr. Johnson
to go to the bathroom.
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.
But so there's some other key times.
There's something called a gastrocolic
reflex that happens about
30-40 minutes after somebody eat.
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.
That will help to start the bowel
Now that may be enough. If it
needs to be more complex,
you'll sit down with the interdisciplinary
team and develop a plan.
But just as a general rule, that's
what we try with bowel training.
Offer them regular attempts
to use the restroom,
usually about 30-40 minutes after
a meal is the appropriate time.
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.
Just know that we have those options.
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.
Now, health care providers are experts,
but dieticians bring a special
set of skills to the table.
Ha! To the table -- pun intended.
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.
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
the clinical dietician, the speech
therapist, and you
to make sure he gets adequate
and safe nutrition.
So we're talking about Mr. Johnson.
So we're going to make sure that we put
him in a High Fowler's position for feeding.
That means he's sitting up right.
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.
Now, before the first feeding, we will
have assessed his gag reflex.
This is not a fun experience
for the patient.
Essentially, to assess a gag reflex,
you stick them in the back of their throat --
and you look for them to do that.
Now there's no need to do this repeatedly
unless there's some type of change.
If he's had the speech therapist in
there, then we know, for sure,
how he does with swallowing.
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.
So, if Mr. Johnson had not seen
a speech therapist yet,
you can just try that on gently
on the back of his throat.
If you don't notice a good gag
reflex, don't feed them.
Usually, we'll even wait to see
how they're doing
and let a speech therapist evaluate
them before we start the meals.
So, also watch them for chewing and
pocketing before you start oral feeding.
When we say chewing, that makes sense to you.
Well, how you normally would
chew your bites of food.
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.
So, there's a sign to watch for
that a patient is having a difficult
time with swallowing,
they'll start pocketing their food.
So, follow every meal with
good oral hygiene.
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.