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同学们好,今天我们来上 老年便秘的护理
便秘是指排便困难或排便次数减少
且粪便干结便后无舒畅感
老年人便秘属于慢性便秘
慢性便秘通常使用
罗马Ⅱ标准来诊断
便秘是老年人的常见症状
其便秘程度随着增龄而加重
据资料统计,我国60岁以上
人群中老人便秘的发病率
为15%~20%之间
随着年龄的增长,发病率不断地增加
84岁以上老年人便秘发生率
可达到20%~37%之间
在接受长期照护的老年人中
甚至可达到80%。
护理评估有四个方面,一 健康史
二 便秘的状况 三 辅助检查
四 心理-社会状况
健康史
1 一般资料
收集患者的年龄 性别 饮食习惯
生活方式等基本信息
2 既往史 了解患者的疾病史
用药史 家族史
3 便秘的原因
引起老年便秘的原因很多
需从心理因素
不良的饮食习惯生活方式
心理因素以及是否有并发症
等方面进行评估。
一 生理因素
随着年龄的增长
老年人的食量或体力活动明显减少
胃肠道分泌消化液减少 肠管的张力
蠕动减弱
腹腔盆底肌肉乏力
肛门内外括约肌减弱 胃结肠反射减弱
直肠敏感性下降
使食物在肠管内的滞留时间过久
水分过度吸收 引起便秘
二 不良饮食习惯
一 膳食纤维摄入
二 饮水不足 老年人的口渴感觉迟钝
对体内的高渗状态调节能力下降
易出现的轻度脱水 增加便秘的危险
三 不良的饮食行为
如饮水过少
3 活动减少
老年人肠内容物长时间滞留
在肠管内 水分被过度地吸收
而造成了排便困难
4 药物作用 抗胆碱能药
阿片类镇痛药
非甾体类药物利尿药
抗抑郁药均可抑制肠道运动
5 神经系统疾病和心理障碍
中枢或末梢神经病变者
均可导致便秘如帕金森病
糖尿病自主神经病变
二 便秘状况
1 便秘情况
询问便秘开始的时间大便的频率
性状
疾病和用药饮食
活动等情况
2 便秘的伴随症状
观察排便是否伴有口渴恶心
腹胀 腹痛 会阴胀痛等
3 便秘的并发症 粪便嵌塞
②粪石与粪瘤 ③粪性溃疡
④大便失禁 ⑤直肠脱垂
三 辅助检查
一 结肠镜直肠镜
钡剂灌肠
直肠肛门压力测定
球囊排出试验等
四 心理 社会状况
长期便秘会导致老年人烦躁
失眠 抑郁 焦虑等心理问题
严重影响着老年人的生活质量
同时也给个人
家庭社会造成沉重的经济负担
常见护理诊断
1便秘
与老化 活动减少 不合理饮食
药物副作用等有关
2焦虑
与患者担心便秘并发症及其预后有关
3 舒适度下降
与排便时间 排便困难
便后无舒畅感等有关
4知识缺乏
缺乏合理饮食 健康生活方式
及缓解便秘方法等相关知识
便秘治疗与护理的总目标
①患者便秘缓解或消失
②患者形成良好生活方式
且定时排便
③患者掌握便秘护理知识
能描述引起便秘的原因
一 排便护理
指导老年人养成良好的排便习惯
一 定时排便
早餐后或临睡前按时蹲厕
二 勿长期服用泻药
防止药物依赖性的发生
三 保证良好的排便环境
便器应清洁而保暖
二 指导使用辅助器
为体质虚弱的老年人提供
便器椅或在老年人面前放置椅背
三 人工取便法
老年便秘者易发生粪便嵌顿 无法自主排出
需采取人工取便法
四 排便注意事项
指导患者勿忽视任何一次便意
尽量不留宿便
注意排便技巧
如身体前倾 心情放松
先深呼吸 后闭住声门
先深呼吸 后闭住声门
向肛门部位用力等
五 生物反馈疗法
此疗法通便成功率为75%~90%
二 一般护理
1 调整饮食结构
饮食调整是治疗便秘的基础
(1) 多饮水
每天饮水量在2000~2500ml左右
清晨空腹饮一杯温开水
以刺激肠蠕动
(2) 摄取足够的膳食纤维
每日膳食纤维摄入量应在25-30g之间
以不可溶性纤维对预防便秘最为帮助
(3) 多食产气食物及维生素B丰富的食物
利用其发酵产气
促进肠蠕动
(4) 增加润滑肠道食物
如蜂蜜水
(5)少饮浓茶或含咖啡因的饮料
二 调整生活方式
行动完全不受限制患者
建议每日行走15-20min或每天2次
不能行走或只能卧床休息者
推荐在椅子或床上运动
通过转动身体
推动手臂等方式进行锻炼
三 满足老年人的私人空间需求
三 用药护理
原则上是指导患者勿长期服用泻药
防止药物依赖性的发生
1、口服泻药
2、 外用简易通便剂
3、灌肠法
4、心理调适
(1) 耐心听取患者的倾诉
取得患者的信任
(2)及时发现并解决问题
增加治疗信心
(3) 讲解便秘发生的原因
调节患者情绪
使其精神放松
(4) 鼓励患者参与集体活动
提高患者的家庭支持和社会支持水平
五 健康指导
1 适当运动和锻炼
(1) 参加一般活动
老年人根据自身情况参加运动
(2)避免久坐久卧
避免长期卧床或坐轮椅等
(3) 腹部按摩
(4) 收腹运动和提肛肌运动
(5) 卧床锻炼方法等
2 建立健康的生活方式
一 培养良好的排便行为
二 改变不良的饮食习惯
三 高血压 冠心病 脑血管
意外等患者应避免用力排便
3 应正确使用通便药物
一 容积性泻药服用时需饮水250ml
二 润滑剂的泻药也不可长期服用
以免引起脂溶性维生素的吸收
三 温和的口服泻药宜在睡前1个小时服用
-1.1 Human Life Expectancy and Age Classification of the Elderly
--Human Life Expectancy and Age Classification of the Elderly
--【Vedio Recommendation】 How do we measure life expectancy ?
-1.2 Population Aging
--【Literature Recommendation】World Report on Ageing and Health: 2015
-1.3 Influence and Countermeasures of Population Aging
--Influence and Countermeasures of Population Aging
--【Literature Recommendation】World Population Ageing Highlights:2019
-1.4 Goals and Principles of Elderly Care
--Goals and Principles of Elderly Care
--【Book Recommendation】Evidence-Based Geriatric Nursing Protocols for Best Practice
-1.5 Theories Related to Elderly Care
--1.5.1 Personality Development Theory and Life Review
--1.5.2 Disengagement Theory and Activity Theory
--1.5.3 Self-efficacy and Chronic Disease Management
--【Vedio Recommendation】8 Stages of Development by Erik Erikson
--【Literature Recommendation】Activity Theory, Disengagement Theory, and Successful Aging
--【Book Recommendation】Self-Efficacy in Changing Societies
-1.6 Elderly Support and Elderly Care
--1.6.1 Concepts of Elderly Healthcare, Elderly Support and Elderly Care
--1.6.2 Home-based Elderly Care Model
--1.6.3 Institutional Elderly Care Model
--1.6.4 Integrated Medical and Nursing Care Model
--【Vedio Recommendation】Day in the Life of Home Care
--【Website Recommendation】Official Website of the National Institutes of Health
-Concept Map
--【Concept Map】General Introduction to Geronological Nursing
-【Test】CHAPTER 1
-2.1 Aging Changes in the Elderly
--2.1.1 Aging of the Respiratory System
--2.1.2 Aging of the Cardiovascular System
--2.1.3 Aging of the Digestive System
--2.1.4 Aging of the Urinary System
--2.1.5 Aging of the Endocrine System
--2.1.6 Aging of the Motor System
--2.1.7 Aging of the Nervous System
--2.1.8 Aging of the Sensory System
--【Literature Recommendation】Exercise Attenuates the Major Hallmarks of Aging
--【Book Recommendation】Hazzard's Geriatric Medicine and Gerontology
-2.2 Comprehensive Health Assessment of the Elderly
--Comprehensive Health Assessment of the Elderly
--【Literature Recommendation】Instruments to evaluate mental well-being in old age: a systematic review
-2.3 Principles of Elderly Health Assessment
--Principles of Elderly Health Assessment
-2.4 Assessment of the Functional Status of the Elderly
--Assessment of the Functional Status of the Elderly
--【Literature Recommendation】The Lawton Instrumental Activities of Daily Living (IADL) Scale
-2.5 Assessment of Cognitive Function in the Elderly
--Assessment of Cognitive Function in the Elderly
-2.6 Assessment and Adjustment of the Living Environment for the Elderly
--Assessment and Adjustment of the Living Environment for the Elderly
-Concept Map
--【Concept Map】Elderly Health Assessment(1)
--【Concept Map】Elderly Health Assessment(2)
-【Test】CHAPTER 2
-3.1 Overview of the Psychological Characteristics of the Elderly
--Overview of the Psychological Characteristics of the Elderly
-3.2 Influencing Factors of Psychological Changes in the Elderly
--Influencing Factors of Psychological Changes in the Elderly
-3.3 Common Psychological Issues and Their Management in the Elderly
--3.3.1 Common Psychological Issues and Their Management in the Elderly (1)
--3.3.2 Common Psychological Issues and Their Management in the Elderly (2)
--【Book Recommendation】Development Through the Lifespan
-3.4 Depression in the Elderly
--3.4.1 Overview of Depression in the Elderly
--3.4.2 Clinical Symptoms of Depression in the Elderly
--3.4.3 Caring for Elderly Patients with Depression
--【Documentary Recommendation】Depression:Out of the Shadows
-3.5 Elderly Patients with Dementia
--3.5.1 Identification of Dementia Symptoms in the Elderly
--3.5.2 Intelligence Rehabilitation of Elderly Patients with Dementia
--3.5.3 Safety Care of Elderly Patients with Dementia
--【Website Recommendation】The Global Voice on Demaentia
-Concept Map
--【Concept Map】Elderly Mental Health and Mental Health Care
-【Test】CHAPTER 3
-4.1 Precautions for Daily Care of the Elderly
--Precautions for Daily Care of the Elderly
-4.2 General Care of Elderly Skin
--4.2.1 Characteristics and General Care of Elderly Skin
--4.2.2 Skin Itching and Its Management in the Elderly
--【Website Recommendation】American Academy of Dermatology
-4.3 Clothing Hygiene for the Elderly
--Clothing Hygiene for the Elderly
--【Literature Recommendation】The Design Methods of Functional Clothing for the Elderly
-4.4 Dietary Care for the Elderly
--4.4.1 Nutritional Needs of the Elderly and Influencing Factors of these Needs
--4.4.2 Dietary Care for the Elderly
--【Book Recommendation】Nutrition Care of the Older Adult: a Handbook for Dietetics
--【Website Recommendation】Nutrition for older persons
-4.5 Sleep Guidance for the Elderly
--4.5.1 Sleep Characteristics of the Elderly
--4.5.2 Sleep Guidance for the Elderly
--【Book Recommendation】An Occupational Therapist's Guide to Sleep and Sleep Problems
--【Website Recommendation】American Academy of Sleep Medicine
-4.6 Exercises Guidance for the Elderly
--4.6.1 Evaluation of Exercise Intensity in the Elderly
--4.6.2 Precautions Elderly Undertaking Exercises
--【Website Recommendation】American College of Sport Medicine
--【Book Recommendation】Handbook of Activities for the Elderly
-Concept Map
--【Concept Map】Elderly Daily Care
-【Test】CHAPTER 4
-5.1 Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly
--Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly
--【Website Recommendation】How Drugs Work In the Elderly
-5.2 Common Adverse Drug Reactions and Their Causes in the Elderly
--Common Adverse Drug Reactions and Their Causes in the Elderly
-5.3 The Principles of the Use of Medications in the Elderly
--The Principles of the Use of Medications in the Elderly
-5.4 Prevention of Adverse Drug Reactions in the Elderly
--Prevention of Adverse Drug Reactions in the Elderly
-5.5 Medication Compliance in the Elderly
--Medication Compliance in the Elderly
-Concept Map
--【Concept Map】Medication Safety and Care for the Elderly
-【Test】CHAPTER 5
-6.1 Falls in the Elderly
--6.1.1 Epidemiological Characteristics of Elderly Falls
--6.1.2 Risk Factors for Falls in the Elderly
--6.1.3 Prevention of Falls in the Elderly
--【Website Recommendation】CDC STEADI(Stopping Elderly Accidents, Deaths & Injuries Tool Kit)
-6.2 Dysphagia in the Elderly
-6.3 Urinary Incontinence in the Elderly
--Urinary Incontinence in the Elderly
-6.4 Constipation in the Elderly
-6.5 Dry Mouth in the Elderly
--【Website Recommendation】Academy of Nutrition and Dietetics
-6.6 Elderly Nutritional Deficiencies
--Elderly Nutritional Deficiencies - emaciation
-6.7 Visual Impairment in the Elderly
--Visual Impairment in the Elderly
--【Website Recommendation】Senior Eye Exams
-6.8 Senile Deafness
-6.9 Elderly Delirium
-6.10 Elderly Frailty
--【Literature Recommendation】Frailty in elderly people/Frailty in older people
-6.11 Pneumonia in the Elderly
-6.12 Hypertension in the Elderly
--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension
-6.13 Stroke in the Elderly
-6.14 Stable Angina in the Elderly
--Stable Angina in the Elderly
-Concept Map
--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases
-【Test】CHAPTER 6
-7.1 Concept of Hospice Care
--【Website Recommendation】 Definition of Palliative Care,WHO
-7.2 Death Education
--【Book Recommendation】The Meaning of Death by Herman Feife
-7.3 Nursing for Pain in the Dying Elderly
--Nursing for Pain in the Dying Elderly
-7.4 Nursing for Major Bleeding in the Dying Elderly
--Nursing for Major Bleeding in the Dying Elderly
-7.5 Nursing for Delirium in the Dying Elderly
--Nursing for Delirium in the Dying Elderly
-7.6 Nursing for Dyspnea in the Dying Elderly
--Nursing for Dyspnea in the Dying Elderly
--【Website Recommendation】The Hospice and Palliative Nurses Association,HPNA
-7.7 Psychological Problems and Nursing in the Dying Elderly
--Psychological Problems and Nursing in the Dying Elderly
--【Book Recommendation】On Death and Dying ,by Elisabeth Kübler-Ross
-7.8 Grief Counseling for the Widowed Elderly
--Grief Counseling for the Widowed Elderly
--【Book Recommendation】I Wasn't Ready to Say Goodbye,by Noel·Brook,Blair·Pamela
-Concept Map
--【Concept Map】Hospice Care for the Elderly
-【Test】CHAPTER 7