The nurse is caring for an 83-year-old bedridden client experiencing fecal incontinence. Which nursing intervention is the highest priority for this client? A)Consult with the wound care nurse specialist B)Insert a rectal tube to contain the feces C)Provide perianal skin care with barrier cream D)Use incontinence briefs to protect the skin

Question

Quizplus · Accepted Answer

Disruptions of motor function (anal sphincter and rectal floor muscle dysfunction) and/or sensory function (lack of urge to defecate or inability to sense stool) can result in fecal incontinence. The presence of stool can lead to skin breakdown, urinary tract infections, spread of infection (eg, Clostridium difficile), and contamination of wounds. Therefore, maintenance of perineal and perianal skin integrity is the highest priority. Stool should be removed promptly from the skin by gently cleansing the perineum and perianal area with mild soap. Dry the soiled area and apply a thick moisture barrier product to the skin (Option C). Clean, dry linens and clothing should be provided. (Option A) Wound care and incontinence specialists are useful resources in developing a bowel and/or incontinence management plan; however, the highest priority is promotion of skin integrity. (Option B) Rectal tubes and other indwelling containment devices can cause skin/mucosal breakdown, decreased response of the anal sphincter, and infection. Skin integrity may be maintained without the risks associated with these devices; however, if other measures fail, these devices may be used. (Option D) Absorptive incontinence products (eg, pads, undergarments) can be used after interventions to prevent incontinence and maintain perineal hygiene have failed. Incontinence products such as adult briefs may cause chemical irritation of the skin, further exacerbating skin breakdown. These products should wick moisture away from the client's skin. Educational objective: Interventions to prevent and handle fecal incontinence should be implemented from least to most invasive. Maintenance of skin integrity through perineal and perianal hygiene is the highest priority. Implementation of containment products (eg, absorbent pads, adult briefs, rectal tubes) can be considered after hygiene practices fail.

The Nurse Is Caring for an 83-Year-Old Bedridden Client Experiencing