Improvement of Constipation Symptoms in an Older Adult Patient by Defecation Care Based on Using a Handheld Ultrasound Device in Home Care Settings
Improvement of Constipation Symptoms in an Older Adult Patient by Defecation Care Based on Using a Handheld Ultrasound Device in Home Care Settings
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在家庭护理环境中使用手持式超声设备通过排便护理改善老年患者的便秘症状
DOI：
10.1097/won.0000000000000610
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Sanada Hiromi
中科院分区：
文献类型：
--
作者：
Matsumoto Masaru;Yabunaka Koichi;Yoshida Mikako;Nakagami Gojiro;Miura Yuka;Okawa Yohei;Sugama Junko;Okada Shingo;Ohta Hideki;Sanada Hiromi
背景：尽管之前的研究已经证明超声能够检测结肠和直肠中的粪便，但护士通过超声成像评估便秘的临床实用性尚未确定。在这种情况下，报告，我们观察到粪便潴留，评估便秘的存在，并进行排便护理的老年患者在家庭护理环境中的一个城市附近的大都市areainJapan.CASE：一名85岁的男性晚期前列腺癌和多个转移被诊断为粪便嵌塞通过直肠指诊检查和粪便的一致性评价。他通过定期数字排便进行管理，但超声成像显示便秘伴直肠和结肠粪便潴留，尽管进行了肠道排空程序。当面对这种情况时，我们提倡肠道管理计划，同时考虑肠道消除功能障碍和粪便运输功能障碍。基于超声成像，通过促进水的摄入来改变粪便的稠度，我们通过要求患者每天早上坐在马桶上尝试移动他的肠道（不管排便的暗示）来促进自我排便。结果，每周灌肠和数字dis-impaction事件的数量减少，而自发排便的数量increased.CONCLUSION：本病例报告表明，超声检查改善了临床严重的慢性便秘患者的肠道管理。
BACKGROUND:Although previous studies have demonstrated the ability of ultrasound to detect stool in the colon and rectum, the clinical utility of evaluating constipation via ultrasonic imaging by nurses has not been determined. In this case report, we observed fecal retention, assessed the presence of constipation, and performed defecation care in an older adult patient in a home care setting in a city near the metropolitan area in Japan.CASE:An 85-year-old male with advanced stage prostate cancer and multiple metastases was diagnosed with fecal impaction via digital rectal examination and evaluation of stool consistency. He was managed by regular digital evacuation of stool, but ultrasonic imaging indicated constipation with fecal retention in both the rectum and the colon despite this bowel evacuation program. When faced with this situation, we advocate a bowel management program that considers both intestinal elimination dysfunction and fecal transport dysfunction. Based on ultrasonic imaging, stool consistency was altered by promoting water intake, and we promoted self-defecation by asking the patient to attempt to move his bowels (regardless of cues to defecation) by sitting on the toilet every morning. As a result, the number of weekly enemas and digital dis-impaction episodes decreased while the number of spontaneous defecations increased.CONCLUSION:This case report demonstrated that ultrasonography improved bowel management in this patient with clinically severe chronic constipation.
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