Question About Standing Orders for Constipation...

  1. If someone has standing orders due to constipation that read like this:
    1. Milk of Mag. if no results...
    2. laxative PO 10mg. if no results...
    3. Bisacodyl supp. if no results
    4. Fleets Enema

    How long between each of these steps do you actually wait before converting to the next step? Also, is it okay to go from Milk of Mag to Fleets Enema? Do you have to call the doctor to ask about this or can this be a nursing judgement? Thanks
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  2. 12 Comments

  3. by   CarVsTree
    Don't sweat the small stuff. Use your nursing judgement. If the order is there, I'd be very surprised if someone c/o the order you chose.
  4. by   NeuroICURN
    We have a standing Bowel Regime in our unit. As a matter of a fact, when the docs write the order, they even just write "bowel regime" and that's it, because we all know what it is. Ours is this:

    It's a Q M-W-F order. We start at 8pm, if the first step is not effective, the next is given at 9pm and if that's not effective, then the last step is at 10pm. Honestly, I've never had to do the third step....always works in two.

    1. Bisacodyl suppository
    2. Fleets Enema
    3. Soap Suds Enema

    Now, of course, common sense applies here. If they've already had a BM that day or are having diarrhea, then they don't get bowel regime. Also, if they haven't had any nutrition (tube feeds or food), then I don't give it then either. I figure "nothing in.....nothing out". LOL
  5. by   skittlebear
    thanks for the responses.
  6. by   HeatherLPN
    We go by shifts--nights give prune juice, days tries MOM, then nights give suppositories. We start at the 2 day mark.
  7. by   nurseangel47
    Use good nursing judgement is a good answer. I remember writing the PRN orders or standing orders of PRNS, rather, as an order to go on chart, with the order, then written " ' per standing prn order...' "....
    Don't forget that important first step, though, of first, checking for an impaction! Lots of bedridden, older folks get impacted hence cannot have a proper BM due to impaction! I think a lot of nurses in their haste forget this. Not enough water intake, usually, or movement of body in general to allow the GI tract to absorb/create enough of a generalized routine of peristalsis to evacuate without help....
  8. by   S.T.A.C.E.Y
    Quote from nurseangel47
    Use good nursing judgement is a good answer. I remember writing the PRN orders or standing orders of PRNS, rather, as an order to go on chart, with the order, then written " ' per standing prn order...' "....
    The floor I did my clinicals on used to do routinely write the PRN LSEs on the scheduled MAR sheets to make sure that they were given every day, without the continued use of nursing judgement to use them as PRN. My instructor and I couldn't believe it. A patient would be complaining of diarrhea or lose stools for several days, and when we looked back through the MAR the pts would have been geting their PRNs for two-three weeks bid or tid! No one ever bothered to ask why they were still giving the med. If the doc wanted the pt to get a LSE regularly, then our instructor felt that the nsg staff should be taking that up with the doc for the scheduled order, not changing the PRN to scheduled. Good nursing judgement was often missing on this floor.

    Urgh....sorry for the rant, just left over-frusteration from clinical this semester.
  9. by   jimthorp
    Our protocol is MOM after the 3rd day with no BM. If not effective then the next shift gives a Dulcolax supp. If not effective Fleets enema on the next shift.

    I always give MOM mixed with OJ (called the blaster) or warm prune juice (rocket). This usually does the trick! Of course the dialysis patients go right to the suppository.
    Last edit by jimthorp on Dec 22, '06
  10. by   P_RN
    I usually give MOM followed with 3 cups of tepid to warm water. The MOM needs the fluid to do its thing.
  11. by   Sunflowerinsc
    Quote from jimthorp
    Our protocol is MOM after the 3rd day with no BM. If not effective then the next shift gives a Dulcolax supp. If not effective Fleets enema on the next shift.

    I always give MOM with OJ (called the blaster) or warm prune juice (rocket). This usually does the trick! Of course the dialysis patients go right to the suppository.
    Use nursing judgment with dialysis pt. We do not give MOM or Fleets to dialylis pt. Also no OJ or prune juice ,Very high in K+. Most times ,use sorbital and if needed a Tap Water enema.
  12. by   jimthorp
    Quote from Sunflowerinsc
    Use nursing judgment with dialysis pt. We do not give MOM or Fleets to dialylis pt. Also no OJ or prune juice ,Very high in K+. Most times ,use sorbital and if needed a Tap Water enema.
    I should have elaborated. I do not give OJ or prune juice to dialysis pts.
  13. by   sunny100
    How often do you give MOM to someone who has constipation all the time. Is it safe to give every daY?
  14. by   kcalohagirl
    Most of our patients are post CABG or valve replacement. We generally don't worry that muh about no BM until Post op day 3. Then we call in the "stronger measures". *grin*

    All our patients get senokot QHS unless for loose stools. Usually a BM will happen by POD 3. If not, we have standing orders for MOM and the "magic bullet" = dulcolax. My personal favorite (and the PAs have been known to write for exactly that) is what I call "the bomb". Warm prune juice, plus MOM, plus a splash of sprite.

    Works like a charm.

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