[kwagner_51]

Hi

I have a pt who is on G-tube feedings who has loose stools. When she has a bm and we clean her up, she bleeds from the anus. She does NOT have bloody stool, it is coming from the outside.



I reported it to the head nurse and she said she is giving her Metamucil to firm up the stools. I tried to tell her that we NEED to give her something to BLOCK and protect the area. She became defensive and said she was doing the best she could. This pt is in extreme pain and screams when we clean her up!!


PLEASE advise!!


Thanks!


____________________________

In His Grace,

Karen

Failure is NOT an option!!

[suebird3]

GT feedings are often loose; it depends on what type of feedings used, also. The Metamucil does work some at my facility.

Has your facility considered a barrier cream, such as Proshield or A&D Ointment to the patient's bottom after every loose stool?

Suebird

[michelle126]

Put in a notice for your dietary dept/ dietician. Sometimes they are able to make a formula change.
Most LTCs have a basic skin barrier that they use..A&D, Selan (a zinc oxide type), Zinc oxide etc. I would use this liberally. If it doesn't seem to help, they need something thicker. Can you call the doc yourself? Make sure you are documenting, leaving notice in report etc.

[luvmy2angels]

I agree, she needs some type of barrier cream, we use baza where I work and it works really well. Her skin will only continue to get worse if this isn't addressed. I also agree to document your observations very well!! Good Luck!!

[manda1027]

I agree with the above options, and I was thinking about Lantiseptic too.

[michelle126]

There really are so many options in barrier creams, no reason this or any other pt should go without.

[ktwlpn]

Also make sure staff knows how to properly use the barrier cream choosen- The area should not be scrubbed to remove all traces of the cream or ointment after each BM...Gently irrigate to wash away the stool and gently blot the area before re-applying...I would also ask for a dietary consult.Metamucil does work well to add bulk to the stool,too...I usually write an order for bed rest for 5 or 7 days and then re-assess the area...

[suebird3]

Originally Posted by manda1027

I agree with the above options, and I was thinking about Lantiseptic too.

If the skin is excoriated, the Lantiseptic burns. Our facility's consultant reminded me of this a few days ago. I know from experience that, if the patient is PA, some things are not "covered" by our Pharmacy formulary.

We seem to have good results (!) with Fibersource HN.....

Suebird

[KellieNurse06]

Does this patient have a new formula? Also many patients cannot tolerate an abrupt change over to a new formula...think of it like this.......you know how you have a dog..( as an example, not saying the patients a dog) and that dog eats the same thing everyday........then one day you give them something new.........what happens usually? yup it goes right through them and they have bowel issues..................just basic.
Also my daughter has had g tube feedings for 17 years and with her we cannot change over to new formulas anyway but very slowly over a few days working up gradually from strengths..............also maybe ask the doctor for Lactobacilus (Acidophilus) because that can help the consistency & may ward off C diff from chronic loose stools..........my daughters GI doctor is one of the docs who developed Culturelle......it works awesome btw.
Is there anything new added to her regimen such as new meds etc? Has the patient been checked for dumping syndrome? Does everyone wash out the feeding bag after every feeding?
I can't tell you how much it drives me absolutley insane when I see the feeding bag & tubing with left over formula sitting in it because no one can be bothered to wash it out with water. I look at it as if you had left over food on a plate from a previous meal...you wouldn't add newly cooked food ontop of it would you?????? Are you venting the gtube regularly? Lots of patients get very gassy & bloated from gas and it's very painful so they need frequent venting .....To me it sounds like hemorrhoids..but I am no doc...Good luck.

[supernurse65]

make sure it's not yeast as some formulas and briefs breed yeast infection on the skin. in this case you may want an antifungal.