[AtlantaRN]

Got a patient with lung, brain, and bone mets.

Impacted, he emphatically refused digital disimpaction, even after ativan and 80 morphine. so I had 2 fleets enema in my bag, didn't work.

went out and got an enema bag with castille soap. filled himup with 1500 extremely warm water, still no results-repeated, still no results. I used surgilube and again attempted digital disimpaction. It's as firm as spackle...

any ideas? Thank you in advance.

linda

[webbiedebbie]

Uhm...call the doctor?

[txspadequeen921]

One of my last resorts is a milk and molasses enema. This is what works for patients that take mountains of morphines and other constipating medications. Of course you need a order for this and this is old school so some of your newer nurses/doctors may have never heard of it much less done it. I use 1 cup milk and about half to three-fourth cup molasses. Anyway put in enema container and give it per gravity . The solution binds with the stool and the patient can easily evacuate it...

[earle58]

milk/molasses, is effective (and messy).
but manual disimpaction is really the only way, when it gets to that stage.
ironically, the ms04 80mg, only worsened the problem.

you literally have to take your finger and dig out, little by little.
at this point, you would not give anything po.
and castile soap, is probably not a great idea, since it irritates the colonic mucosa.
time to get the doc involved.
but i'm quite sure, it will be you or him/her, that will remove it digitally.
poor guy...

leslie

[Em1995]

You've probably already done this..is he on Senna-S 2 tabs bid? I always put all of my patients on this as soon as they start with any narcotic. Some need more, some less. But, I have never had to disimpact anyone in 5 years. There's also lactulose if this is a really persistent problem.

[nightmare]

We constantly get residents back from hospital on Dihydrocodeine without any form of bowel management.Result,impaction and pain. Putting them onto lactulose and senna helps but the initial 'trauma' of getting rid of the impaction is both painful for them and unnecessary.

[Em1995]

I agree! Whenever I get a home patient who has just been discharged from the hospital, NEVER fail, they are ALWAYS constipated! Some have told me it's been 5-6 days without a BM! They received narcotics in the hospital, but NOTHING with it like Senna-S. Whatever happened to being proactive?
My husband was in a large Boston hospital last year and after surgery, they had him on a morphine pump. Did anyone even check his bowel sounds? Nope. He was not on Senna-S, so I went into my backpack and had a box which I often keep for my patients. So, I started him on it. The hospital never addressed it.

[introspectiveRN]

Originally Posted by txspadequeen921

One of my last resorts is a milk and molasses enema. This is what works for patients that take mountains of morphines and other constipating medications. Of course you need a order for this and this is old school so some of your newer nurses/doctors may have never heard of it much less done it. I use 1 cup milk and about half to three-fourth cup molasses. Anyway put in enema container and give it per gravity . The solution binds with the stool and the patient can easily evacuate it...

Gee, Sunday morning breakfast will never be the same now.