bowel care protocols
0Need some information. What do you use in your facillity as bowel care protocol esp. in relation to ICU patients.
When do you intervene for constipation?
What do you use for constipation?
What do you used for stopping/preventing diahorrea?
Is anyone using prune juice or pear juice for constipation?
Is anyone using yoghurt/drinking yoghurt and.or acidophillus bifidus tabs(sp?)
Any information would be a help. I have to finalise our protocols and you would be amazed at what you cannot reference.
0Jul 18, '03 by jayne109I work on a Med/Surg floor so obviously some things won't apply to all ICU pts but I will give what we do in our Bowel Protocol.
If the Dr. orders the Bowel Protocol (and even sometimes when we make the decision and ask the dr for it) the pt gets Colace 100 mg BID.
On day 3 with no BM, We give MOM and Cascara. this is usually as far it it is needed. But if further is needed, we continue the MOM/Cascara QD and give a Dulcolax supp.
If that does not work in 8 hours, then we give Fleet's enema.
Iif all else fails we contact the doctor and give a Cottonseed oil/Colace enema and then enemas until clear. We also consider disimpaction as the case mey be.
There aare exceptions to this and we use our own judgement if no one as caught the days since BM.
We do use the Acidophillus tabs/granules and if someone has diarrhea they are cultured for C. Diff (running rampant right now at our hospital) and started on Flagyl and Kaopectate and Lactinex (the acidoplilus). We hardly ever use Lomotil anymore.
I hope this helps.
MelissaLast edit by jayne109 on Jul 18, '03
0Jul 18, '03 by maureenohemorroids and constipation
and often neglected
constipation is a big topic on our involuntary psych unit right now
we have been having a run on nsg home elderly residents who stop eating
get committed as grave disability
spend expensive time in hospital and in court
all for [turned out] CONSTIPATION!
0Jul 18, '03 by adrienurseAccording to our Nurse Incontinence Specialist (Yes, we actually have one -- how'd you like that job?);
Constipation = presence of stool in the rectum that cannot be cleared by the person (period)
The key is learning the function of each med given to treat constipation -- some do more harm than good, and are just given out of habit.
Some other things I have learned. Senokot/sennosides does nothing to PREVENT constipation. The only effect of taking this drug on a daily basis is to cause Lazy Bowel Syndrome, where the bowel stops being able to recognize urge to pass feces. It is an effective treatment when used occasionally as a bowel stimulent and THAKES 24-36 hours to work.
The best ways to prevent constipation are:
- oral intake of fluids
- Oral intake of dietary fibre (needs to be accompanied by correct amount of fluid intake
- Toileting on a regular basis. Ignoring urge to defecate leads to megacolon and inability to recognize urge to deficate. Take advantage of the body's natural reflexes (ie. instruct to or take person to the toilet ~30 min after meals, especially breakfast.
0Jul 19, '03 by angelbearI know this sounds strange but this is a topic of interrest to me. At our facility BM's are a big deal. Our population is mostly total care(profound mental retardation). A good portion of our residents recieve miralax on a regular basis. From what we the lowly nurses have read this is not good. Miralax is meant to be for short term constipation. We go round and round about all this at work. Any thoughts?
0Jul 19, '03 by gwenithAs I said we have had some success in an ICU population with prune juice. ICU patients generally tend to be either all stopped or please stop. Either nothing for days or 10 times a day!!!:eek!
Like your patients Angelbear it is not as simple as asking the patient if they are constipated and unless you want to subject them to daily rectal examination there has to be a better guideline
0Jul 19, '03 by zambeziGwynith, I know what you mean about being all stopped up or please stop...that is so true in the unit that I work in. We usually give surfak bid routinely. If someone is stopped up we push fluids (if po), encourage movement, colace bid, and definatly prune juice/high fiber diet. We will use fleets enemas as well if we have to. If diarrhea, we usually use lamotal (sorry, long night, can't seem to spell). Mostly we just try to transfer the pt out before we have to deal with bowels...just kidding.