constipation

  1. I was going to post this in the geriatric nursing forum, but issue is not unique to geriatrics. A co-worker and I are doing research on treatment of constipation. We are trying to overhaul our existing system.

    Does your facility have a specified bowel routine that is used to treat/prevent chronic or episodic constipation in patients? What times of the day are these treatments usually given. In what way are these used to complement the body's natural reflexes? What medications/products are you using?

    Any suggestions are gladly appreciated.
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  2. 25 Comments

  3. by   Kayzee
    At the facility I just quit, we gave MOM on day 2 & 3. If this was not helpful we gave Bisacodyl Suppos. on day 4. Usually effective.
  4. by   rose_duspatalin
    regular intake of high fiber diet, and increase fluid intake count much. We give Dulcolax on day 3 , if still no bm , we give enema on day 4.
  5. by   rose_duspatalin
    Originally posted by rose_duspatalin
    regular intake of high fiber diet, and increase fluid intake count much. We give Dulcolax on day 3 , if still no bm , we give enema on day 4.
  6. by   kewlnurse
    M O M in the pm for a bm in the am. plus colace, ducolax if needed, than regular enema than if needed soap suds
  7. by   NurseDennie
    Different bowel regiems depending on the doc and what's going on. Some of them were just -- WOW!!

    I worked out my own little routine, especially for postop pts. I'd encourage warm prune juice (heh heh - I know, that's just cruel - but it works!) and if that didn't work or the person couldn't handle it... I'd give dulcolax PO in the morning as soon as I came on shift. If no results by 1600, I'd give suppository. I almost always had success.

    For procedures that called for it, I pulled out all the stops. MOM PO upon coming back from a barium swallow study suppository 4-5 hours later if no results. I've always been a big believer in working at it from above and below. Ah, Dennie, the poopoo queen.

    Love

    Dennie

    PS - where I worked you could give Fleets enemas on nursing judgment but required MD order for SSE. Fleets doesn't work very well imho, unless you warm it up and then give the dose in 1/3's, moving pt from side - back - side.
  8. by   hapeewendy
    surfak 1 tab OD in the AM
    and senokot 1-2 tabs po QHS
    MOM prn
    if no results - glycerine supp , then fleet enema
    it works rather well if I do say so myself
    well I mean I've seen that it works well
    all the patients poop almost on cue
    hehe
  9. by   Paprikat
    In the nursing home I work in:
    Prune juice TID and this "yummy" stuff called Bran Whip. This is for patients identified at high constipation risk.
    Our protocol is
    Sennosides 1-2 at HS day three
    Glycerine supp AM of day four
    Repeat sennosides in evening of day 4 (if no BM)
    the fleet enema on day 5. Very rarely do we give enemas....
  10. by   Nurse Ratched
    In the ECF it was BAP (own special concoction of bran, applesauce and prunes/prune juice.) One medicinecupful at bedtime seemed to keep people regular.

    I preferred making sure they got regular fluids and walks. In the hospital, it's usually colace, MOM, or triple H enemas for the stubborn cases. Occasionally have to birth one .

    I like Dennie's protocol lol.

    The poop princess (since queen is already taken ).
  11. by   andrewsgranny
    Day 2 and 3 MOM and if that dont work.. Try dynamite
    works everytime
  12. by   OzNurse69
    For intractable clog-ups, we always go with a Shaw's Cocktail (does anyone know who "Shaw" was??!!)
    - 1-2 tablespoon Senekot granules
    - 1-2 tablespoon Agarol (MOM)
    - 2 crushed durolax tablets
    dissolved in warm water & mixed with melted icecream.
    Tastes like a chocolate thickshake, but GUARANTEED to work within 24 hours!!
  13. by   mattsmom81
    Warmed up prune juice mixed with a dose of MOM is quite effective and not too harsh for my hospitalized patients. I hate giving the elderly enemas...they are so hard on them. A Dulcolox suppository is my fave if something is needed 'below'...hehe.

    Some poor old folks coming from home (specially those with a bit of dementia) and haven't had a BM in weeks will need need digging out...they can't pass the huge hard mass (unfortunately)..so time for RotoRooter Nurse to go into action...LOL! If they're from LTC they usually have been on a bowel program there and we try to follow it.

    Home patients we try to institute a bowel regimen they can remember...diet and fibre first, then meds if no results. And yes, many docs prefer their own protocols so we nurses have to institute those....
    Last edit by mattsmom81 on Jul 19, '02
  14. by   hoolahan
    This is really interesting. I have so many pt's with constipation in homecare. Most secondary to pain meds.

    We tell pt's to inc fluids, eat prunes, and one nurse swears by raisins w excellent results! We also have a handout which rx senna tea w prune juice, 1:1 mix and warmed of course.

    I also think fleets don't do much, and prefer dulcolax sup. Have a lot of pt's on lactulose daily, it keeps them fairly regular, though not ideal, better than being admitted for bowel obstruction.

    I remember one pt, a post op heart, who had major complications post op. He hadn't moved his bowels for 3 weeks, they tried everything!! Finally, they got out the dynamite...a enteral continuous "feeding" of Go-Lytely(bowel prep drink.) It ran for about 3 days before any result, but when he went...let's just say it was a code brown! Every night I worked I prayed it wouldn't be the night he went, b/c I knew it wasn't gonna be pretty!!! God must have heard my prayer, b/c I was off!!! LOL!!!

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