Here is the story:
I work HH in the pt's sister's home for 12 hrs every week. Last noc at 8 PM the pt had a major BM. It was all liquid. Today, sister insisted that the pt have a BM. She said that the pt could NOT go without one r/t ammonia buildup. I did my weekly assessment, including BS. They were hypoactive. I had to listen for 2 full minutes to hear them. Anyway, the pt had a upper scope run Thursday. She had a small ulcer that "could" have been old. The MD ordered prevacid for 3 wks and then prn. Sis decided that pt didn't need the med so didn't get the script filled. No varicies were visible and for being in liver failure, she looked great.
Anyway, sis told me to give pt a fleet enema at 5 PM. I started the enema and she started crying. I thought that I had put it in her vagina so I checked her manually. There was no poop! I gave the rest of the enama, and waited 30 minutes. I checked her and all the water had come out with no results except for a tiny smear.
I appologized to the pt for putting her through the pain and discomfort of the enama. I felt really bad.
At 8 PM sis came into the room and asked if she had pooped. I told her no. She told me she was going to take out the trash because the cans were full. She went into the kitchen and searched the trash for the damned fleet bottle!! :angryfire :angryfire :angryfire
She came back into the room and asked me for the container. I had no idea what she was talking about. She finally said she wanted the fleet bottle. I walked over to the small trashcan, pulled it out and gave it to her. She said she was going to give her a "water enema". I repeated that I had given the pt the enema as ordered and that I had NEVER given one with no results. She stated that I should have told her sooner that the enema didn't work!!!
She was pi**** that it didn't work. She kept saying, "she has to poop." I can't make the lady poop! I tried. Have you ever given an enama and not gotten anything? Is this normal?
Here is what she gets in a 24 hr period: TNP 1000 cc. 90 cc's every hr x 11 hrs. 1000 cc's H2O + 4 oz baby food.
Hx: CVA, hepatic failure, resp. failure, ICH.
One other thing, I talked to one of the other nurses on the case today because I couldn't find the MAR. [The nurse that lives close took it home with her. Another story.] Anyway, the RN I talked to said that the sister is in her manic state. I need to know if I should ignore the fact that she accused me of not doing my job, or if I should tell my boss.
That's crazy. A Fleet's enema does not draw ammonia out of the blood stream. Besides that, it doesn't sound like the patient has anything in her bowels to evacuate anyway.
Last edit by Virgo_RN on Dec 9, '07