1. hi,
    k this is not something i want to really discuss kind of gross but its bothering me.
    my first day as a new rn on orentation and a patient was impacted..i think? I say this because he had not had a bm yet and while me and my preceptor were cleaning him, noticed stool right at the rectum. She started to instruct him to push and try to get him to go. We talked about getting a enema but to be honest she never got to it and i tried to give report and mentioned it to the night shift. My question is my gut reaction was this patient was impacted and need it to be removed? i never got to ask about it during the shift. What are your thoughts? was this an appropriate situation to do it in? Or would you order a enema to soften the stool. To be honest am not sure how you would do it since the stool was right there! ok any thoughts also i have to tell you ..i think i would have been a little more aggressive if i was his nurse but it was my first day:uhoh21:. But i am taking note on this situation for how i would handle it if i was on my own. Thanks for any thoughts, comments, or adv!
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    About erin01

    Joined: Mar '09; Posts: 156; Likes: 34


  3. by   Cherybaby
    Every patient is different naturally, but from what you described, I would definately disimpact the patient especially if they are having trouble pushing. Enema isn't a realistic option if the bowel movement is already at the anus. Suppository is also not an option at that point. You want to be careful with certain patients to avoid vagal response or rectal bleeds. You also want to be careful to avoid perfortating.

    I would also ask the doctor to order a stool softener so the patient doesn't run into that situation again. That's just protocol for where I worked. Technically, it is an invasive procedure, so I don't know if it falls into your scope of practice. Every patient/facility has its own rules...so I would ask your charge nurse.
    Last edit by Cherybaby on Jun 23, '09
  4. by   leslie :-D
    yes, it needed to be removed right there and then.
    how would you have given an enema or suppository, with the bowel obstructing the anus?
    again, it should have been removed and THEN given mom, suppository or whatever was deemed appropriate for this pt.
    and while it seems "gross", it still remains a body function that needs attention like every other part.
    your instincts were spot on.

  5. by   erin01
    Thank you! Its not something i would want to do but i felt it didnt make any sense when i asked about it and she was talking about an enema. I feel there are a lot of things i would rather not be doing as a RN but feel its my job to do it. And i just remind myself if this was a member of my family.. ..how would i want the nurse to treat them. it was my first day so i felt limited on what i could do or say. But i am taking notes=) thanks again
  6. by   CoffeeRTC
    Gosh...yrs ago we had to do this alot in LTC. Thank heavens for bowel regimes and new meds.

    I would have disimpacted then and there and like Leslie said..F/u with a good bowel program. Prevention is key...we almost never have to do this where I work.
    Could this person have sat on the toilet? Letting gravity and nature help out works wonders too.
  7. by   Whispera
    I'm not sure what the facility is, where the patient is.... An enema isn't always called for if the patient is functioning, able to move, able to get to the commode, etc. Was the patient uncomfy and just a bit incontinent of hardened stool? Would prune juice work rather than an enema or disempaction. You say the patient hadn't had a BM...for how long?
  8. by   erin01
    well all i know is the patient had hypo active bowel sounds no bm for us and was struggling saying i have to go. But not as nicely as that! He is confused and on bedrest with right sided hemiparesis. We had put the bed pan under him and i could tell he was struggling. And as i said i saw the stool there at the rectum when we were turning and positioning him and cleaning his wound.
  9. by   emnicams
    You sound like you will make a wonderful, caring nurse!

    I would have called the MD right then and there, as disimpaction requires a doctor's order at my facility.
  10. by   erin01
    thanks thats really comforting to hear since I feel so lost & overwhelmed when i am working!
  11. by   Ruby Vee
    if it's a hematology or immunosuppressed patient, you wouldn't disimpact. but in my state, the md disimpacts. yay!
  12. by   Virgo_RN
    We need an MD's order to disimpact, but this situation does sound appropriate to obtain such an order.
  13. by   Heogog53
    Your patient not only needed to be dis-impacted, but as the others said, he needs to be on a complete bowel regime, perhaps even bowel training. He needs a thorough dis-impaction, then stool softeners and more fluids. You were absolutely right to want to dis-impact your patient, but first you need to know if it's an approved nurse action or if you need a doctor's order to dis-impact. Or if it is indeed a doctor's business. At the community hospital I worked at, nurses were allowed to dis-impact with a doc's order. In other places, at academic hospitals, usually the intern on call or the first year resident get do to do the honors.
    Enemas can only help if after dis-impaction is done and he's still constipated, especially if his bowel regime or bowel training hasn't yet started. He does, however, need to be able to somehow be put on a potty chair the enema to help his bowels to move. That, of course, has to be ordered by a doc.

    Good instinct about wanting to dis-impact him. Too bad you weren't able to get an order to do it- or to find out if you could do it as needed.