Not enough attention to BMs in nursing today! - page 6

I think that nursing today is often forgetting the basics. I had a patient this weekend who I transfered from a stepdown bed to med/surg. I followed the patient and floated to Med/Surg. By the end of... Read More

  1. by   kidznurse
    Basic nursing fact: "if you don't eat you don't s--- you don't s--- you die !" I've been nursing nearly 30 years and the basic a & p doesn't change! Regardless of the the latest theory or politics - Nursing is about the basics, stick to that and the patients will thank you. Anything else is ego candy.
  2. by   AuntieNursey
    I work in LTC and we are all about the "poop patrol" It has such an impact on the total body, that you have to pay attention. Just like the story of the rectum that would be king: all the body parts were arguing one day about who should be in charge of the whole body. The eyes stated as they see everything, they should be in charge, the hands stated they do everything, so they should be in charge, the feet complained that they took the body everywhere it needed to go, so they should be in charge. The brain spoke up and said that it controlled everything, so it was only logical that it should be in charge.Then the rectum spoke up and said it thought it should be in charge. well, the entire body was in an uproar, all talking at once about how the rectum really had no business in even thinking it could be king and laughing at it. So, the rectum took offence and tightened up so tight that nothing could pass. After a few days, the eyes began to blur and couldn't focus properly, the hands kept dropping things, the legs were having trouble walking and the brain couldn't finish a thought. So, they all got together and begged the rectum to relax and all agreed it could be king. The moral of the story is: Any rectum can be king. Also never underestimate the power of poo! :spin:
  3. by   lvlissl2ebecca
    One of the first things I do when I get to work is grab that BM book that has all the recordings for the BMs in that month. I check who hasn't had one in 3 days or more and write it down in my "Lax" list. While I'm doing my first med pass, I'll stop at each one (wether they get meds or not) and ask if they have had a BM (In case the staff forgot or neglected to mark a BM, which happens a lot). If no, they get a laxative. If they can tell me that they've had one .. I will go ahead and mark it. Simple as that. However, There are many nurses who will come to work after me and I'll give them report with 5 or 6 laxatives and they'll make that god awful UGH! smacked lips thing that indicates disgust. Too bad, Is all I think to myself. They need these laxatives. Not too long ago we had a lady who absolutely refused to take any medicines, as she was so paranoid. She went a good 2 weeks with out a BM or laxative and ended up not breathing while on the pot trying to pass a BM, to where midnight shift thought she had passed away. A good sternal rub and she aroused, but needless to say scary and never good for the patient.

    As for the reason some don't do these simple steps that prevent big problems? Well, I can assume that it is a number of reasons. Some do truly believe that that is NOT their job (Especially when the laxative has been given and its time to digitally check for hard, dried stool before administering enemas). Other times, I'm sure its probably laziness... others forgetfulness, you just never know, either way its a very important thing to neglect... then again you know what assume makes don't you?
    Last edit by lvlissl2ebecca on Dec 19, '07
  4. by   Ms Kylee
    My roomie used to work in LTC and they had a list on the cart of when each resident had a BM. If they didn't have one in 3 days, they got prune juice, then MOM, then an enema.

    I always joked with her and told her she kept a s list on her cart.

    Daily when I do I&O, I ask if they've had a BM. Sometimes I'm told no, other times I'm told yes, and sometimes I not only get a yes, but a great big description of it. If I have a patient go more than 3 days without one, I tell the nurse.
  5. by   pinksugar
    I won't lie, I don't care for cleaning poop. However, whenever I have a lucid pt I will ask them when their last BM was. After that I ask them what their normal pattern is. If they have fallen outside of their normal pattern I will offer a stool softener or suppository. You would be surprised how many of my patients actually refuse these things. One pt told me that she 'didn't want to poop in the hospital', she'd rather wait until she got home! I am a good little nurse and I did my mounds of bowel regime education, but to be honest it usually falls on deaf ears. I wonder why my pts don't want to use the softeners and suppositories?

    Do any of the seasoned nurses have any ideas to make these things more appealing? I am no lover of poo but I do like my pts to have normal BMs.
  6. by   AtomicWoman
    Thank you all for these posts! I recently had someone very dear to me become impacted because of opoid meds. He was in horrendous pain and was so sick I was scared! And then it took a good 3 weeks for his bowels to return to normal after the disimpaction (bouts of diarrhea, ironically). That experience impressed me so much that I vowed that when I become a nurse, I will make sure my patients poop!
  7. by   marilurn
    I had a patient on the floor who was obsessed with his colostomy and wanted it change every hour practically he was afraid it would smell and offend someone. I was caring for him one might and the charge nurse answered his call light and came to the room I was in at the time which was next door to the patient to tell me he need me. I was very busy at the time and she would not go into his room to see what he needed because she was afarid she would have to change the colostomy. I hurried with what I was doing went to his room and all he wanted was a breathing treatment. Some nurse do avoid BM
  8. by   smilin_RN
    HAHA
    I am not sure what its like in a larger hospital, but..... the aides and I seem to have more than our share of poop... we even have names for ourselves such as......the commode commandos, the poop patrol, and the crap nazis.
    of course my least favorite activity is digging someone out, i have nightmares about it. but its gotta be done some times.
  9. by   EmmaG
    Quote from LoriS
    Thank you all for these posts! I recently had someone very dear to me become impacted because of opoid meds. He was in horrendous pain and was so sick I was scared! And then it took a good 3 weeks for his bowels to return to normal after the disimpaction (bouts of diarrhea, ironically). That experience impressed me so much that I vowed that when I become a nurse, I will make sure my patients poop!
    Diarrhea can actually be a sign of impaction, as the liquid is the only thing able to pass the impacted stool.
  10. by   dbsn00
    My facilty was sited by the DOH this past year for not having proper bowel protocol. Now almost everyone has colace daily & PRN MOM. This is working very well, it's rare now that we have to disimpact a resident. The CNAs on my unit are really good with informing the nurses if someone doesn't have a BM in 2 days so we can start the MOM, etc. And warm prune juice is the BOMB but my resident's are always reluctant to drink it so we use stewed prunes (warm) which works just as well and tastes better. There's nothing worse than trying to disimpact a very confused and combatative LOL...and I do not want my frail cardiac residents straining to have a BM.
  11. by   AprilFro
    I work on a spinal cord injury unit where most of the patients cannot have a BM on their own so we automatically do bowel programs in the evening with suppositories. It is routine nursing care for our unit, but I so notice that when our patients are sent to the hospital for emergencies and are kept their for care, they do not have a BM for several days and come back to us with an impaction. They do get very sick and some do not realize that you have to POOP to stay alive!
  12. by   leslie :-D
    Quote from AprilFro
    It is routine nursing care for our unit, but I so notice that when our patients are sent to the hospital for emergencies and are kept their for care, they do not have a BM for several days and come back to us with an impaction. They do get very sick and some do not realize that you have to POOP to stay alive!
    dig that. (ha!)
    wouldn't you think it common sense, that neuro pts require active intervention w/b&b?
    *shaking my head*

    leslie
  13. by   psalm
    Quote from smilinLPN
    HAHA
    I am not sure what its like in a larger hospital, but..... the aides and I seem to have more than our share of poop... we even have names for ourselves such as......the commode commandos, the poop patrol, and the crap nazis.
    of course my least favorite activity is digging someone out, i have nightmares about it. but its gotta be done some times.

    Make sure you double-glove!! Seriously, you dont' want any surprises when you withdraw your digits from the area.

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