Not enough attention to BMs in nursing today!

  1. 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 the shift I became aware that the patient really needed a BM, and in report I suggested that the patient needs some MOM, ect.

    This didn't get addressed and the patient went into A-fib with RVR in the night and ended up an ICU patient on a cardiziem drip. I took care of him the next day, he was distended and no appetite, and was more SOB (his underlying dx was pneumonia)

    I told the hospitalist I was going to get his bowels moving when I reported some things to him in the AM, which I did with MOM and a suppository, much to the patient's relief. He had been having runs of wide-complex beats, most likely V-tach, and once he got into bed after his BM (med, hard) he settled down, his nausea went away (doctor had started troponin protocol based on nausea sx), and his heart gradually slowed down, allowing me to wean him off the drip. He converted to NSR at around 1500. The hospitalist put the patient on metamucil, and suggested that cardiziem (patient was on PO cardiziem at home) is a poor choice for a patient with tendency to be constipated.

    My point in telling this story is that, I notice patients are being allowed to go too long without BMs. It seems that the basics of nursing care are being lost in a sea of regulatory overdrive demands and high tech wizardry.
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  2. 89 Comments

  3. by   leslie :-D
    Quote from jlsRN
    It seems that the basics of nursing care are being lost in a sea of regulatory overdrive demands and high tech wizardry.
    this is such crap!!

    it has little to do w/the demands of nsg.
    we're all stressed.
    but how long does it take to ask your pt, "how are your bowels? are you moving ok?"
    trust me, they'll tell you.

    the problem is, too many nurses get the "i'm not doing that" attitude, and don't address these problems.

    i don't know how many pts i've seen crash on me, all what started out as constipation and ended up as impaction.
    the impactions are a domino effect to a whole set of secondary complications.
    a pt has a lg bm, and voila, everything goes back to normal.
    it's ridiculous and it's pitiful, that such a simple intervention, goes ignored.

    no, it's not r/t being busy.
    it's much more r/t "i'm above that", "that's disgusting", "i'm not going to do that".
    inevitably, you spend a heck of a lot more time, trying to rectify the situation.

    basic nsg care, has gone out the window.
    i'm just waiting for a healthy dose of humility, to fly back in.

    pfffffffffft.

    leslie
  4. by   TheCommuter
    Quote from jlsRN
    It seems that the basics of nursing care are being lost in a sea of regulatory overdrive demands and high tech wizardry.
    Perhaps nurses could place more focus on the basics of nursing care if only they had reduced patient loads, less repetitive paperwork, minimal interruptions, less "customer service" duties, less phone calls, more understanding hospital administrators, and so forth.

    When you're trying to cater to too many patients, the basics tend to be bypassed in favor of simply keeping the patients breathing and pulsating for the next shift. Patients should be walked to the toilet if they're physically able to, but some nurses take the easy way out and insert catheters without any medical justification to do so. Showers, back rubs, oral care, and all of the basics simply become lost in the sea of madness that we call the healthcare facility.

    Give me less patients, and each one will have more of my time. Then, I can go back to the basics.
  5. by   TheCommuter
    Quote from earle58
    no, it's not r/t being busy.
    it's much more r/t "i'm above that", "that's disgusting", "i'm not going to do that".
    inevitably, you spend a heck of a lot more time, trying to rectify the situation.
    I'll admit that some people don't want anything to do with bowels.

    However, I've disimpacted more patients than I can count. I've given suppositories, enemas, laxatives, and anything else humanly possible to make the patient defecate. I regularly walk patients to the bathroom and pay attention to the physical attributes of their stools.

    Not all of us have the attitude that poop is below us.
  6. by   FireStarterRN
    I just think there isn't much emphasis any more placed on passing on BM info. We don't get any JCHAO edicts, or QAs on BMs. Management recently instituted a rather useless fall precaution sheet that really doesn't change how we deliver care, but only gives us another form to fill out. But we have nothing in place to cue nurses on the value of making sure the patient's bowels are moving each day.

    I agree with Leslie that we shouldn't use that as an excuse, my point is that current nursing culture seems to have forgotten some of the basics of nursing that go back to antiquity.
  7. by   leslie :-D
    Quote from TheCommuter

    Not all of us have the attitude that poop is below us.
    no need to get defensive, commuter.
    i said "too many nurses..." - obviously, not all.

    leslie
  8. by   oneLoneNurse
    As I get older, I have and continue to have a greater appreciation for what constipation can do to a person.
  9. by   SuesquatchRN
    I think the point, though, is that constipation can literally kill a sick, frail old person and all the meds in the world won't help if what they really need is a simple Dulcolax butt-blaster.
  10. by   TheCommuter
    Quote from earle58
    no need to get defensive, commuter.
    i said "too many nurses..." - obviously, not all.

    leslie
    No offense (or defense) taken, Leslie.
  11. by   leslie :-D
    Quote from jlsRN
    my point is that current nursing culture seems to have forgotten some of the basics of nursing that go back to antiquity.
    maybe nsg culture has minimized the implications...

    but many nurses have (conveniently) forgotten, also.

    leslie
  12. by   FireStarterRN
    Quote from earle58
    maybe nsg culture has minimized the implications...

    but many nurses have (conveniently) forgotten, also.

    leslie
    Why do you think? Is nursing education to blame? I was talking the oncoming nursing supervisor this weekend and she said that nursing schools these days are emphazing careplans and fluff too much, and students are not getting enough practical clinical skills.
  13. by   CoffeeRTC
    Now you all need to get on over to LTC...we are all so bowel fixated! P and P coming out of our @#$ concerning bowels.
  14. by   Diary/Dairy
    Quote from earle58
    this is such crap!!


    leslie
    Or not!!! I'm sorrry - your choice of words hitmy funny bone!

    On the other hand, I think you are absolutely right! Pooping regularly is very important to getting better, as is sleeping right.....

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