Proper way to give suppositories - page 2

hello allnurses! i need your opinion on something. i am an lpn in ltc. we have several floors or units in my building. one floor is being renovated so that floor is dispersing its patients to... Read More

  1. Visit  RedhairedNurse profile page
    1
    Why would someone want a suppository inserted while they're sitting on the commode? Doesn't make sense to me.

    It seems like the suppository would just squirt out immediately, how does she hold it in?

    Anyway, I would refuse to insert it in the way she is requesting. It's against the 'Nurse Practice Act' for us to perform or administer anything other than the way it is correctly to be done.
    agldragonRN likes this.
  2. Visit  leslie :-D profile page
    2
    except for the awkward ergonomics, i'm not understanding the big deal.
    and i'm esp not understanding why/how your face is near the pt's "crotch"?
    wouldn't you be standing on her side, using the closest arm/hand to palpate and insert?
    and speaking of palpation, what is wrong with doing it blindly?
    it's not anatomically challenging to find the anus.

    fwiw, elderly often are prone to bowel/constipation problems, so when they find a routine that works, they stick with it.
    i like the suggestion about sticking to the p&p manual (if it's even addressed).
    but other than that, keep your face away from her crotch and see if you can insert it before she sits down on the toilet.

    hope everything comes out ok.
    heh.

    leslie
    systoly and agldragonRN like this.
  3. Visit  leslie :-D profile page
    2
    Quote from RedhairedNurse
    It's against the 'Nurse Practice Act' for us to perform or administer anything other than the way it is correctly to be done.
    now, that's a stretch.
    it's not as if he's inserting it up her nose.

    leslie
    sharpeimom and Tait like this.
  4. Visit  agldragonRN profile page
    2
    Quote from leslie :-d
    except for the awkward ergonomics, i'm not understanding the big deal.
    and i'm esp not understanding why/how your face is near the pt's "crotch"?
    wouldn't you be standing on her side, using the closest arm/hand to palpate and insert?
    and speaking of palpation, what is wrong with doing it blindly?
    it's not anatomically challenging to find the anus.

    fwiw, elderly often are prone to bowel/constipation problems, so when they find a routine that works, they stick with it.
    i like the suggestion about sticking to the p&p manual (if it's even addressed).
    but other than that, keep your face away from her crotch and see if you can insert it before she sits down on the toilet.

    hope everything comes out ok.
    heh.

    leslie

    she is in the toilet (with toilet chair) in a small confined bathroom, no space for me to go on either side or the back, only through front. i am 6 feet tall and the toilet is low.

    she likes the suppository to be inserted when she is sitting already on the toilet chair so inserting it before she sits down is deviating from her "routines".

    i know where the anus is. i took ap i & ii and i have my own as well. the problem is me bending so low and my face near her crotch and blindly inserting it.

    caliotter3 and leslie :-D like this.
  5. Visit  agldragonRN profile page
    0
    Quote from redhairednurse
    why would someone want a suppository inserted while they're sitting on the commode? doesn't make sense to me.

    it seems like the suppository would just squirt out immediately, how does she hold it in?

    anyway, i would refuse to insert it in the way she is requesting. it's against the 'nurse practice act' for us to perform or administer anything other than the way it is correctly to be done.
    i heard from agency nurses that come to my floor who took care of this pt previously that sometimes the dulcolax would squirt out as soon as you put it and she would ask you to insert a new one.
  6. Visit  leslie :-D profile page
    1
    ah, ok...

    then yes, i would refuse just by reason of its inappropriateness.
    esp being different genders.
    heck, i would never insert it on a male pt, from a frontal position.
    never.

    seriously, see if it's addressed in your p&p.
    or, if the toilet is movable, move it elsewhere.

    eek.

    leslie
    sharpeimom likes this.
  7. Visit  NREMT-P/RN profile page
    4
    I find it kinda funny that I am posting to a suppository question - as, thankfully, air transport sort of eliminates the possibility of ever using them - but, strangely enough we have some tylenol ones on the helo.

    I think this is a simple issue of medication administration. Follow the P & P to the letter and then Standards of Administration to the letter. (I would think that the "bearing down" that takes place on the toilet alone would make that position for insertion of a medication that should be retained for a certain time - UNSUITABLE). Anyway, unless you can find a guide to administration that details this "position" as suitable and the P & P do not detail the same - then just follow the written rules.

    As for the position issues that you note due to your height - well, those are real. I am concerned that you would not have a basis (or they will have a defense) for any resulting back injury that you may sustain while doing "anything the patient wants, anyway they want" - all the while the administration notes "informally" (as in tells you) for you to - just do it!

    The biggest issue that I see - is if you hurt your back they can note that you were not administrating the medication in the proper position, not using proper body mechanics. You lose. The defense that they "said" just do whatever - others do it, you should too - is absurd.

    As for the poster that notes a psych issue - that may be a component, or it could be less the suppository that is making her go as it is stimulation of the anal area while on the toilet (that statement seems disturbing once I typed it :eek ). Momma cats lick kitten bottoms to stimulate them to poo so that is my mindset - not that the mental image is improving.

    I say - FOLLOW THE RULES.

    IF you were to have an injury (or exposure due to "crotch" vicinity - this is getting worse, sorrry) the only thing that will save you is that you were hurt despite following good positioning mechanics and following some standard of care.

    Good Luck.
    Emergency RN, sharpeimom, Virgo_RN, and 1 other like this.
  8. Visit  RedhairedNurse profile page
    2
    Quote from leslie :-D
    now, that's a stretch.
    it's not as if he's inserting it up her nose.

    leslie
    Thats being a little sarcastic, Leslie, please keep you sarcasm to yourself.
    I didn't say it's going up her nose. Give respect please.


    To the OP -- I've seen many women that
    have a crazy amount of hemorrhoids and may even possibly have a fistula or two back there.

    I'm going to see where I'm inserting a suppository before I attempt to go in blindly. Or at least get
    an idea of what their anatomy is like back there before I start sticking things where they
    possibly shouldn't go.

    Have a nice day. That goes for you too, Leslie. ; - D
    Last edit by RedhairedNurse on Dec 5, '09
    canoehead and agldragonRN like this.
  9. Visit  caliotter3 profile page
    2
    I injured my back while doing a transfer of a patient one time and my employer saw to it that I did not get worker's compensation for the medical care I required. I was following proper procedure. I am also concerned about the consequences of you hurting your back. I would refuse to do this. They can not force you to injure yourself by not following accepted procedure.
    scoochy and agldragonRN like this.
  10. Visit  XB9S profile page
    5
    Could I please remind all posters to refrain from posting off topic. Let's keep on track and keep the personal comments off the board

    thank you
  11. Visit  sharpeimom profile page
    3
    would she perhaps consider using a bedside commode on suppository days? by positioning the potty chair so you had adequate room to work in, you would eliminate (no pun intended...) the groping around from the front because you had enough room to work from the side of the chair.

    kathy
    shar pei mom
    systoly, agldragonRN, and leslie :-D like this.
  12. Visit  leslie :-D profile page
    2
    Quote from sharpeimom
    would she perhaps consider using a bedside commode on suppository days? by positioning the potty chair so you had adequate room to work in, you would eliminate (no pun intended...) the groping around from the front because you had enough room to work from the side of the chair.

    kathy
    shar pei mom
    kath, that's what i was wondering as well.

    op, seriously, have a 1:1 with her.
    listen to ea other's concerns/issues and see if you can negotiate something, i.e., using a commode.
    if she refuses to budge, then you have the support of your nm.
    let the 2 nm's duke it out betw themselves.

    redhairednurse, all i'm saying is you can't go around saying something's against the npa, when it isn't.
    in the meantime, i'll try to control being facetious.

    leslie
    agldragonRN and sharpeimom like this.
  13. Visit  agldragonRN profile page
    3
    i did speak to her yesterday. i was hesitant at first because i didn't want her to report me as confronting her. but i spoke to her professionally and she said she had no problem standing while inserting the suppository. her problem was i don't insert it at exactly 5pm. now this is the heavy med pass time to my 25 patients and she wants me to stop and give her the suppository. i was told during orientation that i am not supposed to stop my med pass even for treatments because that's infection control. isn't inserting suppositories like doing treatments or worst?

    anyway, i explained to her i am usually done in 2 mins. she said "yeah i know." so i asked her how come her former unit manager said that she was complaining to her. she said she did not say anything to her. so i think she says something different to us and to her old floor staff.

    i will try to use the bedside commode but i am not very hopeful because whatever she wanted, she got when she was on her former unit. and what the don said about "whatever the pt wants, we have to follow" makes me sick. so i don't think i can change the time either because she wants it at this time
    leslie :-D, sharpeimom, and systoly like this.

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