About I an O's

leslie :-D · Oct 19, 2007

bm's vary from person to person.

you need to find out what is usual for your pt.

nsg interventions usually begin, when a pt hasn't had a bm for 3 days.

if their po intake is less than usual, i would check for constipation.

when is the last time your pt had a bm?

a quick digital will reveal stool in the rectum.

your second question is a little more vague.

does this pt has a med'l hx of dysuria or urinary retention?

is it a current issue or one that happened long ago?

if current, then yes, you need to ascertain that he is urinating.

check for bladder distention.

is fluid intake adequate?

again, communication is everything.

often, the nurse has to actively assess, and not wait for pt c/o.

best of luck.

leslie

Zookeeper3 · Oct 19, 2007

hmn a bit more complicated in my ICU environment because we have surgery, sedation, npo, paralytics and such with multisystem stuff that immediately shuts down the gut. So with this in mind bear with me as I try to help.

3 days no poop with a minimal intake of roughage equals minimal poop. Now, assuming NO narcotics have been given to slow the gut down, try the old warm prune juice (order from dietary, 3 of 'em). Get the docs on day 2 to order colace or pericolace (should be standard on day 2), MOM on the NIGHT of day 2 no poop to get a stool on morning of day 3, day 3 equals enema and a bit of a "search" for impaction, maybe an abdominal flat plate and a reglan 5mg Q6hr order (increases peristalsis).

URINATION- well we have a rule of thumb, non surgical that 30cc/per hr must happen. Even if no I&O ordered, it is nursing judgement to do this and get the order on the next shift (to make the "lazy" nurse do it.. sorry). Now on the floor, I'm assuming I&O are tallied every 8 hours. So if No pee, immediate check on last shift I&O as to how much and if possible when, (ask the patient if you can).

If more than 8 hrs. has passed, no urine and you've done all the threatening the foley, running the water trick... you've a retention problem and the doc needs to be called. Even if your order is to straight cath, bring in all the supplies for the foley, because if you've greater than 500-600cc in the bin, you need to attatch the bag and call the doc and ask if they'd like the foley left in. (you leave the balloon shortly inflated for the call, d/c it if ordered removed, leave it as it most likely will stay. ((you saved your time and trauma to the patient by choosing a different catheter with a balloon)). Why straight cath, only to have to do it again for a foley.

Some units on the floor have the bladder scanner, if yours does not, ask your charge and supervisor if you can borrow it, it will guestimate very accurately how much is in the bladder if you're uncomfortable with switching foley's (new nurses are, no worries).

Retention is a very serious issue, it causes urosepsis, and urosepsis causes many complications and death in our elderly, it cannot be ignored.

So always call with concerns on retention well before you leave shift with 8hrs of no voiding.

I think I understand your issue here, and think your preceptors, clinical ladder people or clinical educator need to work with your fellow staff and implement a house wide bowel and bladder program... A huge undertaking... but many nurses have the same issues, how simple it would be to follow a written protocol, with orders to provide the best care... be warned this is about an 18 month process and sometimes never happens but parts and pieces and policy changes occur. If interested offer to become part of the process. It's a great learning experience especially for someone like you who wants the best care for their patients.

zooey