Bowel care basics...what makes sense?

[scootermcnutt, RN]

Just wanted input from other nurses on bowel care on post-op pts. Often, total hips. What I see most often are: bisacodyl tabs or supps, mom, colace or pericolace or fleets enemas or metamucil. Frankly, I'm never sure what to use when. If I get a post op, I generally order colace po bid right off the bat as prevention, but what next if it doesn't work? Or, what about when you come across a pt who is post-op day 3 or so and no one has started any bowel care, where do you start and how do you progress? I sort of fly by the seat of my pants and I need a better plan. Thanks.

[tiger]

i like to use mom the first morning i have the pt. if no bm by the evening, try a supp. if no results i give mag citrate or another shot of mom. depending on how many days with no bm. mag citrate usually does the trick. janet oh, and of course the stool softeners

[Huganurse]

We have standard orders for a bowel program.

[JenMarie]

I worked for a while on an oncology ward that I thought had the strangest protocols. I guess because of morphine and other pain relievers that are so comon at causing constipation. They were always charted on strong laxative medications and if they didn't work we used to give 20 mls of olive oil using a rectum tube in the evening and then follow this up the next morning with a fleet again using a rectum tube.

Anyone else done anything similar?

[TracyB,RN, RN]

About 2 ounces of warm prune juice works wonders.

[P_RN, ADN, RN]

it depends on the patient and the "reason" for no bm. many post op ortho patients develop an adynamic ileus due to the long surgeries and the pounding... especially total hips.

you need to check the bowel sounds.and you may even need decompression by ng tube if there is distension (per md order of course.)

if no bm by pod 2 then check for impaction, then a dulcolax suppository and fleets enema prn.

of course loc...usually mom... daily, and stool softeners with sufficient liquid intake.

i give my 30-60cc mom in a cup of about 200 cc of warm water (dilutes the taste, gets liquid in) followed by 2 more cups of water. it almost always works.

i don't like metamucil , because it turns to sludge if they don't drink.

then there are the dy-no-mytes of mag citrate or phospho-soda.

and then there is the atom bomb.......240 cc of milk and 30 cc of molasses given as an enema........no body stays constipated after that.

the milk and molasses enema was used by one of our orthopods whose mother was a nurse and she said her mother always knew best!!!

[NRSKarenRN, BSN, RN]

IMO, all rehab/LTC/post surgery patients should have standing orders for a bowel program, in this day and age! Good topic for a Quality indicator audit. Like P-RN advice too.

What is affect of surgery or advanced elderly age? Decreased peristalsis of bowel.

What will help increase peristalsis? Irritant like roughage: fruits + fiber, laxatives or mobility.

Assess GI: check bowel sounds, distension, patients prior BM pattern and any GI meds taken/bowel regimen in past--use whats worked before prior to trying something new.

Active ingredient of Colace (docusate sodium) + Surfak (docusate calcium) is a stool softener, minimal effect to push stool bulk out.

Better choice is a laxative or laxative with softener:

Surefire choices from 25+ yrs in nursing

1. Senna concentrate with docusate sodium: e.g. Senakot S(laxative plus softener)...I get CVS brand for Grandmom $10.00 cheaper. Liquid version is Fletcher's Castoria. Good for narcotic induced constipation, used as many as four tabs BID

2. MOM

3. Warm prune juice 1-2 oz.

4. Biscodyl tabs

5. Mag Citrate or Phospho soda

6. Lactulose (many pts won't take as too sweet...don't use with diabetics).

7. Fiber powders + tablets: Ok if client used in past, many pts don't drink enough fluids afterwards or only drink half dose.

Good LTC recipie is equal amounts applesauce, prune juice and bran mixed together. Start with 1 tbsp BID, increase 1 TBSP at a time after two days: 2 tbsp AM, 1 tbsp PM...2 days later 2 TBSP BID....if no result try 3 tbsp AM, 2 tbsp PM...etc ---most patients will be regular with this regimin.

Enemas:

Fleets---if hard balls use Mineral oil enema: Snake rectal tube or old foley cath up past impaction to deliver enema.

Soap suds

Dynamite: Milk and Molasses Enema (never failed me, too!) I've used equal amounts: 1 cup milk + 1 cup Brear Rabbit Mollasses (favorite as dark n thick)...mix together in saucepan on stove till well blended then cool to room temp : check temp on inside of your wrist.

Tombstone epitaph: Have glove + lubricant, will travel!

[Kidagora]

I saw a med combo during clinical and was curious so I found this thread hoping someone might be able to clue me in and help explain the details.

A patient is on 100mg of docusate sodium (t.i.d.) and 2 tabs of doc-q-lax (q.d.).

Is the docusate sodium the same docusate used in doc-q-lax? I couldn't quite understand why two different types of docusates were being used. If they're the same and one just has the laxative, is there any reason why there aren't separate orders for a stool softener and a laxative? Is it just a doctor's preference or specific to the patient? A classmate suggested that the docusate sodium might draw more water in than the other (because of the osmotic properties of sodium) but I thought it's just a surfactant, not a osmotic agent.

Also, is there a difference in effectiveness between docusate sodium, calcium, and potassium? Is there any reason why one would be used over the other?

Any help is appreciated!