bowel obstruction?!?!

Specialties Hospice

Published

I have a 93 y/f patient with a moderate ileum. Recent abd. x-ray showed no obstruction (she was cleaned out in the hospital), docs said she would not survive surgery. Lots of right-side abd. pain - loose stools, dysphagia, emesis, increasing weakness. Scheduled MS contin and PRN Roxanol, levsin (bowel spasms), phenergan PR PRN, what else should I be thinking here? Bowel sounds are distant. Thoughts?

Higgs

109 Posts

Specializes in Med/surg. ED. Palliative. Geront.

terminology question - moderate ileum? What's that?

Well, whatever it is, with all the loose stools, dysphagia, emeisis and the like she wont be taking or absorbing any meds, try and get her switched to subcutaneous where possible..

She will certainly need fluids of some sort - depends how 'aggressive' you want to be. Subcutanous fluids are good and work well.

levsin - not heard of that one, but buscopan works well.

Also octreotide subQ to help slow down intestinal juice secretion.

We find nozinan (6.25mg to 12.5mg) and haldol (0.5 to 1mg) really helps with nausea - both subQ

If she is terminal, bowel sound are not so important, really.

As for the loose stools, just lots of changes and barrier cream to stop excoration.

Good luck, I hope you help her.

Kymmi

340 Posts

Specializes in CVICU-ICU.

"Subcutanous fluids are good and work well" ??????????

Higgs

109 Posts

Specializes in Med/surg. ED. Palliative. Geront.
"Subcutanous fluids are good and work well" ??????????

In palliative care, where appropriate, yes.

Do you have experience otherwise?

Kymmi

340 Posts

Specializes in CVICU-ICU.

Not in palliative care so I didnt make any suggestions I was just questioning what sq fluids were because I've never heard of that and was wondering if you could explain how sq fluids work....maybe I am misunderstanding but I assumed you were referring to fluids for hydration and I do not understand how sq fluids would hydrate.........I didnt mean to seem condensending I guess I should have asked it this way instead of just with question marks...sorry about that but I am interested in knowing the therory.

I work critical care and have honestly have never heard of sq fluids.

Higgs

109 Posts

Specializes in Med/surg. ED. Palliative. Geront.

Is ok, I didnt read it as condesending, dont worry. I thought that you'd maybe used it and it wasn't such a good thing for your pts.

To save me a load of typing, follow this link http://www.aafp.org/afp/20011101/1575.html

and have a read.

Hypodermoclysis is the posh name for it. There's no way of predicting how much fluid per hour for an individual - some can tolerate 100ml an hour (!) and some can only tolerate 10ml - it's a matter of trial and error, ultimately.

I'm guessing you're on night shift too? :)

Cheers.

Kymmi

340 Posts

Specializes in CVICU-ICU.

Oh yea....nightshift also :)

I will give that a read when I get a chance but for now its time to go home!!! :)

I am very interested because I am used to seeing IV infiltrates (which would make them sq fluids) and all that causes is loads of problems so this is interesting to me....thanks for the info.

Sleep Well!!!!

Higgs

109 Posts

Specializes in Med/surg. ED. Palliative. Geront.

No worries.

Have a good sleep - I still got 3 hours to go...*yawn*

jerseyRN

140 Posts

Using levsin all the time but never heard of buscopan. Ditto for nozinan. As for the octreotide, it makes sense, but it's a pricey drug. Which makes me wonder.... are you practicing in the US?

I might consider ABHR (ativan-benadryl-haldol-reglan) supp or gel for the N/V (leaving out the Reglan if there's evidence of obstruction). You can also add "D" - decadron to this compound... sometimes that will help if there is obstruction, depending on cause.

Like compazine better than Phenergan. Have a hard time finding phenergan nowadays anyway.

If this lady is a hospice patient, I wouldn't be quick to give IV or SQ fluids unless that was the only option to relieving the nausea. Does she want things possibly prolonged, or simply symptom mgt?

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