Bowel Routine/Protocol

fultzymom · Jan 21, 2008

Our facility uses a lot of Prune Juice if someone is constipated. We usually will start with that. It is not really part of our protocol but many of the nurses will give that first. I did have one little lady who insisted that she have a little serving of butter put in hers as she said that is what worked at home for her. But she was the only one who ever told me that. I can't imagine drinking that but she always requested it.

nightmare, RN · Jan 21, 2008

We have used psyllium husk but what can happen is that the stool becomes too soft and ,in frail elderly,they just can't expel it because there is no bulk.Problems can also arise if your frail elderly do not drink enough fluids as this can lead to bowel obstruction.We tend to use senna laxative,prune juice,lactulose solution and if these do not work well,glycerine or bisocodol suppositories or microlax enemas.Encouraging the eating of fruit and plenty of fluids helps as well.

Scrabbler · Jan 21, 2008

Most of our residents take Colace, Senna, Lactulose fairly regularly; of course, we know fluids and roughage are best, but for elderly folk who may have no appetite, may not get enough exercise, etc., what's simplest isn't always feasible...I tend to give prune juice to those I know are more susceptible to irregularities...but I cannot imagine putting butter in it--ew!!

LibAnne10 · Jan 21, 2008

We use a product by Hormel called Fiber Basic. It's used during the med passes and the residents really like it. Here is a link for more information: http://www.hormelhealthlabs.com/protocols_bowelmanagement.aspx

gt4everpn, BSN, RN · Jan 21, 2008

Lactulose, Miralax, Senna, Colace, Sorbitol, biscadol, dulcolax are used at my facility

pfongk · Jan 22, 2008

ours used are prunes, lactulose, coloxyl & senna, agarol, sennokot, metamucil, pear juice, ducolax, and various enemas/supposotories etc that I can't remember as I don't personally give them.

marjoriemac, LPN · Jan 22, 2008

We must be quite lucky, we have loads of folk on cocodamol etc but never have much of a problem with constipation. A few folk use movicol regulalry but we generally encourage to drink loads and take loads a fruit n veg!

IowaKaren · Jan 23, 2008

When I worked in the hospital, a CNA claimed the sure cure of 1/2 glass prune juice, 1/2 glass of orange juice put together and warmed was the way to go. I've taken that idea to the NH and it does seem to work and or help. Just call it a "hot toddy", haha. Anything before using 'scripts is good. Metamucil type products usually aren't good for the elderly d/t not drinking enough fluids, that's my opinion anyway.

Daytonite, BSN, RN · Jan 23, 2008

When I was working in LTC, I just worked with each patient individually to find out what worked best for them. Part of my assessment activities was to ask them (or their family) if they had had previous problems with constipation and what they did about it. You'll find you get all kinds of different answers. If the problem is easily handled by having dietary add something on a regular basis to their diet, then make sure the kitchen knows to do that and make sure you follow up on it. Make it an order on the chart if you have to so it's documented for everyone to know about. If you have to go to certain types of laxatives or bowel softeners, the same, make sure there are written orders so everyone is on the same page and not just you and God who knows about it.

CoffeeRTC, BSN, RN · Jan 23, 2008

Great response Dayonite! Sometimes it is as simple as the morning cup of coffee and assisting the resident to the toilet. Do drugs or magic fiber mix needed...just keeping with the routines that they had at home.

catslave · Jan 24, 2008

In addition to any scheduled laxatives, our bowel protocol goes as follows:

Day 1 - 4 oz of prune juice

Day 2 - 2 Tbs of BAP (a puree of bran, apples and prunes)

Day 3 - 30 cc of MOM

Day 4 - dulcolax suppository

MOM and dulcolax suppository require orders obtained upon admission.