What do you make of this??? I am a new LPN working at a SNF. Have a resident that for the past few days has only passed clear, odorless, mucous like bowel movements. (Heard it has actually been going on for at least a week, he's not my resident) No diarrhea, no vomitting and pain has been hard to nail down because he is forgetful and often has pain. I immediately think bowel obstruction. I palpate his abdomen. He has a large, solid feeling mass in the upper right quad. He is a rather large man. Further research in his chart reveals that he has been losing weight steadily the past few months, however this month has gained almost 15#'S. No bowel sounds around mass but other quadrants have sounds. The Dr. is phoned and he absolutely does not think it is a bowel obstruct. He orders a KUB and enulose 30ml now (this was yesterday( and 30 ml BID. Today the results come back that show there is a possible volvulus. We send him to the hosp. where they do an xray and a cat scan (with the swallow). They send him back and say he needs more fiber, there's nothing wrong, colon may be a little looped. Within a couple hours he has a bowel movement. It is now mucous, oily tinged brown. (obviously the enulose is seeping passed carrying a little feces.) He has had intestinal surgery before so I figured there is an adhesion causing the blockage but the hosp. Dr. says no, nothing to worry about. Send back when he has pain etc. Abdomen is still hard. What the heck is going on? I like this guy, he's not that old. Could it be a paralytic ileus? Has anyone seen this? Does anyone else think this is a big deal? Or am I just paranoid? Any insight is appreciated. I always learn from this group. thanks
