Constipation - Need ideas...

nckdl · Jul 12, 2008

At my nursing home we had a concoction made up called "power pudding" its a mix of prunes, whip cream, applesauce, bran in equal parts and blended into a pudding mixture. It is supposed to help regulate their bowels. I think we started residents out on 2-3 tsps daily until regular the cut them back (depending on the resident) to 1/2-1 tsp daily. We give this to residents who are regularly constipated, it could be worth a try. you might want to do some research just in case i forgot an ingredient. (our kitchen mix it up) I hope this helps.

nightmare, RN · Jul 12, 2008

First of all,does she drink a lot of fluids? This is very important in keeping stool from becoming too hard especially in a warm environment.We use Fybogel granules as well to keep things moving but again,this only works when they drink plenty.Has a medication review been done to check for the side effect of constipation? The pattern of several days constipation then diarrhoea suggests 'overflow',liquid faeces passing the hard faeces.What she needs is to have that hard stuff softened so that she does not impact.

You say she has physical limitations,if she can be mobile several times a day this will also help to move things along as exercise stimulates the gut along with eating plenty of fruit and veg.for fibre.

nick98 · Jul 13, 2008

Our pt's get Colace 100mg BID, 17.2mg senna @ 12pm and Miralax every other day. Some also get supp. every other evening as needed :rolleyes:with everything else. We're pretty good about not having pt's constipated. I also agree with the other poster about Fluid. Hope that helps.

Skeetersmom119 · Jul 13, 2008

I have been a LPN for a year, but I am also a Certified Dietary Manager (can run the kitchen, do everything that the Dietician can do but sign "RD" LOL). I have found that from both professions, MOM chased with warm prune juice did quite well. If she has hemorrhoids, have them order her something (i.e. tucks suppositories) for about a week. Raisin Bran cereal is good too. I have a resident that had to get an enema weekly due to constipation. When I requested lactulose 30cc q day , he has not had to have an enema since. He does take two senna tabs in the morning. You can also try sorbitol. They help with the motility. :nurse:

cmonkey · Jul 13, 2008

Can she eat cherries? I'm taking prenatals *and* extra iron and eating about a cup of fresh cherries a day and I couldn't be constipated if I tried. Good point for any other preggos out there. :up:

kcochrane · Jul 13, 2008

We have the same routine...colace and senna daily. We also have liguid fiber bid or tid. For the really tough ones, we do the bisacodyl supps three times per week with maybe MOM every other day. I agree that sorbitol and lactulose are other options too.

santhony44, MSN, RN, NP · Jul 13, 2008

At my nursing home we had a concoction made up called "power pudding" its a mix of prunes, whip cream, applesauce, bran in equal parts and blended into a pudding mixture. It is supposed to help regulate their bowels. I think we started residents out on 2-3 tsps daily until regular the cut them back (depending on the resident) to 1/2-1 tsp daily. We give this to residents who are regularly constipated, it could be worth a try. you might want to do some research just in case i forgot an ingredient. (our kitchen mix it up) I hope this helps.

I knew of a nursing home which used something very similar to this. I think it was bran, applesauce, and prune juice. The residents got I think 1-2 tsp. twice a day. Most took it very willingly and very few required any other interventions for constipation.

Tash4nvyblues, RN · Jul 13, 2008

I agree, your grandmother needs plenty of fluids and plenty of high fibre foods. I would be asking some questions at the home to see what meals are being prepared and how much access there is to fluids. I have worked in two nursing homes, with completely different bowel regimes. The first one had unlimited access to water and the water jugs were freshened twice a day. The clients also had a high fibre diet with plenty of fresh fruit and veg (not frozen). Hardly any laxatives were required and incontinent episodes of both urine and faeces were kept to a minimum. The second nursing home restricted fluids to six glasses a day maximum. The reason for this, was to decrease the use of continence aides as too much money was being spent on pads, isn't that disgusting. As a result of this and a low fibre diet, UTI's were frequent, faecal incontinence was extremely high, related to overflow. The constipation caused pressure on the bladder causing an increase in urinary incontinence and every single resident was taking multiple laxatives. Which nursing home works better, I wonder. So do your self a favour, investigate the facility before increasing the medication. Good luck

Tash4nvyblues, RN · Jul 13, 2008

Sorry, I have no idea what MOM means, I am sure it is very simple.

OklaLPN · Jul 13, 2008

MOM is milk of magnesia.:wink2:..

Meraki · Jul 13, 2008

Thanks all...

I think some of the concoctions you have mentioned along with keeping a closer eye and intervening sooner might be a good plan. She certainly does not have a high fiber diet...she eats very little and they only serve very processed, canned, frozen food, nothing fresh really at all. She has a really hard time chewing but refuses to take any minced food so she only eats soft foods. I do occasionally give her applesausce when she's constipated but i think i need to start doing that on a more regular basis. The home is pretty good at encouraging fluid intake in that she gets a cup of fluid (juice or water) at all meals and at two snack times. (Although I'm not 100% sure she always drinks it.) She also keeps a water bottle in her room and drinks at least one and sometimes two a day.

As to the fiber...there was some concern about a high fiber diet due to the past obstruction..I think she has a lazy bowel too...need to do some reading on how to retrain it.

Someone also mentioned UTI...she pretty much has what they tell her is a chronic UTI. They treated it with antibiotics for awhile but now just have let it go. She has a lot of pain with urination which they have given her a cream for however I doubt she gets much of it in the right place as she can barely bend. I know UTI's can play a part in incontinence...they (med staff at home) have pretty much given up treating the UTI as it didn't seem to respond well to anitbiotics anyways and just came back. I bring her cranberry juice at times...any other non medical interventions that might aleviate some of ther urinary discomfort?

As for mobility...she is primarily in a wheelchair although she can ambulate with a walker from her chair to the bed (maybe 10 - 15 steps is her max) so she gets very little exercise.

Great ideas...keep them coming!