Contraindicated?

Sun0408, ASN, RN · Apr 20, 2016

Why would you give Imodium if they have issues with constipation??? I wouldn't give it without knowing all the background information.

Danielle12684 · Apr 20, 2016

Pt. Was given suppository and Milk of Mag for constipation d/t narcotic pain meds. Has had large loose stools for 48 hours (10 on day two). Would it be safe to give the imodium after a certain time frame? Bowel sounds active. Abdomin non-distended.

enuf_already · Apr 20, 2016

Patient could actually still be impacted and leaking liquid stool around the impaction.

Is the patient still on narcotics? Are they aware enough to feel like they still need to go? How long has it been since they last went before the suppository and MOM? Does the patient have a history of diarrhea?

As a previous poster said, without having more information, it is impossible to know. It's not a simple yes or no answer.

heron, ASN, RN · Apr 20, 2016

What do his bowels sound like? The last time I saw opioid related small bowel obstruction it presented as diarrhea. Maybe time for a KUB.

Danielle12684 · Apr 20, 2016

It was a discussion so I don't have all details but no history of diarrhea, pt. Unaware of last Bm prior to interventions. Bowel sounds were active, non-distended Abd (which had been firm, and distended prior to interventions). No longer on narcotics as they were PRN and given due to c/o pain in ABD..

Basically, the nurse who gave imodium (per pt. Request) was told it could be cause for reprimand due to risk of impaction. I guess my question is this always a "no no" or is it situation based?

Note: in this case an abd scan ruled out impaction and the imodium didn't stop the diarrhea. I'm just curious if there is a guideline.

Karou · Apr 21, 2016

Did anyone ask the physician about the Imodium? Was it something the doctor intentionally ordered, or was it part of a standard order set and perhaps overlooked?

If I had a patient admitted with constipation who then developed diarrhea (still taking narcotics, right?) I would be extremely hesitant to give an anti diarrheal agent even if specifically approved by the physician. This patient is still at risk for constipation. Narcotics, nearly resolved constipation, probably less mobile than at home... Despite current diarrhea the pt is still at risk

I would explain my rational for not administering it to the patient, discuss with the physician as appropriate, and encourage increased fluid intake to prevent dehydration.

Sun0408, ASN, RN · Apr 21, 2016

It's a back and fourth situation. MOM and the suppository was given for constipation. It worked even tho I question the loose stool and then the other end of the spectrum was given to stop the excessive stool. It's a yoyo. I would have waited a few days before adding Imodium. One to make sure he is not impacted and two to get everything backed up, out.

Perf bowel is no joke and yes it can happen with constipation.

Danielle12684 · Apr 21, 2016

Thank you. Very useful.