COPD and no BM for 40 days!

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Specializes in BNAT instructor, ICU, Hospice,triage.

Miralax then lactulose, fleets enema and no impaction felt with digital exam. Patient is not uncomfortable. Its bothering us more than it is the patient! She did refuse any treatment for quite some time. Finally convinced her to try the laxatives and enema.

This is a record for me, never had a patient go this long!

She's non-ambulatory for 2 months.

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Specializes in Hospice.

Have they tried relistar?

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Specializes in Medsurg/ICU, Mental Health, Home Health.

Not a hospice nurse by any means, but is it possible that there is some sort of obstruction? How is the patient's PO intake and what kind of opiods are being taken?

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Specializes in BNAT instructor, ICU, Hospice,triage.
Not a hospice nurse by any means, but is it possible that there is some sort of obstruction? How is the patient's PO intake and what kind of opiods are being taken?

She is passing gas, has good bowel sounds. PO intake is very little (mostly liquids) she weighs 68 lbs. No opoids until last night. We just started morphine. She has not been on anything except lorazepam.

Convinced her to let me give her an enema which she was totally against before but somehow I got her to agree. No results from that, did a digital exam, nothing felt in there either.

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Specializes in psych, addictions, hospice, education.

I'm confused....she's not uncomfortable...her intake has been very little and mostly liquids...why give an enema?

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Specializes in Nephrology, Cardiology, ER, ICU.

Why, if she is comfortable are you doing ANYTHING! Leave the lady alone, especially when you are talking her into procedures she doesn't want.

I don't mean to sound harsh. But this just seems like common sense to me.

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Specializes in Hospice.

I understand your concern ... obstipation/obstruction can be a nightmare.

However, your description leads me to believe that she may be entering the early stages of active dying or is, at least, close to it.

Therefore, I tend to agree with other posters that, given that she's not uncomfortable (no abd pain, vomiting, distension, etc.), continued aggressive measures don't make sense. If it was me, I'd just monitor closely for new symptoms and let her be.

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Specializes in psych, addictions, hospice, education.

I've been thinking about this since I posted my last thingie about it. Did the laxatives and enema bring any results? If she's not uncomfy, giving her laxatives and an enema will make her uncomfy. 68 pounds? I bet she has fragile tissue. You could perforate her colon with an enema, leading to a bleed-out. Please reconsider intervening if she's not uncomfotable.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

I agree with the others...watch her for discomfort and maximize her ability to pass stool if it can get to her rectum.

With active bowel tones and absence of other unpleasant symptoms in an otherwise comfortable hospice patient, I would be implementing the softeners and stimulants now that she is on the opiates and observing her closely for further symptom development.

Good luck.

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Specializes in Medsurg/ICU, Mental Health, Home Health.
She is passing gas, has good bowel sounds. PO intake is very little (mostly liquids) she weighs 68 lbs. No opoids until last night. We just started morphine. She has not been on anything except lorazepam.

Convinced her to let me give her an enema which she was totally against before but somehow I got her to agree. No results from that, did a digital exam, nothing felt in there either.

Sometimes the Medical nurse and the Surgical nurse in me fight, but both of them are freaking over my conclusion here - just let her be.

I am a fighter, and it is difficult for me to accept this rather than battle with it. However, if there is no painful process occuring...well...then what IS the problem? (Other than my inner bowel police wigging)

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Specializes in Hospice.

I don't know we would intervene.........and with more than just senna. The only time we don't actively treat opioid induced constipation is if they are actively dying. Like mentioned before at the very least I would try to get a one time order for relistor.

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Specializes in Hospice.
I don't know we would intervene.........and with more than just senna. The only time we don't actively treat opioid induced constipation is if they are actively dying. Like mentioned before at the very least I would try to get a one time order for relistor.

No opioids until "last night" ... non-ambulatory + almost no po intake also sounds very much like the earliest stages of active dying. IMHO, with nl bowel sounds, passing flatus, no n/v or abd pain, and no mention of abd masses/distension, I would respectfully disagree with getting more aggressive than tewdles' suggestion of softeners/laxatives and monitor for sx ... especially since the pt made her wishes clear (had to be talked into an enema). In the absence of opioids, relistor seems like an unnecessary expense.

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