COPD and no BM for 40 days!

[Vtachy1]

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.

[leslie :-D]

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.

i too, sense she'll enter dying phase soon (within monthish).

if she remains comfortable, maybe an enema once a week (only if no s/s.).

otherwise, as has been brought up, stimulants/laxative have their own set of distressing side effects.

don't take her word for it, if she denies s/s, monitor continually.

obstxn, is one of the most uncomfortable consequences of opioid-induced obstipation...

and takes aggressive action to reverse.

keep us updated?

leslie

[ErinS, BSN, RN]

I always wonder when this happens with my patients- are they having sneaky bowel movements? Maybe there is someone who has changed a bowel movement brief, but did not know to report it.

I am always torn when a pt has long term constipation- do we treat it before they become uncomfortable (which is my gut feeling), or do we leave them alone until they are uncomfortable (often what we do with someone who is actively dying, but then they rarely become uncomfortable with constipation).

Tough situation. Good luck.

[BethHospiceRN]

Chart well what you see and what pt says (lack of pain, bs present, pt preferences) and continue to closely monitor. I would hate to cause pt more discomfort. Good luck!

[lumbarpain, ADN, RN]

Sounds like Failure to Thrive. Or just a need for attention due to her illness which is completely normal....doesnt want to die alone and she is 68 pounds?

A simple xray may show some stool in the system but an ultrasound would be more definitive. Is she overly concerned about her stool passage or are you because you THINK she has to have a bowel movement every day at least.?

Has an ultrasound been done? what does the doc say? Is this a situation that has occurred before in her lifetime? History of constipation, bowel problems anything that would give you a hint about it. Review her chart, ask the family, primary doc. I go through all the motions to get an answer if you think she is constipated.

Also po intake? possible obstruction, mental issues, If all tests were completed for digestive problems and there is no infection present, mental issues, meds to blame, or other problems....most likely I would think its her low dietary intake, slow digestive process and it ends there.

[Vtachy1]

Thank you so very much for all your responses!! We did not intervene anymore, I had notified her doc quite a while ago. Patient did not want us to intervene, and she did pass last night. It was bothering us more than it was bothering her. Thanks again!

[lumbarpain, ADN, RN]

You are so very welcome. We nurses are special arent we? We have to be to be in this profession. So Sorry about your patient passing but she is in a great place right now and away from all that suffering and pain. If we as nurses werent concerned about our patients comfort and well being then we shouldnt be nurses. You were great in all this. Very caring and a great nurse.

[AtlantaRN, RN]

I currently have a lung ca pt w bone mets w a "normal" bm q9-19 days (YIKES). She has senna, miralax, something called enemeze (small suppositories she knows to use 3x a day prn. Sister wants her to go q2-3 days, but that is just not her reality. She is passing flatus. It is what it is.....Can't fix it, denies obstipation, won't let me check for an impaction.....