Coworkers Reporting Powerful Bowel Movements

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At our facility, we've had a few bowel obstructions.  As such, we've all become hyper aware of bowel movements.  One thing I've noted is that some will chart "Resident had a powerful bowel movement" I'm not sure, but don't recall being taught in nursing school to document a bowel movement as being "powerful."  What are your thoughts on this? Does this make sense or does it make us sound uneducated when we document lime this? 

Specializes in Rehab/Nurse Manager.
MPKH said:

If you do not understand something your staff has charted, you should speak to whoever charted the unclear statement and ask for a clarification. If you do not deem the charting to be professional, you, as the manager, can implement changes. You, as the manager, can also set guidelines on the unit's charting.

I looked into it, and the staff members charting this way were using the word "powerful" to describe how large and loose the bowel movements were.  They were also using the word "powerful" to mean "explosive." 

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Specializes in retired LTC.
On ‎4‎/‎23‎/‎2021 at 9:19 AM, hppygr8ful said:

I just love that you used the Bristol Stool scale. It is a powerful teaching tool. In answer to OPs question I don't think "Powerful" is the best descriptor for a bowel movement. The way we used to chart it in the LTC rehab was "Patient had a (small, medium, large), (hard, soft, liquid) bowel movement. In California this is the way the the State inspectors like to see the documentation."

Hppy  

The only thing I can see a need to explain is if the BM is very 'quick'' or if the pt has to bear down & strain to start the peristalsis.

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Specializes in retired LTC.

Also, how does one communicate that the pt was continent or incontinent?

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Specializes in Pediatrics, Pediatric Float, PICU, NICU.

I have a powerful bowel movement most times when I read your posts, SilverBells ?‍♀️

Anyway, powerful really isn't the best description to use when describing and documenting a bowel movement. You knew that already though. 

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Specializes in Occupational Health.

"powerful"...faster than a speeding bullet; able to clot a toilet in a single flush

Arch Nemesis: Metamucil Man or a really well-made plunger

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Specializes in Rehab/Nurse Manager.
1 hour ago, JadedCPN said:

I have a powerful bowel movement most times when I read your posts, SilverBells ?‍♀️

Anyway, powerful really isn't the best description to use when describing and documenting a bowel movement. You knew that already though. 

Ah, well...I suppose I did.   

I was just curious how other nurses felt about bowel movements being documented as "powerful" 

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Thats messed up... excuse the pun!

For real... these are your co-workers? I can see why you had some other concerns. 

I was taught to just keep it simple:

Small, medium, and large

Loose, soft, normal, and hard.

Small is a little relative, but generally anything thats like about the equivalent to maybe a half of a plum worth of fecal matter. 

Anything less than about half of a plum, like if its one grape sized ball of hard poop, we don't count as a BM, because the person is obviously very constipated, and recording a too small non- BM passage of a ball, keeps them from getting their suppository in time, and thats dangerous. 

The next size up I guess is the plum sized poop. Thats about average, so thats medium. 

Anything thats, you know, enough poop to fill two plums, is a pretty big bowel movement. 

We didn't get any official training on small medium and large, but thats basically how we figured it out, size wise. 

Hard poop is hard and usually comes out in little or big balls. Thats constipation. 

Normal poop consistency appears malleable, like play dough, may have a slight sheen to it, and doesnt look like it will slip through a colander, if that helps someone to describe it. 

Soft poop that is nearly diarrhea looks soft, can be almost pretty slimy, and shiny but seems to have some shape to it still, but it doesnt hold its shape well. It looks a bit like whipped chocolate mousse (pudding and whipped cream whipped)

Loose stools are definitely watery and runny, like someone spilled a chocolate shake. It can have some chunks of more solid stool in it, but it still counts as loose. Thats diarrhea. 

Anyways thats how we learned it and I am only using food references because most people can identify food items. 

Maybe make a chart of your own at your station, and ask everyone to look at the chart and to just chart the BMs as they should. 

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Specializes in Med-Surg, Geriatrics, Wound Care.

There used to be a website "rate my poo".. I can imagine "powerful" being a descriptor of some of those photos. Sometimes I have some "powerful" stools since Metformin likes to get me on the throne quickly... So, yeah, I imagine powerful involving some sort of force, and perhaps splashing... Hopefully in the bowl!

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Specializes in Psych, Addictions, SOL (Student of Life).
11 hours ago, CalicoKitty said:

Sometimes I have some "powerful" stools since Metformin likes to get me on the throne quickly... So, yeah, I imagine powerful involving some sort of force, and perhaps splashing.

I feel your pain as I take metfartmore as well

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On 4/21/2021 at 11:29 PM, SilverBells said:

At our facility, we've had a few bowel obstructions.  As such, we've all become hyper aware of bowel movements.  One thing I've noted is that some will chart "Resident had a powerful bowel movement" I'm not sure, but don't recall being taught in nursing school to document a bowel movement as being "powerful."  What are your thoughts on this? Does this make sense or does it make us sound uneducated when we document lime this? 

You are the best! I bow cravenly to you. What a topic! I don't know what the others are saying but don't change. I really love your posts. ??????

Powerful bowel movement ????♨️???

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On 4/21/2021 at 11:29 PM, SilverBells said:

At our facility, we've had a few bowel obstructions.  As such, we've all become hyper aware of bowel movements.  One thing I've noted is that some will chart "Resident had a powerful bowel movement" I'm not sure, but don't recall being taught in nursing school to document a bowel movement as being "powerful."  What are your thoughts on this? Does this make sense or does it make us sound uneducated when we document lime this? 

You are the best! I bow cravenly to you. What a topic! I don't know what the others are saying but don't change. I really love your posts. ??????

Powerful bowel movement ????♨️???. 

Just wondering, do you need an extra strength toilet bowl for a powerful bowel movement? ????????????? 

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NRSKarenRN said:

One of the important aide functions  in SNF/Rehab is recording bowel movements since constipation significant issue in the elderly.

Sounds like an in-service on Bowel documentation needed including use of Bristol Stool chart + language describing stool. include need to notify Charge nurse of ongoing constipation/diarrhea.

image.thumb.png.c67c6f06c3aa7be50792ddb00d8a6b4b.pngAmerican Nurse Today Jan. 2015

Refining stool consistency descriptors can help prevent adverse outcomes

Might be a good project for your final MSN classes. Contipation is a real concern due to side effects of medications, especially narcotic meds post op/l ong term use.

When I worked SNF eons ago,  Many residents responded well to this Constipation recipe --made up by the kitchen, dished out with bedtime med pass -- 1 to 2 tablespoons standard dose, Prevented bowel obstructions.

That sounds like a recipe to orbit the planet ?????. 

Who needs rocket fuel ??????⛽⛽

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