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? 

On 4/22/2021 at 1:15 PM, JBMmom said:

It seems to me that maybe one person documented a "powerful bowel movement" for whatever reason they thought it was appropriate and then others thought that was maybe a good description and have copied it. I would not think that is the best descriptor, as others have mentioned the Bristol stool chart can be important and a documentation of the relative amount of stool. Maybe your educators can come up with some standard wording around this issue. 

Totally and utterly disagree! There is nothing on that chart for powerful bowel movements? What does it look like ???? Does it smell powerfully???? Can you smoke ???? 

New chart needed ??????

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TriciaJ said:

The only time I could describe a BM as "powerful" would be when I worked psych.  We would routinely receive overdose patients from the ED where they had received charcoal and Ipecac.  Projectile vomiting and projectile diarrhea would ensue.  We often found ourselves washing walls.

Of course no one thought to use the word "powerful".  It's not a good descriptor generally and your staff should be discouraged from using it.  We didn't have to describe the stool or emesis; both looked exactly like the liquid charcoal the patient had previously been given.

Bet those patients didn't know if they were coming or going ?????? 

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On 4/25/2021 at 3:15 PM, amoLucia said:

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

Why are you dragging geography into this ????? And that's an insensitive statement saying someone had a powerful bowel movement the size of a continent ?????

On 4/26/2021 at 12:56 PM, sleepwalker said:

"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

Bet you can't say that three times really quickly? ???

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Gillyboo said:

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. 

OMG ???

CalicoKitty said:

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!

Do you have to hold on to anything in case of liftoff ?????♨️♨️♨️? 

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Specializes in Psychiatric, in school for PMHNP..
On 4/24/2021 at 12:49 AM, cardiacfreak said:

I have used "explosive" before.  The patient was having diarrhea and when he went to sit on the BSC it just came out full force, spraying all over the room.  As a hospice nurse we are taught "to paint a picture of decline" explosive was as descriptive as I could be!?

I have also charted something similar, like “large, watery, explosive diarrhea”.  It is a running joke in our family too, when we don’t want to do something.  I was going to go to the gym and work out but I had explosive diarrhea.  

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Specializes in Occupational Health.

anyone else ever administer a molasses and milk enema?

the results were usually "powerful" and NAAAASSSTYYY!

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Specializes in retired LTC.

Oh yeah! The old M & M enema!

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Specializes in Rehab/Nurse Manager.

Today's new one: Resident had an "explosively powerful eruption" ???

 

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Specializes in Vents, Telemetry, Home Care, Home infusion.
On 5/3/2021 at 11:10 AM, sleepwalker said:

anyone else ever administer a molasses and milk enema?

the results were usually "powerful" and NAAAASSSTYYY!

Given quite a few M+M  enemas in my career ---does not work via PEG tube in client with Parkinson's who is rigid immobile---but worked via rectal admin been my experience.

 

 

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On 5/3/2021 at 11:10 AM, sleepwalker said:

anyone else ever administer a molasses and milk enema?

the results were usually "powerful" and NAAAASSSTYYY!

While on a travel gig, I had a handwritten order for this.  I assumed I read it wrong, and thought I would bust the doc's chops by saying "So your order appears to say 'milk and molasses enema'.  What did you really want?"

Sure enough, in the break room was molasses, containers, and microwave instructions.

I no longer eat molasses.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

P.S prefer Brer Rabbit over Grandma molasses as higher blackstrap molasses content thus better peristolic action.   Grandma for cookies!   ?

 

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NRSKarenRN said:

P.S prefer Brer Rabbit over Grandma molasses as higher blackstrap molasses content thus better peristolic action.   Grandma for cookies!   ?

Sounds like a blast ?????? 

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