what is your facility protocol?

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Specializes in LTC.

I have a resident who refuses to get out of bed, refuses to eat anything other than magic cups and drink strawberry glucerna. He is on a mechanical diet with nectar thick liquids. Once in a while he will eat and drink things his family brings him in that are totally off limits to him d/t being diabetic and based on his MBS and ST. Here is the problem he is unable to have a BM this is a continuing problem. He gets 30 mls sorbitol nightly and just about every day his wife comes in and wants him to get a suppository or to get an enema. We have been round and round with her about this.:banghead: So the other day I give him the enema and we sit him up on the BSC and he is just sitting there and nothing. After he has sat there 20 minutes and is now demanding to get back in bed I attempt to manually remove, all I can reach is two very small hard balls of fecal matter. There is more I just can't reach. So now he is back in bed and I am having a conversation with his wife, these never go well. She proceeds to tell me that the reason he can't have a BM is because of all the thickener that he consumes is causing his stool and his saliva to thicken up.:stone I pretty much had to get out of that room right then cause if I didn't I just may have had to :chuckle.

So anyway what would any of you suggest that we do to help him along?

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Specializes in Ortho, Neuro, Detox, Tele.

How about asking for some go-lytely... mag citrate, etc.....that go-lytely works wonders on colonoscopy bowel prep patients..I have people up all night going poop! (people falling asleep pooping on the commodes...) good times....

Seriously, why not try something else....Also, is it possible that due to not EATING a balanced diet, he could be getting impacted and not having good intestinal motility? just a thought.

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Specializes in Psych, Med/Surg, Home Health, Oncology.

Fleets phospho soda is also good as well as lactulose;

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Specializes in Peds HH, LTC.

we have specific bowel protocol in our facility.

On the people that are always on it, I start w/warm prune juice. This works most of the time.

However, our protocol is:

On evening 2 w/no BM, our kitchen has this mixture of blended prunes, applesauce and whipped cream that we give a medicine cup to (30 cc size).

Day 3, milk of mag

Evening 3 - suppository

Day 4 - fleets

then call MD if still ineffective.

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Specializes in LTC.
How about asking for some go-lytely... mag citrate, etc.....that go-lytely works wonders on colonoscopy bowel prep patients..I have people up all night going poop! (people falling asleep pooping on the commodes...) good times....

Seriously, why not try something else....Also, is it possible that due to not EATING a balanced diet, he could be getting impacted and not having good intestinal motility? just a thought.

I wish that someone could get it through to his wife that if you don't eat a variety and if you refuse to move around that things are going to stop up.

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Specializes in LTC.
we have specific bowel protocol in our facility.

On the people that are always on it, I start w/warm prune juice. This works most of the time.

However, our protocol is:

On evening 2 w/no BM, our kitchen has this mixture of blended prunes, applesauce and whipped cream that we give a medicine cup to (30 cc size).

Day 3, milk of mag

Evening 3 - suppository

Day 4 - fleets

then call MD if still ineffective.

We have the same protocol minus what you all do on day 2. Problem is he won't drink the prune juice/milk of mag and usually wants to go straight for a fleets or a sse.

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Specializes in Peds HH, LTC.

some of my residents receive 2-cal, so I will usually put the MOM in that. You can try putting the MOM in his healthshake, if you know that's what he drinks all of. Just a suggestion.

I have a couple residents who are completely with it and will wait until evening 3 for the suppository, and will not take anything before then.

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Specializes in LTC.

A fair percentage of older folks are OBSESSED with bowel movements. No amount of teaching will shake their convictions there, these are practices that have been in place for decades. That being said, the wife must have heard from one of her buddies that thickener causes stool/saliva to "thicken" as well. (Snort!) It would likely take an act of congress to convince her otherwise because afterall, "Eunice" has never steered her wrong. Most of our people are on Senekot BID, along with Metamucil and a stool softener.

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Specializes in Geriatric/Psych.

My first question is: is he taking his medications? Our protocol is 2nd day MOM, 3rd day supp, 4th day enema. Have you ever done a Mayo Clinic enema....those work like a charm! It is Baking soda and sugar and warm water :)

I would add something to his routine medications. Our protocol is 2 Senna Bid and 1 tbspn Lax loaf (applesauce, prunes, figs and senna leaves) if not better we add DOSS, if not better we add Miralax.

As far as the wife is concerned, have you tried giving her literature on "reality" of bowel movements? I know sounds funny, but try like WebMd and print her off some stuff. Helps me with some families.

Oh, and have we tried adding fiber to his magic cups or shakes? Ask his wife if she'll bake him some diabetic brownies with prune puree. Yummy! :)

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