Fecal impaction treatment

amoLucia · May 17, 2015

I think a point is being missed here. It has been asked what else can be done for constipation issues BESIDES changing her constipation-producing pain med management.

Like how about increasing fluid intake?

Like how about including fiber-rich foods into her diet?

Like considering some physical activities to promote improved bowel motility?

Any Colace? Metamucil? Or other regularly administered laxative?

These are basic fundamental approaches which should be in nsg texts. They are also approaches that ANYONE in the general public can undertake at home.

And just for a point of interest - manual disimpaction is SEVERELY frowned upon by some survey teams. It is considered undignified, risky and not needed as proper bowel management should be maintained.

It needs to be care-planned for this pt. And if this facility is LTC, it probably is triggering the MDS process.

allnurses Guide · May 17, 2015

Pt hasn't had a bowel movement for 6 days. Was not given stool softener. Given a suppository this morning. Has diminished bowel sounds but no distended abdomen. She does take meds that can cause constipation. She was manually dis impacted and felt some relief

Weather it's a homework question or not these would be my suggestions. Remember sometimes in advocating for your patient you have to lead Doctor's where you want them to go. For sever constipation where bowel sounds are still active we give 40ml contulose solution which usually breaks everything loos in in 6 to 12 hours. If there is no fluid restriction they need lots of fluids as constipation is often a sign of dehydration. If they can't drink IV fluids are indicated. You may have to get out some lubricant and perform manual disimpaction (sic). When all else fails clear liquids for 12 hours followed by a dose of mag sulfate or Go-lytely and put on a catcher's mit.

Hppy

Farawyn · May 18, 2015

Dis-impaction may be frowned upon, but sometimes patients NEED it. Nothing is better than emptying the vault if it gets too far gone.

DatMurse · May 18, 2015

Disimpact and buy a scratch off lottery ticket To maintain equilibrium in your life. :)

applewhitern, BSN, RN · May 18, 2015

You would need a doctor's order before giving any type of medication, even if it doesn't require a prescription. You would also need an order to give any type of enema. Personally, I would be hesitant to digitally dis-impact anyone, but sometimes that is all you can do. (I am assuming this patient is in a hospital, not long-term care. If it is long-term care, then other measures can be taken to prevent constipation; if the patient is in a hospital, you won't have time to implement anything for long-term, except for their "discharge to home" plan.) We frequently have patients who come to the ER simply because they haven't pooped in days, and sometimes we get admissions who are severely constipated. We have to aggressively take care of the problem during the few days they are in hospital, but as a student, remember, you need a doctor's order.

allnurses Guide · May 18, 2015

Weather it's a homework question or not these would be my suggestions. Remember sometimes in advocating for your patient you have to lead Doctor's where you want them to go. For sever constipation where bowel sounds are still active we give 40ml contulose solution which usually breaks everything loos in in 6 to 12 hours. If there is no fluid restriction they need lots of fluids as constipation is often a sign of dehydration. If they can't drink IV fluids are indicated. You may have to get out some lubricant and perform manual disimpaction (sic). When all else fails clear liquids for 12 hours followed by a dose of mag sulfate or Go-lytely and put on a catcher's mit.
Hppy

I did want to clarify that all these interventions do require a physician's order. However I would usually call the Doctorand say something like ' Yes I have Mrs. P here and she states she hasn't had a bm in 6 days. Her abdomen is soft but her bowel sounds are diminished can we give 40 ml contulose?" Dr will ususally say yes or give you his own idea.

Hppy