bowel care protocols

jayne109, RN · Jul 18, 2003

I work on a Med/Surg floor so obviously some things won't apply to all ICU pts but I will give what we do in our Bowel Protocol.

If the Dr. orders the Bowel Protocol (and even sometimes when we make the decision and ask the dr for it) the pt gets Colace 100 mg BID.

On day 3 with no BM, We give MOM and Cascara. this is usually as far it it is needed. But if further is needed, we continue the MOM/Cascara QD and give a Dulcolax supp.

If that does not work in 8 hours, then we give Fleet's enema.

Iif all else fails we contact the doctor and give a Cottonseed oil/Colace enema and then enemas until clear. We also consider disimpaction as the case mey be.

There aare exceptions to this and we use our own judgement if no one as caught the days since BM.

We do use the Acidophillus tabs/granules and if someone has diarrhea they are cultured for C. Diff (running rampant right now at our hospital) and started on Flagyl and Kaopectate and Lactinex (the acidoplilus). We hardly ever use Lomotil anymore.

I hope this helps.

Melissa:)

gwenith, BSN, RN · Jul 19, 2003

Thanks Melissa - would you believe there is no consensus in the literature as to a definition of constipation?

Problem is it means different things to different people appearently.........

maureeno · Jul 19, 2003

hemorroids and constipation

very important

and often neglected

constipation is a big topic on our involuntary psych unit right now

we have been having a run on nsg home elderly residents who stop eating

get committed as grave disability

spend expensive time in hospital and in court

all for [turned out] CONSTIPATION!

:eek:

gwenith, BSN, RN · Jul 19, 2003

OMG! Maureeno!! All for the want of a cup of prune juice?? :eek:

adrienurse, LPN · Jul 19, 2003

According to our Nurse Incontinence Specialist (Yes, we actually have one -- how'd you like that job?);

Constipation = presence of stool in the rectum that cannot be cleared by the person (period)

The key is learning the function of each med given to treat constipation -- some do more harm than good, and are just given out of habit.

Some other things I have learned. Senokot/sennosides does nothing to PREVENT constipation. The only effect of taking this drug on a daily basis is to cause Lazy Bowel Syndrome, where the bowel stops being able to recognize urge to pass feces. It is an effective treatment when used occasionally as a bowel stimulent and THAKES 24-36 hours to work.

The best ways to prevent constipation are:

- oral intake of fluids

- Oral intake of dietary fibre (needs to be accompanied by correct amount of fluid intake

- Exercise

- Toileting on a regular basis. Ignoring urge to defecate leads to megacolon and inability to recognize urge to deficate. Take advantage of the body's natural reflexes (ie. instruct to or take person to the toilet ~30 min after meals, especially breakfast.

ERNurse752, RN · Jul 19, 2003

Eeeeeeeeewwwwwwwwwwwww...poop.

(Sorry...I have been awake for WAAAAY too long!)

angelbear · Jul 19, 2003

I know this sounds strange but this is a topic of interrest to me. At our facility BM's are a big deal. Our population is mostly total care(profound mental retardation). A good portion of our residents recieve miralax on a regular basis. From what we the lowly nurses have read this is not good. Miralax is meant to be for short term constipation. We go round and round about all this at work. Any thoughts?

gwenith, BSN, RN · Jul 19, 2003

As I said we have had some success in an ICU population with prune juice. ICU patients generally tend to be either all stopped or please stop. Either nothing for days or 10 times a day!!!:eek!

Like your patients Angelbear it is not as simple as asking the patient if they are constipated and unless you want to subject them to daily rectal examination there has to be a better guideline

zambezi, BSN, RN · Jul 19, 2003

Gwynith, I know what you mean about being all stopped up or please stop...that is so true in the unit that I work in. We usually give surfak bid routinely. If someone is stopped up we push fluids (if po), encourage movement, colace bid, and definatly prune juice/high fiber diet. We will use fleets enemas as well if we have to. If diarrhea, we usually use lamotal (sorry, long night, can't seem to spell). Mostly we just try to transfer the pt out before we have to deal with bowels...just kidding.

gwenith, BSN, RN · Jul 20, 2003

Thank-you everyone for your input

passing thru · Jul 20, 2003

""ALL STOPPED UP OR PLEEEEEEEEEEEEEEEZZZZ STOP !!!!!!""

That about sums it up where I work too. ROFL :)