bowel care protocols

  1. Need some information. What do you use in your facillity as bowel care protocol esp. in relation to ICU patients.

    When do you intervene for constipation?

    What do you use for constipation?

    What do you used for stopping/preventing diahorrea?

    Is anyone using prune juice or pear juice for constipation?

    Is anyone using yoghurt/drinking yoghurt and.or acidophillus bifidus tabs(sp?)

    Any information would be a help. I have to finalise our protocols and you would be amazed at what you cannot reference.
  2. Visit gwenith profile page

    About gwenith

    Joined: Jul '02; Posts: 10,260; Likes: 233
    icu nurse


  3. by   jayne109
    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.

    Last edit by jayne109 on Jul 18, '03
  4. by   gwenith
    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.........
  5. by   maureeno
    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!
  6. by   gwenith
    OMG! Maureeno!! All for the want of a cup of prune juice??
  7. by   adrienurse
    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.
  8. by   ERNurse752

    (Sorry...I have been awake for WAAAAY too long!)
  9. by   angelbear
    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?
  10. by   gwenith
    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
  11. by   zambezi
    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.
  12. by   gwenith
    Thank-you everyone for your input
  13. by   passing thru

    That about sums it up where I work too. ROFL
  14. by   passing thru
    Back to my first rate-first class hospitals............

    Isn't this an issue that should be addressed by the doctors from day one?
    Is there a place where every doc and nurse can look to see when the last b.m. was?
    If not, why not?

    Lots of constipation admits where I work now. "Abdominal Pain."

    Is it a $$ issue....?
    After 3-4 days of hospitalization and cat scans of tummy, etc., then the old "clean 'em out" routine is done and they poop 30 gallons, feel great , have their EGD, AND colonoscopy and go home.