Constipation

[adrienurse]

I was going to post this in the geriatric nursing forum, but issue is not unique to geriatrics. A co-worker and I are doing research on treatment of constipation. We are trying to overhaul our existing system.

Does your facility have a specified bowel routine that is used to treat/prevent chronic or episodic constipation in patients? What times of the day are these treatments usually given. In what way are these used to complement the body's natural reflexes? What medications/products are you using?

Any suggestions are gladly appreciated.

[hoolahan, ASN, RN]

This is really interesting. I have so many pt's with constipation in homecare. Most secondary to pain meds.

We tell pt's to inc fluids, eat prunes, and one nurse swears by raisins w excellent results! We also have a handout which rx senna tea w prune juice, 1:1 mix and warmed of course.

I also think fleets don't do much, and prefer dulcolax sup. Have a lot of pt's on lactulose daily, it keeps them fairly regular, though not ideal, better than being admitted for bowel obstruction.

I remember one pt, a post op heart, who had major complications post op. He hadn't moved his bowels for 3 weeks, they tried everything!! Finally, they got out the dynamite...a enteral continuous "feeding" of Go-Lytely(bowel prep drink.) It ran for about 3 days before any result, but when he went...let's just say it was a code brown! Every night I worked I prayed it wouldn't be the night he went, b/c I knew it wasn't gonna be pretty!!! God must have heard my prayer, b/c I was off!!! LOL!!!

[nakitamoon]

In my assisted living..., try to deal with it first with diet and plenty of fluid intake...

Prunes...warmed... or prune juice...warmed...next...

Then MOM with the warmed prune juice... works most every time...

LOL... most of my residents are bowel obsessed... so first we have to be sure they are really constipated... some would like bowel movement every time they urinate!!!!!!! LMAO

[disher]

The bowel routine for most of our in-patients is MOM 3xs wk at HS, Duloclax suppository 3xs wk in am following the MOM.

Some patients get rid of this routine when they go home and have had sucess with the bran, applesauce, prune juice concoction that Nurse Ratched posted. The recipe is

½ cup prune juice

1 cup of applesauce

2 cups all bran cereal

Place ingredients in a bowl and let sit for 10 minutes.Mix ingredients together.Store in airtight container in the refrigerator for up 2 weeks.

[sharann, BSN, RN]

Happeewendee :)

I KNOW it was a typo (I hope)

but I was laughing so hard when I read

"Surfak 1 tab OD..."

Is that only in the right eye?

I thought they had come up with a new bowel routine!

I'm sorry, I have to run after all this bathroom talk....

[adrienurse, LPN]

Here in Canada OD means once a day in am. If we mean right eye, we say right eye. :chuckle :chuckle Funny though.

[warrior woman]

Try holistic lower abdominal massage to stimulate peristalsis. It's drug-free and usually works like a charm. Let us know what you think. Hope this helps you out. Warrior Woman.

[night owl]

Our unit uses MOM and cascara aka a black and white M-W-F @ HS for the chronics followed by a fleet enema in the am if no results. How I hate those d@mn fleets! Dulcolax supps work better I think. Some receive senna 2-3 tabs OD, w/ a prn B&W, others receive Colace OD or BID and a prn fleets. Seems that no one likes prune juice. We used to use the bran /applesauce mix, but I haven't seen that in a long time. Of course lots of liquids, ^ activities and ROUGHAGE helps, good old Mag citrate works wonders for the more difficult residents and then there's Lactulose--that sweet, sticky, syrupy stuff which you don't ever want to spill! And last but not least, Metamucil OD. If nothing else works, there's always a quarter stick of dynomite that's guaranteed to work EVERY time!

[adrienurse, LPN]

Once spilled Lactulose all over my shoe and sock. Not fun!

Does anyone use microlax enema (no relation to OUR micro). What are H and H enemas?

[disher]

Tried microlax but haven't seen it used routinely. Occasionally use "magic bullet" water soluble supository, works faster than regular dulcolax.

H H H stands for high hot and a h*ll of alot refers to enema (usually soap suds).

[night owl]

adrienurse,

i spilled it once all over my scrubs and shoes and my clothes were soooo stiff when it dried and the shoes were very shiney!

i guess when everything else fails, we can always use "turbolax"...

with an order of course! :stone :rotfl:

[adrienurse, LPN]

Wow, we can talk about poop for hours can't we? Our current routine is dulcolax & glycerine supps on 3rd day, if nothing on 4th day give microlax, next day give fleet enema. As I said, we need to overhaul out routine. Amazing how this problem is dealt with so inconsistantly. One more question if you please:

- When you give supps/enemas what time of the day is best?

[bandaidexpert, BSN, RN]

Our docs prescribe Miralax 7gms in 8oz of H2O QD, which is very effective. We do have a bowel protocol, 3 days no BM, MOM is given by 3-11 shift. If no results, day shift gives suppository, still no result...3-11 gives enema. We also have a concoction we call a "Brown cow" which is mighty effective. It consists of 30mls of MOM, 1/2 cup chocolate ensure, 1/2 cup prune juice. If this doesn't work, you better order a KUB/Flat plane!