Not enough attention to BMs in nursing today! - page 5
I think that nursing today is often forgetting the basics. I had a patient this weekend who I transfered from a stepdown bed to med/surg. I followed the patient and floated to Med/Surg. By the end of... Read More
Dec 11, '07Occupation: RN, BSN Specialty: 37 year(s) of experience in Med-Surg/Peds/O.R./Legal/cardiology ; From: US ; Joined: Sep '07; Posts: 988; Likes: 1,182OMG!!! Emmanuel? would that kill a person like myself??? and BTW is there a nursing diagnosis for the men who leave 1 square of toilet paper on the roll??? My husband and I had quite a "fellowship" meeting last eve because he seems to think that replacing the roll causes BRAIN DAMAGE!! well, he had a violent attack of diarrhea last eve and guess what --I left that single piece of toilet paper right on the roll!hahaha!! I figured it won't work for me and I weigh 120lbs. let's see how that works for you?? ain't i mean???
Dec 11, '07Occupation: ER Nurse Specialty: 2 year(s) of experience in Med-Surg/Tele, ER ; Joined: May '07; Posts: 460; Likes: 347Quote from bethem:rollhttp://www.youtube.com/watch?v=jsVgi8hoFFc
Is anyone a fan? This song should help to keep the importance of poo high in nurses' minds!
That was hilarious. I love Scrubs.
Great thread, people. Maybe we should start a nursing public awareness campaign - "Get back to basics - check for poo!".
I agree the basics aren't emphasized enough. I think it's a combination of factors including being buried in JCAHO-inspired paperwork, basic nursing not being emphasized enough, and as has been addressed - some nurses just don't want to go there.
Dec 11, '07Occupation: Freelancing Specialty: 15 year(s) of experience in LTC, Med/Surg, Peds, ICU, Tele ; Joined: Jun '07; Posts: 5,292; Likes: 7,635Thanks for the video, very funny! I love that show!
Dec 11, '07Specialty: 5 year(s) of experience in ICU, telemetry, LTAC ; Joined: Apr '04; Posts: 1,483; Likes: 1,003Great, I had that song on my mind for a week the first time I heard it, here we go again. Great song, good show. It's one of the only med shows I can watch without going ballistic.... wait, yes it's the only one.
I always ask for poop status in getting report. I seriously want to avoid ever having to disimpact someone, so PRN's and prune juice are my friend. Warm prune juice and MOM mixed, call it a prune juice cocktail, and boy does it work.
Impactions kill people, ileuses kill people, people have surgery sometimes due to a lifestyle that involves too many lortabs and too much stress, and then wind up in a world of hurt when they get constipated after surgery. And you know they were probably constipated beforehand too.
Ahhhhhhhhh, let's not forget those young people who think their gut isn't ever supposed to hurt! They'd rather be zonked on painkillers than have a decent BM if it's gonna be uncomfortable. And no, they don't usually see the value in prune juice. (This is a vent, not all young ladies are like this, just a few who have greatly tried my patience.)
The students who come to my unit hopefully are learning the importance of good bowel habits and what the nurse can do to facilitate gut health. Unfortunately if you have an overworked medsurg unit, not all the CNA's want to clean up poop, the nurses are happy to just get their charting and meds done on time, it may be that safer staffing would go a LONG way towards helping that issue.
Little funny story: My first med error was complicated and involved reading a protocol wrong (really wrong) when it was spat out of the computer. So I gave my man who was to have an upper GI series the next AM, a bottle of mag citrate, a pack of baby wipes, two towels and a bedside commode. Hehehehe. No really, it was funny to everyone but my nurse manager. Poor patient, I didn't have the heart to tell him about the error as he was up all night and at one point said, "I think I died six months ago and am just now finding out about it" regarding the stink. HOWEVER, his runs of vtach that he had since admission, stopped altogether. Nice pretty tele rythyms after that. Headache gone too, by AM he had no complaints.
Dec 11, '07Occupation: RN, BSN Specialty: 37 year(s) of experience in Med-Surg/Peds/O.R./Legal/cardiology ; From: US ; Joined: Sep '07; Posts: 988; Likes: 1,182OMG!!! I am about to die laughing here!!!!! Here's my assessment of the health care situation: the entire system needs a good old hot double prune juice cocktail. and STAT...
Thanks! I feel better already! Oh! and I haven't had time to watch that show yet. Good Lord, I've GOT to get my head out of my rectum!!!!!
ebearLast edit by ebear on Dec 11, '07
Dec 11, '07Joined: Jun '07; Posts: 1,876; Likes: 2,605Quote from TheCommuterYou know, this is true. The NCLEX and NS are still fresh in my memory, for the most part, and very little emphasis was on the simple things. It seems like after you get them Nursing 1, you don't really hear about them again.Although I might be incorrect, I think that today'stend to do whatever they must to simply get the students to pass NCLEX on the first attempt. Therefore, the basics in nursing programs may get brutally pushed aside to make room for learning about life-sustaining knowledge, technological advances, dosage calculations, and so-called 'priorities.'
Just browse through the NCLEX forums, and virtually none of the recent test-takers mentions anything about test questions related to defecation, impaction, constipation, obstipation, diarrhea, or anything dealing with BMs. Therefore, I think nursing educators are purposely shoving the importance of BMs aside.
Dec 11, '07From: US ; Joined: Jan '06; Posts: 13,193; Likes: 17,911Quote from IndyI'm dying!Little funny story: My first med error was complicated and involved reading a protocol wrong (really wrong) when it was spat out of the computer. So I gave my man who was to have an upper GI series the next AM, a bottle of mag citrate, a pack of baby wipes, two towels and a bedside commode. Hehehehe. No really, it was funny to everyone but my nurse manager. Poor patient, I didn't have the heart to tell him about the error as he was up all night and at one point said, "I think I died six months ago and am just now finding out about it" regarding the stink. HOWEVER, his runs of vtach that he had since admission, stopped altogether. Nice pretty tele rythyms after that. Headache gone too, by AM he had no complaints.
It gives new meaning to the term, "It smells like something crawled up your butt and died in there!"
Dec 11, '07Occupation: new hospice nurse, previously oncology Joined: Oct '03; Posts: 166; Likes: 106I always tell my hospice patients that nothing makes a nurse happier than proper responses to the 3 p's. Poop, pee and pain.
Dec 11, '07Occupation: RN, BSN Specialty: 37 year(s) of experience in Med-Surg/Peds/O.R./Legal/cardiology ; From: US ; Joined: Sep '07; Posts: 988; Likes: 1,182There ya go, Debb! If the plumbing system is kinked, some where down the line there's going to be a major problem! I don't care which filtration system that is.:spin:
Dec 13, '07Occupation: former cna, janitor From: US ; Joined: Jan '06; Posts: 1,243; Likes: 1,227Quote from earle58Truly a messed up sense of priorities.........................
mom ended up in the icu r/t septicemia, and ultimately needed myoplasty sx.
and to top it off???
ed's family was furious w/me, for making a scene...
that my sister-in-law, had friends in high places, at this 'leading' hospital, and i had embarrassed the family.
Which is more important---someone's life, health and wellbeing---OR---what others think?:trout:
Dec 13, '07Occupation: lady of leisure at moment Specialty: 10 year(s) of experience in ITU/Emergency ; Joined: Jan '06; Posts: 362; Likes: 192How to tell if you are a nurse: Read this thread while having your lunch! Yummy!!!
Dec 14, '07From: US ; Joined: Jul '05; Posts: 856; Likes: 1,525I work 12 hour nights. When I assess everyone between 1930-2030 I ask them when was their last bm. If it's been more than 2 days and the pt is on narcs, the pt has a choice, laxative now or prune juice with breakfast ( I can't get prune juice from the kitchen after 1800). Most pt's have MOM, sorbitol, or ducolax ordered, or I can invoke a bowel protocol dependent upon pharmacist review of their renal status. More than three days, I really push for a laxative. More than 4, I usually try to call for a suppository.
Of course if the pt isn't fluid restricted or severly restricted on ambulation due to his cardiac status, I'll encourage fluids and ambulation.
Also I educate all pt's on the importance of keeping track of bm's, and let them know that if 2 days go and no bm, you better bring it to someone's attention, even if you are on stool softeners.
Dec 14, '07Joined: Sep '07; Posts: 2,660; Likes: 7,607Quote from scattycarroti'm drinking a vanilla coke float right now. looks much like what i emptied from my patient's ileostomy this morning.how to tell if you are a nurse: read this thread while having your lunch! yummy!!!
anyway, in my health care system, all inpatients can be started on a constipation protocol. at admission, the admitting rn is to assess the patient's need. if he or she has not experienced a bm in 48 hours or more, and doesn't fall into the "contraindication" category (i.e. npo, s/p bowel surgery), the patient is started on:
bid colace for the 1st 3 days,
then senna qhs is added for the next days (prn after that)
and if the senna doesn't produce a bm in 12 hours, mom can be given. i know dulcolax suppositories are involved as well...i think that's next after the mom.
there's also a special set of orders for stool in rectum, involving enemas at first, leading up to disempaction. i know it's not perfect, but at least it gets us assessing bowel habits from the get-go!
ps - i hope that made sense...i had a loooong 12 hour night. :icon_confused: