Not enough attention to BMs in nursing today!

[FireStarterRN]

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 the shift I became aware that the patient really needed a BM, and in report I suggested that the patient needs some MOM, ect.

This didn't get addressed and the patient went into A-fib with RVR in the night and ended up an ICU patient on a cardiziem drip. I took care of him the next day, he was distended and no appetite, and was more SOB (his underlying dx was pneumonia)

I told the hospitalist I was going to get his bowels moving when I reported some things to him in the AM, which I did with MOM and a suppository, much to the patient's relief. He had been having runs of wide-complex beats, most likely V-tach, and once he got into bed after his BM (med, hard) he settled down, his nausea went away (doctor had started troponin protocol based on nausea sx), and his heart gradually slowed down, allowing me to wean him off the drip. He converted to NSR at around 1500. The hospitalist put the patient on metamucil, and suggested that cardiziem (patient was on PO cardiziem at home) is a poor choice for a patient with tendency to be constipated.

My point in telling this story is that, I notice patients are being allowed to go too long without BMs. It seems that the basics of nursing care are being lost in a sea of regulatory overdrive demands and high tech wizardry.

[ebear, BSN, RN]

There 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.

[squeakykitty]

........................

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.

:stone

............

leslie

Truly a messed up sense of priorities.

Which is more important---someone's life, health and wellbeing---OR---what others think?:trout:

[scattycarrot, BSN, RN]

How to tell if you are a nurse: Read this thread while having your lunch! Yummy!!! :rotfl:

[elthia]

I 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.

[Penelope_Pitstop, BSN, RN]

how to tell if you are a nurse: read this thread while having your lunch! yummy!!! :rotfl:

i'm drinking a vanilla coke float right now. looks much like what i emptied from my patient's ileostomy this morning.

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!

*jess*

ps - i hope that made sense...i had a loooong 12 hour night. :icon_confused:

[kidznurse]

Basic nursing fact: "if you don't eat you don't s--- you don't s--- you die !" I've been nursing nearly 30 years and the basic a & p doesn't change! Regardless of the the latest theory or politics - Nursing is about the basics, stick to that and the patients will thank you. Anything else is ego candy.

[AuntieNursey]

I work in LTC and we are all about the "poop patrol" It has such an impact on the total body, that you have to pay attention. Just like the story of the rectum that would be king: all the body parts were arguing one day about who should be in charge of the whole body. The eyes stated as they see everything, they should be in charge, the hands stated they do everything, so they should be in charge, the feet complained that they took the body everywhere it needed to go, so they should be in charge. The brain spoke up and said that it controlled everything, so it was only logical that it should be in charge.Then the rectum spoke up and said it thought it should be in charge. well, the entire body was in an uproar, all talking at once about how the rectum really had no business in even thinking it could be king and laughing at it. So, the rectum took offence and tightened up so tight that nothing could pass. After a few days, the eyes began to blur and couldn't focus properly, the hands kept dropping things, the legs were having trouble walking and the brain couldn't finish a thought. So, they all got together and begged the rectum to relax and all agreed it could be king. The moral of the story is: Any rectum can be king. Also never underestimate the power of poo!

[lvlissl2ebecca]

One of the first things I do when I get to work is grab that BM book that has all the recordings for the BMs in that month. I check who hasn't had one in 3 days or more and write it down in my "Lax" list. While I'm doing my first med pass, I'll stop at each one (wether they get meds or not) and ask if they have had a BM (In case the staff forgot or neglected to mark a BM, which happens a lot). If no, they get a laxative. If they can tell me that they've had one .. I will go ahead and mark it. Simple as that. However, There are many nurses who will come to work after me and I'll give them report with 5 or 6 laxatives and they'll make that god awful UGH! smacked lips thing that indicates disgust. Too bad, Is all I think to myself. They need these laxatives. Not too long ago we had a lady who absolutely refused to take any medicines, as she was so paranoid. She went a good 2 weeks with out a BM or laxative and ended up not breathing while on the pot trying to pass a BM, to where midnight shift thought she had passed away. A good sternal rub and she aroused, but needless to say scary and never good for the patient.

As for the reason some don't do these simple steps that prevent big problems? Well, I can assume that it is a number of reasons. Some do truly believe that that is NOT their job (Especially when the laxative has been given and its time to digitally check for hard, dried stool before administering enemas). Other times, I'm sure its probably laziness... others forgetfulness, you just never know, either way its a very important thing to neglect... then again you know what assume makes don't you?

[Ms Kylee]

My roomie used to work in LTC and they had a list on the cart of when each resident had a BM. If they didn't have one in 3 days, they got prune juice, then MOM, then an enema.

I always joked with her and told her she kept a s list on her cart.

Daily when I do I&O, I ask if they've had a BM. Sometimes I'm told no, other times I'm told yes, and sometimes I not only get a yes, but a great big description of it. If I have a patient go more than 3 days without one, I tell the nurse.

[pinksugar]

I won't lie, I don't care for cleaning poop. However, whenever I have a lucid pt I will ask them when their last BM was. After that I ask them what their normal pattern is. If they have fallen outside of their normal pattern I will offer a stool softener or suppository. You would be surprised how many of my patients actually refuse these things. One pt told me that she 'didn't want to poop in the hospital', she'd rather wait until she got home! I am a good little nurse and I did my mounds of bowel regime education, but to be honest it usually falls on deaf ears. I wonder why my pts don't want to use the softeners and suppositories?

Do any of the seasoned nurses have any ideas to make these things more appealing? I am no lover of poo but I do like my pts to have normal BMs.

[AtomicWoman]

Thank you all for these posts! I recently had someone very dear to me become impacted because of opoid meds. He was in horrendous pain and was so sick I was scared! And then it took a good 3 weeks for his bowels to return to normal after the disimpaction (bouts of diarrhea, ironically). That experience impressed me so much that I vowed that when I become a nurse, I will make sure my patients poop! :)

[marilurn]

I had a patient on the floor who was obsessed with his colostomy and wanted it change every hour practically he was afraid it would smell and offend someone. I was caring for him one might and the charge nurse answered his call light and came to the room I was in at the time which was next door to the patient to tell me he need me. I was very busy at the time and she would not go into his room to see what he needed because she was afarid she would have to change the colostomy. I hurried with what I was doing went to his room and all he wanted was a breathing treatment. Some nurse do avoid BM