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Discussion

Having pooping issues!!!

You know...I know we're not all lazy, but here's the deal.

Last week, I had a patient who was all set to be discharged...orthos came in, medical came in....but she hadn't pooped in 6 days! (2 days before surgery)....and NOBODY apparently thought it was a big deal, asked docs for fleets or suppositories, etc....til I came in on the 6th day...and she didn't go until right AT shift change!!!! Shouldn't somebody have made her go before that?

Then I had someone who was due to go to rehab tonight....she hadn't gone in 5 days! a combo of not wanting to get up, and not taking stool softeners....So, I call rehab...they had no CNA, and they would call me. i call doc, get fleets and mag citrate on top of MOM, and suppository. this is at 1800...she had MOM and suppository at 0600....why wouldn't the day nurse ask the doc for the fleets and mag citrate, just in case? And why am I dealing with this at shift change...and trying to take a admit, get peeps comfortable, etc....AHHHHH!!!!!! Shouldn't somebody of made her poop yesterday??? no matter what it took? Then they call me at 2030...say their ready..she finally goes at 2140...and they tried to get me to keep her because past 10..oh she'll be up, and she's getting up at 7 for breakfast and PT for the day......I knew I'd get a phone call today if she was still on the floor this morning...so we did a poop and go! LOL.

Ok, poop rant over....may all your bowels be fine...

Featured Replies

I totally understand your frustration. The date of last BM is something we obsess about in LTC, LOL. It is on our admit assessment and you would be surprised that we get folks that go well into a week or so since their last. Normally....it would be before the surgery. When they come to us...you can imagine what we need to do to get things going.

I understand that it isn't always posible to have them go before they leave or are discharged. (I remember years ago, you weren't allowed to leave until I had my first post partum BM

Just something to consider...

  • Author

that's just it...before they leave our floor...they HAVE to have a BM..they recently discharged someone without that happening...they came back in with a perforated bowel...

  • Guides

I believe that some LTC's won't take patients back from my hospital unless they've had a recent BM as well.

At my hospital we obsess over BM's. At the last hospital I worked, they obsessed over the last time every patient urinated; EVERY patient. Where I work now, it never even comes up in report. Weird.

I have run into this also. Always tried to stay on top of these problems with my patients. Got annoyed about it just like you.

  • Experts

I remember the days of the little old ladies and men who we admitted and all they talked about while we did their admission history and physical assessment was their bowels! We seldom had constipation problems with them because they were their own watchdogs. They were always asking for prune juice and enemas. This post also reminded me of the charge nurse in one nursing home that used to wait until the end of her shift before giving laxatives so her "girls" didn't have to deal with the results.

  • Experts

I work on the rehab unit of a nursing home. It is common for me to receive patients from the hospital who have not had a BM in 10+ days.

  • Guides

LOL, I always giggle about this because it reminds me of my husband's grandfather. You will NEVER meet an old man who is more obsessed over his bowels, and he insists on a colonoscopy at LEAST once a year! He goes to the VA and I believe they've been granting his requests for yearly colonoscopies, except for this last time that he went. :chuckle

I remember the days of the little old ladies and men who we admitted and all they talked about while we did their admission history and physical assessment was their bowels! We seldom had constipation problems with them because they were their own watchdogs. They were always asking for prune juice and enemas. This post also reminded me of the charge nurse in one nursing home that used to wait until the end of her shift before giving laxatives so her "girls" didn't have to deal with the results.

It's just another sad commentary on the sorry state of Nursing and Nursing education and nurses' character. Laziness plus inexperience plus heavy workloads.

Why blame just the nurses, t hough? Why didn't the doctors, OP, who were involved in your surgical patients' cases, have standing orders for MOM, Fleet's, Mag Citrate, Dulcolax, Colace, Pericolace, Benefiber, Lactulose, whatever would do the trick?

If you work with the same doctors a lot, why not develop an order sheet that contains all the orders you wish they'd automatically write on each patient and have them sign it upon admission of their patients? Tylenol, bowel stuff, routine labs, routine PT and weightbearing/transfer, etc. could all be included.

At the very least, have a checklist that would jog the doctors' memories when they are writing their orders in recovery room or wherever they write them. It would help avoid most scenarios such as you describe. And attendings and residents would appreciate the lack of middle of the night calls, too, I'm sure, asking for routine stuff that they should have learned to order on Day 1 of Medical School clinicals.

Where it's not contraindicated, I have had great success using abdominal masssage to stimulate the colon muscles. Many of the massage therapists on our in-patient hospital team have seen some very stubborn bowels completely release everything with a little therapeutic massage. The massage work also helps the pt relax, which makes it easier for the parasympathetic nervous system to start the digestive track up again.

I hope we see more therapeutic touch incorporated into hospital settings for this type of issue. We've seen impressive results!

Everyone gets Colace and Fibercon, puls we have a bowel care protocol with standing orders for bowel meds. Constipation is rarely a problem.

  • Author

see we have standing orders for patients who are general ortho/neuros...which this patient happened to be on...she had been getting the MOM/suppositories..wouldn't accept an enema until last night, wanted mag citrate..which there is no order for...so, I guess I was just venting about people waiting so long to ask for bowel meds....I just work there sometimes.

I KNOW I'm going to be one of those obsessed BM and urine after a foley's pulled nurses....but I'd rather make sure patients are ok, than let them go so long and have it come back to bite me in the butt....good to hear the sides here.

Where it's not contraindicated, I have had great success using abdominal masssage to stimulate the colon muscles. Many of the massage therapists on our in-patient hospital team have seen some very stubborn bowels completely release everything with a little therapeutic massage. The massage work also helps the pt relax, which makes it easier for the parasympathetic nervous system to start the digestive track up again.

I hope we see more therapeutic touch incorporated into hospital settings for this type of issue. We've seen impressive results!

Can you go into more details about the type of massage you are referring to?

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