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...
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?
My facility has implemented a Nursing protocol to help resolve this problem. If a patient has not had a BM in 3 days, Nursing staff is able to initiate a bowel protocol, which places the patient on Colace and Senna BID for 3 days, as well as a PRN dose of MOM if they have not had a BM within 12 hours of receiving the Colace and Senna. There are special health considerations that may exclude some patients from being started on this protocol. It has really enabled Nursing to gain control over patients going days and days without having a BM.
Also, it is standard for facilities in this area to not accept patients who have not had a BM within 2 days of discharge.
I try to be the Bowel Police with my antepartums - these poor women are pregnant, on bedrest, and generally at the mercy of hospital food. It's a bad combination. So I am always asking them when they pooped last. We also generally give Colace at least once a day (sometimes twice or thrice) to these women. I have become a big believer in Colace the Miracle Drug!!! :)
30cc MOM and 8 ounces prune juice. Stir well. Microwave until coffee temp. Serve/Administer immediately. Will make a concrete brick poop. We call it "the bomb".
loricatus
1,446 Posts
Can you go into more details about the type of massage you are referring to?