How do you adjust your bowel programs?
For instance. If you start all pts on senna-s on admission, then add norco, do you automatically up to another senna product?
As weekend on call im noticing a disconnect with patients receiving adequate meds/interventions for bowel issues.
for instance, this weekend visited a bedbound Pt. Dear wife reported giving him fleets enemas & suppositories for the last 8 days, but he just can't poop well. Ok. I give him a high hot & hell of a lot soapsuds enema, abdominal massage counterclockwise while guy is nearly standing on his head. It was enough to move things downstream to his rectum so I could disimpact, but today he will most likely need another soapsuds enema to clear residual.
we are great about asking about pain relief but what about the quality of our patients bowel movements?
Thoughts? Thank you in advance for your input. This has always proved to be a community with a wealth of information.
We typically favor senna and bisacodyl with opioids as they are the most effective on Mu receptors. We don't have a set formula for increasing bowel regimens since everybody is different (and disease processes are different). Typically we increase the dose and frequency as needed. Some patients PRN is adequate (take if they haven't had a good BM in x days), others need 2 senna bid routine and go up from there.
P.S. I love that you integrated non-pharmalogical interventions in addressing this patient constipation! I just learned a new one the other day from our medical director ... placing a warm towel across the abdomen and then massaging.