Laxative Abuse and the Elderly

Fiona59 · Nov 10, 2004

Ask her to check for UTIs. Many behavioural changes result from those. The chem 9 is fast, relatively cheap to perform and rules out one problem for her before she hits the sennekot. We usually gave supps when there had been no BM for three days..

CapeCodMermaid, RN · Nov 10, 2004

You should also ask her to assess the resident's level of pain. All the studies show that many behaviors on Alzheimer's units are the resident's response to pain they are not able to verbalize....better APAP 650 or 1000mg than a suppository..and just how does she think sticking something up THERE lessens agitation?????????????

steff_rn1 · Nov 11, 2004

Do you have a BM book and policy/ orders as to when laxatives are to be given?

In our facility, a suppository is given on the 3rd day of no BM. It sounds to me that if she is not following the policy and MD orders, she should be reported and disciplined. Constipation can cause discomfort, behaviors, etc, but she should be using them right.

Antikigirl, ASN, RN · Nov 11, 2004

We do MOM third day, supp morning of day 4 followed by fleets if no results in 1-2 hours by house protocol. And many times I give those poor folks till day 5 before digital.

Putting supps or fleets, or fingers up the rectum can damage tone...and for some folks that have constipation issues that is the last thing you want to do! Check the abdomen, check for bowel tones...do an assessment first! It seems once you really start using supps, you have to KEEP using them to stimulate BM...I try to keep that at a minimum!

And I agree...do the orders say anything besides for constipation? Because that is using a medication for something other than its ordered purpose, and only a doc can change that (well, or an NP, PA..you get the jist). SO she maybe going against orders and that can be seirious...even if it is just a supp (because in our business there is no such thing as "just a" any medication). I would warn her of that fact.

Supps are what I consider invasive, and I keep invasive down to a minimum when I can! Prune juice, activities, even just getting your nonmobile patient into a hoyer and seated in a chair for a while helps...and I have found hot tea to be suprisingly helpful as well (guess it relaxes folks enough..works for me quite often! :) ). Music can help, running water (stimulates both!), letting them have something to read, anything to make this more relaxing or natural so the body will do its job...

But for agitation??? I would be extremely agitated if it was me getting one, and I would also consider it a punishment too!!!

merricat · Nov 11, 2004

when i was in LTC, i swear there were folks who would hold onto the BM until you put them on the toilet... no matter the pain... no bedpan, no bedside commode, toilet only. it was amazing, they just had this idea they were clinging to of How One Must Poop. it seemed the more demented they were, the more they seemed to remember this one thing. i wish LTC would give aides time to always put everyone (except those who truly do not want it, of course) on the toilet. but the system favors attends because they are convenient--- no interrupted dinners because of trips to the bathroom, etc. i realize this is all slightly beside the point but maybe if she tried alternative approaches she would not always be reaching for the supps and stuff. it is true warm fluids help make people poop-- i guess they are stimulating. (maybe a coffee/tea/ cart after luch or dinner, the aides could do it)? of course, pts have rights to refuse the really invasive stuff (or actually any of it) --- maybe talking to her about pt rights and alternative approaches would be beneficial. i mean, i would bet most of these people are not agreeing to all these supps. i have never seen it. she's gotta be pushing the supps (in multiple senses of the word). EW!

UM Review RN, ASN, RN · Nov 11, 2004

One of my LPNs is a world class nurse, but she honestly thinks that Laxatives will fix anything.

:rotfl: No one over 65 escapes me asking, "And when was your last BM?"

I learned it in NHs because that's a fairly common problem. However, I don't give anyone anything who

a) can't remember

b) has no abdominal distention/discomfort, or

c) has already had one marked within the past 3 days.

Like previous posters mentioned, it's not the solution every single time. I'd think her knowledge base was limited, but your post makes it sound like she's been offered education but has basically not really taken it seriously.

Maybe it's time for some more formal counseling, especially if she's not investigating further with problems that could be potential liabilities?

JamiRN · Nov 11, 2004

I have also worked with an LPN in the LTC setting who firmly believes that everyone needs to poop on a daily basis. That makes me laugh. She is always dishing out the MOM if they did not go that day!!! God help me if I ever end up living in an institution with one of these loverly ladies....EVERYONE GOES DIFFERENTLY!

Blackcat99 · Nov 11, 2004

Yes I think my job has a few of those types of nurses. At my job we give a Dulcolax if no BM in 3 days. If that doesn't work then we gave a suppository the next day. However, a few nurses sometimes ask me to give lax's early before the 3 days are up.

CoffeeRTC, BSN, RN · Nov 11, 2004

Well..the life of most LTC residents does revolve or focus on thier BM patterns. Doesn't it?? Sounds like she has a fixation? But really, she isn't following doc orders? Thats the problem. I would review with her that she cannot prescribe or adminster laxatives that are not ordered.

Now if we can only get her to come to my LTC and give out some laxatives.

Antikigirl, ASN, RN · Nov 12, 2004

LOL!!!!! Yep, my residents don't even start a convo with a nurse without saying 'and my last bm was on...large, normal...now this is why I called you in.." LOL!!!!

Yeah, I have quite a few folks that believe that if you haven't pooped in two-three days you automatically have an impaction. Uhhhhhgggg, most of my folks are on narcotic pain relievers routine...yeah try pooping when you are on those suckers every 2-3 days (even with colace, prune juice, fluids, fiber....)! I have to tell them all the time..RELAX...do an assessment, and don't get my patients so wound up that they either vagal out on the toliet trying to appease you, or blow a gasket! LOL!

I have responded to two almost, and one code call on vagal patients on the toliet trying to poop because they were anxious about a suppository or digital! I don't like calling EMS for that when it was totally preventable! (all made it by the way ).

Yeah...guess it is time to be less an*l about BM's...LOL!