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Discussion

laxative protocol?

does your unit have a protocol for what time of day a laxative is given?

I feel that we shouldn't be giving suppositories or meds like lactulose after 3 pm because weak patients, especially those who feel that they may be able to walk to the bathroom are then high risk for falls. If they are bedbound (most are), we dont' always get to them as soon as they ring their bell, and that is if they are with it enough to ring the bell.

In our palliative care, if the patient has not had a bm by day 3, the protocol starts with dulcolax and glycerin supps. But, lactulose will be given as well, depending on the patient.

Of course, most of them are on regular softeners every day as well.

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My facility does not have a protocol for what time of day laxatives are to be given. We are expected to give them if the patient has gone an entire 3 days without defecating, regardless of the time of day.

I happen to work at a nursing home and, typically, our continent patients don't vocalize the need to defecate until the morning hours immediately prior to the breakfast meal.

in the hospice facility, mom was given on the 3-11 shift, usually right after supper.

if there were no results, then suppositories would be given at 6am the following morning.

this was according to the p&p book but ea pt usually had their own customized regimen.

those laxatives/cathartics/stimulants can be increased 10 fold on any given day.

we used bedpans, bedside commodes, or attends if the former wasn't a feasible method.

leslie

I have two residents on my unit who get latulose. One gets it at 5pm and the other gets it at 8pm. our standing orders for no bm x3days is to first give 30 mL of MOM at HS. of course if the day nurse notices that someone hasn't gone to the bathroom in 3 days she can give it too.

On a side note I have someone on 60cc of lactulose qid but it's not for BM function.

Why are we nurses so obsessed with the bowels? One of the first questions a nurse will ask me when giving report. I can go on and on about what is really happening, and there respiratory status, and the first question, "when did they last have a BM?" This primarily is asked when giving report to a stepdown, tele, or M/S. Instead of getting fixated on this natural occurence, why don't we ask the patient how often they go per week and what their normal bowel regimen is? Some people only go a few times a week. How about doing crazy things like increasing there fluid intake, encourage PO, and don't forget the craziest of them all. Get them up and ambulate. Rocket science I say.

  • Author
Why are we nurses so obsessed with the bowels? One of the first questions a nurse will ask me when giving report. I can go on and on about what is really happening, and there respiratory status, and the first question, "when did they last have a BM?" This primarily is asked when giving report to a stepdown, tele, or M/S. Instead of getting fixated on this natural occurence, why don't we ask the patient how often they go per week and what their normal bowel regimen is? Some people only go a few times a week. How about doing crazy things like increasing there fluid intake, encourage PO, and don't forget the craziest of them all. Get them up and ambulate. Rocket science I say.

Well, in our case, it's a palliative care residence so they won't be getting up to ambulate. Bowel care in palliative cancer is very important because it's one thing to feel miserable and in pain because of your disease, it's another to feel miserable and in pain because of your disease *and* you are uncomfortable with pain and nausea because you are constipated.

  • Experts
Why are we nurses so obsessed with the bowels?
I, as a nurse, am not obsessed with the bowels at all. I happen to work at a nursing home with many elderly patients. To be perfectly honest, it is my elderly patients who are overly obsessed with their own bowel movements. They come to me and ask for laxatives, enemas, and suppositories. If the CNA has reported that the patient has defecated within the last 48 to 72 hours, I usually refuse their request for laxatives.
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