I know this isn't a very pleasent subject and I'm sorry, but I ran into a LOL at my new LTC that is apparently obsessed with her bowels.
The other nite she insisted that she was 'just full of BM' and wanted me to remove it - she had had 3 bowel movements in the past 2 days - the evening nurse had done a rectal check and felt nothing - so I refused.
She is A/O and I tried to tell her the dangers of poking around in her rectum, but she was having none of it. My preceptor says she eats very little, has had psych consults, and even her doctor doesn't know what to do with her anymore.
I think she could benefit from an anti-anxiety med, but they tell me that she won't take them.
I tried to offer her some hot tea, but she was upset still that I wouldn't go digging in her bottom. Any suggestions?
I'm sorry if I've upset you, bandit, and clearly I have, it's just that I find it alarming that you're even considering giving a dulcolax to an elderly patient who's already had "3 BMs in the past 24 hours." The serious cardiac problems you're concerned about would be far more likely to arise from that intervention (dehyration and electrolyte imbalance) than from a single non-poking-around digit into the rectum. (Maybe you could even throw in a "Nope! Nobody home!" lol )
"Vagus nerve stimulation, causing cardiac irregularities with possible fainting or weakness," In some elerly this can be caused just by Flatulence. i have had it happen to a resident that was being assisted to the toilet.
I'm sorry if I've upset you, bandit, and clearly I have, it's just that I find it alarming that you're even considering giving a dulcolax to an elderly patient who's already had "3 BMs in the past 24 hours." The serious cardiac problems you're concerned about would be far more likely to arise from that intervention (dehyration and electrolyte imbalance) than from a single non-poking-around digit into the rectum. (Maybe you could even throw in a "Nope! Nobody home!" lol )
Just a thought and good luck.
Yeah, when someone comes into a thread, sounding as rude as you did, that's a little offputting.
I did say that she had those things ordered, I didn't say that I gave or would give them - I didn't state myself very clearly, I should have said other PRN methods. After working critical care for many years, I DO know about electrolyte imbalance. and dehydration.
It wouldn't be just a single 'digit in the rectum' as you stated. If I start doing this, it will be an every night affair - and I'm not going to allow myself to be manipulated in that manner. I'm going to have to investigate some less harmful methods of helping this lady.
Nope...I wouldn't make it a habit of doing digital checks on her to make her happy. Trust me..I would end up being a daily thing. I too have had folks go vagal with a good fart or trip to the toilet. Not funny.
I would go the route of more intesive bowel regime..maybe she has the feeling of being full?
Just curious...what do you all do if you see it crowning, but they are unable to push it out? In LTC..it could be days before a doc comes in. No nurse wants to do it, but at those times...yah gotta do what yah gotta do.
Really? Like what? Syncope? Come on. What about our duty to remove, digitally, fecal impaction? Are you not going to do that because of the "major cardiac problems" you might cause?
Please. If the patient is in genuine distress over the matter and has no PRNs and is not open to reason (or who may be incapable of being open to reason) I'm with the nurse who suggested a rubber glove and a little surgi-lube for a brief pretend survery. It will give her the relief she seeks at small expense to yourself. I would also speak with the nursing supervisor about a psych consult.
Giving dulcolax to a patient who is not constipated borders on abuse.
Perpetuating unhealthy behavior is much more abusive than saying "NO" and giving dulcolax tabs would be the next thing to do (if the lady was indeed constipated.) Because the evening nurse had already checked the "loading dock" and verified it to be empty, attempting manual removal would be wrong and possibly abusive. (Not to mention the cardiac implications) And because the lady feels constipated, and there is nothing in the rectal vault, dulcolax tabs would be the next choice to bring the BM down.
Would that be manual vs using some mechanical apparatus, like say, a dynamap?
Have done digital stimulation or just hook and drag a block in the rectum to avoid impaction. Paraplegic pts for instance just can't get going other wise.
Oh, yeah, in spinal cord injury patients, of course this must be done with great care. But, oddly, if the rectum is not evacuated, you can end up with autonomic dysreflexia, which is really nasty too.
So stuff like this is case by case, and you do need to check out if it is appropriate for individual patients.
Frankly, I suffer from IFOPI (irrational fear of patient impaction). But even to me this sounds like OCD on the part of the patient. Treat her anxiety, and give her metamucil.
This is not a professional opinion, I am not a nurse!
mauxtav8r
365 Posts
In my hospital, digital removal of impaction in elderly or pt with h/o cardiac issues is only performed by a physician.