need help please

[honeygirl1189]

hi everyone, Im a new grad RN just passed my NCLEX and got a job on medsurge in my towns hospital. my pt had an order for bisacodyl supp prn for constipation. so she said she didnt have a bm for a few days and nothing was charted so i gave her the supp. the thing is while i was inserting it i could feel something inside her rectum. it didn't feel like stool it was harder and deeper inside like way up. LOL i didn't want to probe to much because of the vassal vagal response. i was to embarrassed to say anything to her and to the doctor. could it have been hemmroids?? or a forign object?? i just didnt know what to do, im back to work tonight and probably have her as my pt. should I tell the doctor so he can check her himself?? or ask the pt what is is?

[Sniper RN]

Stool can get pretty hard, like a rock. Think about all the moisture being pulled out. I bet she is impacted. Is there another nurse you could ask?

[mentalhealthRN]

I would have let the doc know. Sounds like stool and the doc may need to to a digital extraction and sounds like she needs to be on colace to SOFTEN the stool....you should talk to the doc about an order--usually they start with 100mg qday then if not better increase to 100mg BID....along with senna sometimes. But yeah sounds like stool. You could also be sure the pt is getting enough fluids.......but all of this should be discussed with the doc.....nothing to be embarrased about. That is your job. To let the doc know that that kind of stuff is going on....so they can take care of it and see what they can do to then keep it from happening again.

[katkonk, BSN, RN]

You need to say something to someone right away, so she does not end up with a perforated colon from being impacted, since it has been several days since last BM! Understand the mistake since you are a new grad, but you definitely need to say something when you notice something that is "not right" in any assessment. At least bounce it off another nurse there.

[JBudd, MSN]

Constipated stool can feel like rocks, but if all you were doing was putting a suppository, why would your finger be up high enough to feel something "way up" there? It isn't like an enema where you need to go high.

Vasovagal response isn't all that common, by the way. I've put in innumerable suppositories with no problem, as well as quite a few digital disimpactions.

But as the others have said; if you find something out of the ordinary or are unsure of, ask! sooner rather than later. I hope your coworkers are open to a new grad needing to check things out with them.

[canesdukegirl, BSN, RN]

Oh wow. This was almost certainly stool. Did it feel like rocks? Hemorrhoids are just soft tissue that have become inflamed, and can be inside or outside. I have never felt them to be hard like you are describing.

Is your patient on narcotics? Has your pt been ambulatory? Passing gas at all? What did her abdomen feel like? Any bowel sounds? Has she been eating solids? What is her liquid intake? A vasovagal response will usually be seen in something like a lower GI study or an enema delivered by gravity. Placing a suppository should not garner a vasovagal response in general.

Don't ever be embarrassed by an unusual finding in your assessments. Private matters like this is what we are in the business of! This is where you must overcome embarrassment and become a patient advocate. This could very well turn into an ugly scene if it is not addressed. The last thing you want is for this pt to have a perforation, like a previous poster mentioned.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

Hard object in the rectum? Have the doc look into it!