Needy, needy, needy... vent please.

xtxrn, ASN, RN · Nov 6, 2011

I don't know what to say here but DANG!. My patient is on my last nerve right now. He's CONSTIPATED at 2AM!! What in the world do you want me to do???? I gave your miralax. You have nothing else. NEWS FLASH... I'm not calling MD at 2 am for something. CHECK FOR impaction??? omg ... and on my birthday just real irritated right now at this needy needy man. HE's not fooling me. He can do much more than what he's portraying.

If he has nothing ordered PRN, and is complaining this much, I'd call the doc. True, the doc won't be happy- but then maybe the next time he will write PRN orders for constipation. Being constipated or impacted is a very painful thing at times (impaction, for sure). To make him wait another 6-10 hours to get something- then have to wait for it to act, it's too long to make someone wait- IMHO.

carolmaccas66, BSN, RN · Nov 6, 2011

Why u have a patient who needs to use his bowels at 2am is beyond my ken.

I had a patient like that not long ago. She was absolutely obsessed with her bowel. U have to remember with the older generation that pooh was seen as a poison in the body, and if you didn't go each day - or more - drastic measures were taken. Manual removals were common. Many older people have told me they had soap & water enemas everyday if they didn't go. My Mum had fish oil forced down her throat when she was young. If you didn't go, you were MADE to go.

Explain he will probably go in the morning - enemas etc, take time to work. Distract him with a warm blanket, and a warm heating pad over his stomach, wrapped in a towel to make him comfy. Offer a sleeping aid if he has one. Empathise/sympathise but be firm. He also needs to get into a bowel routine, ie: sitting on the loo in the morning using your bowels and in the afternoon will help his bowel send signals to his brain when it's appropriate times to go. If he still has problems later on, contact the doc next day and maybe have a continence team/nurse & dietary look at him.

It's very hard when old people are in bed, cos they're not moving around which leads to constipation. Ask doc to also write up a stool softener.

Just smile at him, then go into the toilet & kick the door - that helps!!

rksgray13 · Nov 6, 2011

Let me be a little more honest. He's not complaining "this much". He just called out. I did research his chart and found a PRN order. I've sent for it. I've given him more pain medicine as requested, even though it will cause constipation. Plus I checked him for impaction because his history listed this. He is impacted and I am about to manually un-impact him. I am a good nurse. If it came down to it I would call the MD( if nothing on hand worked) cause he's a great doc and prolly wouldnt be on call anyways. I'd get the one A-HOLE that cusses me for calling about an impaction. This was a VENT, guess I'll keep it to myself next time.

carolmaccas66, BSN, RN · Nov 6, 2011

Let me be a little more honest. He's not complaining "this much". He just called out. I did research his chart and found a PRN order. I've sent for it. I've given him more pain medicine as requested, even though it will cause constipation. Plus I checked him for impaction because his history listed this. He is impacted and I am about to manually un-impact him. I am a good nurse. If it came down to it I would call the MD( if nothing on hand worked) cause he's a great doc and prolly wouldnt be on call anyways. I'd get the one A-HOLE that cusses me for calling about an impaction. This was a VENT, guess I'll keep it to myself next time.

Sweetie, it sounds like ur a great nurse, kudos to you! Just remember to tell patients if u give them more codeine - or whatever - that it does cause more constipation.

Might be worthwhile looking at possible non-constipating pain meds for him, or give them either anally or IV.

Just document it all & let the doc know. And if the doc gives u a hard time for calling, remind them diplomatically that they CHOSE to be a doctor who WILL be called in the wee hours of the morning, and crawl a bit, I always say something like: 'Well I'd appreciate yuor great advice doc on what YOU want to do re YOUR patient!', then they usually calm down.

Sounds like ur doing great :up:

xtxrn, ASN, RN · Nov 6, 2011

Let me be a little more honest. He's not complaining "this much". He just called out. I did research his chart and found a PRN order. I've sent for it. I've given him more pain medicine as requested, even though it will cause constipation. Plus I checked him for impaction because his history listed this. He is impacted and I am about to manually un-impact him. I am a good nurse. If it came down to it I would call the MD( if nothing on hand worked) cause he's a great doc and prolly wouldnt be on call anyways. I'd get the one A-HOLE that cusses me for calling about an impaction. This was a VENT, guess I'll keep it to myself next time.

It's ok to vent :)

I'm glad you found some stuff to help :up:

Nobody is posting that you need to keep it to your self....when you are fairly new, it's hard to know what is worth a wake up call to the doc. Here's my thought on that- You didn't force him to become a doc- and it's not your fault he's on call You're looking out for the patient- and if they find fault with that- RUN. :) :hug:

rksgray13 · Nov 6, 2011

Thanks all. I'm not new though. 11 years under my little belt. I also have that mentallity, that the dr made that choice to be a doc and that's the brakes. KInda like I don't want to stick my arm into that man's orifice and remove his stool but that's the brakes. My patient is #1. I'm #1 in a #2 business lol. There is one dr though that no matter what he will belittle and yell no matter WHY you called him, be it 2am or 2 pm.

student forever · Nov 6, 2011

Ever try "Smooth Move" herbal tea? Give 'em two cups of that stuff and he'll be smilin'!!

Plus at 2 am the tea would calm him down, too!

DixieRedHead, ASN, RN · Nov 6, 2011

I don't know how often this exact scenario happens, but I do know that patients are often constipated due to surgical procedures, decreased exercise, pain meds,etc.

Here are a couple of things that you can do.

1. See to it that there is always some prune juice on your unit. You don't need a doctor's order to give it. It usually works, and if you can get them to take it warm it works even better and faster.

2. In the long run you might consider trying to get some standard orders for your unit for constipation.(I'm very surprised there aren't any).

Hope this helps.

EmergencyNrse · Nov 6, 2011

1 word: Versed

Sorry but that's why I'm in the ER. I'm giving 4mg Versed

and let him try again in the morning when he wakes up and after my shift is over.

:-)

nerdtonurse?, BSN, RN · Nov 6, 2011

I had a pt who was so obsessed with bowel movements it was almost a psych issue. She was alert and oriented, in her 50's, not a sundowner, no dementia. She had a normal, formed stool, good sized, right after my shift started. Good bowel sounds, not dehydrated, not on narcs. She was in for something relatively benign for our floor, like getting her BP medications straight. So, long about 2300, she calls me and tells me she's constipated. Go down, tell her she had a REAL good BM 4 hours ago, and she probably just doesn't need to go. She starts pitching the mother of all fits about it, to the point where I digitally check her to make sure nothing's "stuck." Nope, clean as a whistle. Dayshift had reported she pooped once for them.

I try to educate, tell her she probably doesn't need to go -- OMG, wrong answer. She starts cussing and swearing that none of us want to have anything to do with poop, (uh, hello, didn't I just go exploring?) and she's going to get me in trouble for not giving her something. Okay. So, I go get crazy lady some MOM, write that I was giving it at patient's insistence, no s/s of constipation noted, good BS, visualized good BM, etc.

30 minutes later. RING. "This isn't working. I know you just gave me some milk or something. I need something to help me move my bowels." Okay, now sometimes that can be cardiac, so I get a 12 lead and a troponin, just in case. Nothing. Normal. So, I happen to see one of the docs, get an order for a enema. Do that. Nothing.

30 minutes later. RING RING. "You're just messing with me, I know how lazy you nurses are, you don't want to do anything for me" (digital exam and enema don't count, apparently), and she is just throwing a fit. Doc hears this, comes in, and she starts cussing HIM out, and telling him HE'S lazy.

Wrong thing to do.

So the lady gets a soap suds enema, 2 bisacol, followed by a bottle of mag citrate. By 5 am, she can't stay off the BSC, and it's just water No solids at ALL. We could have scoped this woman by the time we were done.

So, it gets to be shift change, tell the oncoming shift what's up and that she probably won't have a BM since we've cleaned her out from one end to the other, literally. As I'm walking by her door, the day shift nurse goes in, and I hear,

"They didn't do a THING for me last night, I need to move my bowels, now you get me something or I'm calling the head of this hospital."

:banghead:

GHGoonette, BSN, RN · Nov 6, 2011

You are wise not to call the doc; you might get a response like this...."Nurse, take two Fleet enemas. Give one to the patient and one to yourself..."

Yep, one of our surgeons said that to a nurse who called him in the wee (or poo) small hours of the morning.