Needy, needy, needy... vent please.

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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.

Really... he's impacted. OMG really and I've just had to push my clock back 1 hour. :(

Specializes in Ortho, Neuro, Detox, Tele.

Have to be honest. If in pain, give pain meds. If also feeling constipation, consider how much patient has been eating. if orders available, give prns. If drastic measures needed, offer rectal check. if impacted, hold breath and try to clean em out.

We gave a ortho evening cocktail to patients who hadn't pooped in 2-3 days. MOM and warm prune juice. MMMMM yummy!

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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:

I had a pt who 12 hours after he had a upper and lower GI complained that he was constipated. When I explained that he had drank an entire bowel prep, followed by an enema, then had an endoscope shoved up his colon all the way to his small intestine, and an endoscope shoved down past his stomach into the beginning of his small intestine, and there was NO STOOL there...and we had the pictures to prove it.

He just didn't get it. He looked at me like I was a simpleton. Then calmly explained to me, that after his procedure, he was able to eat dinner. His entire adult life he has had a bowel movement after meals. He didn't have a bm after dinner, ergo he was constipated.

The fact that his pipes were clean, and it might take a while for the dinner to make its way down the other end to form stool, was something he didn't care to hear. Not from me, any other nurse, the resident, or the GI doc.

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i hear you about the lady who still felt like she had to go after the last-ditch "prep," but it puts me in mind of a chart i reviewed a few months ago for delayed diagnosis. pt had been getting pain meds for chronic back pain but after thirty+ years had his bowels under reasonable control. he began to c/o feeling like he had to go all the time, sounding very much like this lady. finally the pcp sent him to the ortho to check his back (and, i think, to get him the hell out of her office already). ortho did a lumbar mri....and found his retroperitoneal space chockablock full of tumor. up until then he had had no wt loss or other signs of malignancy but within weeks he was in real trouble and in a coupla months he was gone.

of such are lawsuits made. just sayin'. it's not all about you. and of course, she could have something organically wrong with her head if she either doesn't remember all that, or if she really is crazy, then.... that's why the goddess gave us psych consults.

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Specializes in Gerontology, Med surg, Home Health.
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.

:-)

I really really hope you're joking.

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Specializes in LTC,Hospice/palliative care,acute care.

Having been impacted I can tell you it HURTS like hell-it has happened to me twice and I cried like a little bytch. I was so sick to my stomach and my bum hurt-really HURT. Sometimes it happens-I was on morphine and had the whole bowel prep going and it still happened. I literally thought I would rather just die.I sent my hubbie to get a bottle of mag citrate and managed to choke that down but still had to go the manual route.And that hurt like childbirth-on top of the pain the morphine was supposed to be controlling. Maybe I have become bowel obsessed now because I will do anything to NEVER have to go through that again.If something throws me off my regular schedule by more then 4 hours it's time for the warm stewed prunes...or a beer. Then some colace-and I have an emergency bottle of mag citrate in the cupboard.I gets lots of fiber and I have a regular routine-a "window" if you will and if that window closes without results I know I am in trouble.(after reading this post I can see I have become one of my residents-next week they'll strap my MerryWalker to the medcart)

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Having been impacted I can tell you it HURTS like hell-it has happened to me twice and I cried like a little bytch. I was so sick to my stomach and my bum hurt-really HURT. Sometimes it happens-I was on morphine and had the whole bowel prep going and it still happened. I literally thought I would rather just die.I sent my hubbie to get a bottle of mag citrate and managed to choke that down but still had to go the manual route.And that hurt like childbirth-on top of the pain the morphine was supposed to be controlling. Maybe I have become bowel obsessed now because I will do anything to NEVER have to go through that again.If something throws me off my regular schedule by more then 4 hours it's time for the warm stewed prunes...or a beer. Then some colace-and I have an emergency bottle of mag citrate in the cupboard.I gets lots of fiber and I have a regular routine-a "window" if you will and if that window closes without results I know I am in trouble.(after reading this post I can see I have become one of my residents-next week they'll strap my MerryWalker to the medcart)

I have had a few partial bowel obstructions, and have been impacted a few times, the joys of adhesions. I drink bowel prep for the obstructions but for the impactions and severe constipation...Milk and molasses enemas...old fashioned and amazing.

http://www2.mdanderson.org/app/pe/index.cfm?pageName=opendoc&docid=31

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Specializes in Med-Surg; Telemetry; School Nurse pk-8.
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.

Really... he's impacted. OMG really and I've just had to push my clock back 1 hour. :(

Hey there OP, It's okay to vent. Sorry that you are having a sh*ty b-day. :redpinkhe

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Specializes in ICU.

OP..first of all happy birthday...second of all it is ok to vent..if you don't you may pop.

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Warm prune juice mixed with MOM. It'll blast the everything out of the most chronically constipated out there. Works better than any med I have tried. Especially good if the stool is hard and dry. Oh. It's given PO.:cool:

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(after reading this post I can see I have become one of my residents-next week they'll strap my MerryWalker to the medcart)

:lol2:

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OP..first of all happy birthday...second of all it is ok to vent..if you don't you may pop.

Or poop!

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had a frequent flyer (med-surg floor) who called ems if she didn't poop q3days. she would insist that the ed put in an ng, and con the docs to admit her. the 3 med-surg charge nurses (me, one of them) did a random ed check on the computer every few hours during chart checks to see if she was 'hovering' in the ed, then call the supervisor immediately after seeing her last admission and discharge dates (and which floor) and beg to have her sent elsewhere :D

she'd get admitted, then after a day or two of "cathartic buffet", she'd be whining about the brand of oj we had :uhoh3: head guru of the cult of supreme colon consciousness. :down:

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