Not enough attention to BMs in nursing today!

[FireStarterRN]

I think that nursing today is often forgetting the basics. I had a patient this weekend who I transfered from a stepdown bed to med/surg. I followed the patient and floated to Med/Surg. By the end of the shift I became aware that the patient really needed a BM, and in report I suggested that the patient needs some MOM, ect.

This didn't get addressed and the patient went into A-fib with RVR in the night and ended up an ICU patient on a cardiziem drip. I took care of him the next day, he was distended and no appetite, and was more SOB (his underlying dx was pneumonia)

I told the hospitalist I was going to get his bowels moving when I reported some things to him in the AM, which I did with MOM and a suppository, much to the patient's relief. He had been having runs of wide-complex beats, most likely V-tach, and once he got into bed after his BM (med, hard) he settled down, his nausea went away (doctor had started troponin protocol based on nausea sx), and his heart gradually slowed down, allowing me to wean him off the drip. He converted to NSR at around 1500. The hospitalist put the patient on metamucil, and suggested that cardiziem (patient was on PO cardiziem at home) is a poor choice for a patient with tendency to be constipated.

My point in telling this story is that, I notice patients are being allowed to go too long without BMs. It seems that the basics of nursing care are being lost in a sea of regulatory overdrive demands and high tech wizardry.

[Diary/Dairy, RN]

this is such crap!!

leslie

Or not!!! I'm sorrry - your choice of words hitmy funny bone!

On the other hand, I think you are absolutely right! Pooping regularly is very important to getting better, as is sleeping right.....

[leslie :-D]

Why do you think? Is nursing education to blame? I was talking the oncoming nursing supervisor this weekend and she said that nursing schools these days are emphazing careplans and fluff too much, and students are not getting enough practical clinical skills.

why does it even have to be nsg education?

as nurses, we are accountable to the implications of drugs and their s/e's, immobility, decreased motility, trauma, and anything that can cause constipation.

just as we know the risks of dvt's/pe's, malnutrition, pain, unstable vitals, and on and on.

some things shouldn't even have to be taught, such as the pervasive constipating factor that runs (or not) rampant through hospitals/snf's.

i think our memories are rather selective.

we choose to remember what we want to.

i don't know about students getting enough clinical time.

but surely, it would be taught in class.

this is basic stuff, but oh so lethal.

this is b.s.

i'm not buying into any of it.

there's no (good) reason for it.

shabby, shabby, shabby.

leslie

[TheCommuter, BSN, RN]

Why do you think? Is nursing education to blame? I was talking the oncoming nursing supervisor this weekend and she said that nursing schools these days are emphazing careplans and fluff too much, and students are not getting enough practical clinical skills.

Although I might be incorrect, I think that today's nursing programs tend to do whatever they must to simply get the students to pass NCLEX on the first attempt. Therefore, the basics in nursing programs may get brutally pushed aside to make room for learning about life-sustaining knowledge, technological advances, dosage calculations, and so-called 'priorities.'

Just browse through the NCLEX forums, and virtually none of the recent test-takers mentions anything about test questions related to defecation, impaction, constipation, obstipation, diarrhea, or anything dealing with BMs. Therefore, I think nursing educators are purposely shoving the importance of BMs aside.

[FireStarterRN, BSN, RN]

So, you think it's just today's nurses being irresponsible and disgusted by BMs, earle?

[CaLLaCoDe, BSN, RN]

I will be the first to admit that there can be way too many things to do on one's shift and the bowels get secondary treatment. Sometimes it just happens just so. And I end up hating myself for it.

I just recall those times when I did address the bowel concern and had the patient resting without complaints of abdomenal pain whatsoever; and no more Vicodins to be given lol. Sweet success!

We have one doc who puts in a protocol order of MOM, Fleets, Ducolax...whatever, it's there in your MRA ammo bag.

I just wish all my patients had reinforcements in place without having to call the doc at three am!

[leslie :-D]

So, you think it's just today's nurses being irresponsible and disgusted by BMs, earle?

for the most part, yes, RN.

leslie

[leslie :-D]

We have one doc who puts in a protocol order of MOM, Fleets, Ducolax...whatever, it's there in your MRA ammo bag.

hmmmm

try getting many of these nurses, to use these prn's.

let's get this straight.

i KNOW there are very responsible, committed nurses out there.

i am not talking about you guys.

we all know to whom i'm referring.

and there are too darned many of 'em.

just can't escape that "eeeewww" factor.

leslie

[SuesquatchRN, BSN, RN]

I think to a large degree there's too much emphasis on theory and fluff, as has been said, and a lot of people seem to have a lot invested in being thought of as a professional. And professionals don't do poop.

But I also think it has a lot to do with time. Get report at 7, hit the floor at 7:40, and you have vitals and meds for 5 people due at 8 - and everyone, these days, is categorized as a high fall risk so no one can do anything without you.

[cmo421]

Read about Toxic bowel syndrome and its incidence in the critical care areas. With high use of antibiotics and opiates, bowel problems should be a high priority,but sadly they are not. High temp,sedate elder person? Possibly just ***. I so remember getting a terminal middle age woman from a LTC,chronic abd pain,high temp, high WC. Turned her over to assess her backside,and her rectum was dilated no less then 4 inches around, no kidding. Since then, I always think of the bowel regeme as high priority.

[Ms Kylee]

Gotta love my patients... if they haven't had a BM for 2 days, they ask for MOM or a Colace. 99% of my patients are bowel obsessed.

[Daytonite, BSN, RN]

I think you are right! In working with students on care planning and doing their assessment of patients, I find that they don't assess ADLs like they should. Somehow, many student nurses just get caught up in the excitement of medical diseases that patients have and forget that we nurses primarily and foremost should be attending to ADLs as well, and whether or not the patient has had a regular BM is part of that. Nursing homes know this. They get cited by the state if they don't keep track of patient BMs and they have issues with patient's getting regularly constipated.

Another peeve I have is the people who come out of the hospitals with decubitus ulcers because they didn't get turned or attention wasn't paid to bony prominences when they were lying in bed. This, too, is another basic nursing function that gets tossed into the wind and blamed on some other silly reason for not getting attended to. There are days when I am glad that I started my career in nursing homes because this kind of basic nursing was drummed into our heads. And, some hospital nurses look down on nursing home nurses? They could learn a thing or two from them about basic nursing!

[SuesquatchRN, BSN, RN]

Another peeve I have is the people who come out of the hospitals with decubitus ulcers because they didn't get turned or attention wasn't paid to bony prominences when they were lying in bed.

I've had people come back in disgraceful states. Just unconscionable.