Not enough attention to BMs in nursing today!

FireStarterRN, BSN, RN · Dec 10, 2007

*groan*

Ms Kylee · Dec 10, 2007

Yinz guys are funny... :lol2:

EmmaG, RN · Dec 10, 2007

I just think there isn't much emphasis any more placed on passing on BM info. We don't get any JCHAO edicts, or QAs on BMs. Management recently instituted a rather useless fall precaution sheet that really doesn't change how we deliver care, but only gives us another form to fill out. But we have nothing in place to cue nurses on the value of making sure the patient's bowels are moving each day.
I agree with Leslie that we shouldn't use that as an excuse, my point is that current nursing culture seems to have forgotten some of the basics of nursing that go back to antiquity.

Perhaps if JCAHO realized that the majority of the falls occur when someone is attempting to go to the bathroom (strictly anecdotal admittedly, but from my own experience).

My 'brains' have a check-off for BM. It's part of my assessment.

We had a patient die some years back because of constipation. That is truly what killed him. No BM for >2 weeks, developed a megacolon which compressed his diaphragm to the point he simply couldn't breathe.

ebear, BSN, RN · Dec 10, 2007

Y'all are CRAZY !! (a requirement for nursing)!!!!! :lol2: Please don't give the "suits" another bright idea for another "form"!(although this one would make sense)That's already preventing nurses from being nurses.

NurseNatashaO · Dec 11, 2007

This is one of my pet peeves. I used to work in a nursing home and had 61 patients to care for. I barely had time to do my job, but i made it a point to make sure everyone had at least a BM every other day. Problem is that the nurse aide's wasn't marking the bms down right. Either they were giving them BMs when they wasnt truly have a bm it was run around. or they werent even acknowledging them at all. I preached and preached to management and my nurse aides about the importance of knowing when they had a bm or not. Needless to say it was falling on deaf ears on both sides. I think if we have nurse aides they need to be better trained and explained to the rasoning behind the importance of charting the bms and so forth. Just my opinion. oh btw i love nurse aides and not all are bad

ebear, BSN, RN · Dec 11, 2007

HUH????? I don't know...but I think I need to go have a BM!!!! :lol2: :lol2: :lol2:

ebear

EmmaG, RN · Dec 11, 2007

HUH????? I don't know...but I think I need to go have a BM!!!!:lol2:
ebear

FireStarterRN, BSN, RN · Dec 11, 2007

HUH????? I don't know...but I think I need to go have a BM!!!!:lol2:
ebear

Nothin' like a little bathroom humor!!!:trout: :lol2:

caliotter3 · Dec 11, 2007

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.

You are so right. Wish I could work with someone like you. Common sense and the basics. They go so far to make things easier.

TRAMA1RN · Dec 11, 2007

I don't know where you work but I work ER and we do address this very question in every triage even if the person doesn't come in with an abdominal complain. In the rest of the hospital 99.9% have standing orders for MOM. This is ALWAYS addressed where I work now and the other fscilities I have worked at. Maybe you should check your facilities policy.

psalm, RN · Dec 11, 2007

...yeah, we have it on our shift assessment under GI system. I will write in date of last BM. If it has been more than 2 days and the pt. is eating and BS present and/or passing gas, I will check MAR for PRNs. Sometimes just more fluids, or activity will help. But take it seriously!! As others have mentioned, megacolon and SBO are possible.

bethin · Dec 11, 2007

this is such crap!!
it has little to do w/the demands of nsg.
we're all stressed.
but how long does it take to ask your pt, "how are your bowels? are you moving ok?"
trust me, they'll tell you.
the problem is, too many nurses get the "i'm not doing that" attitude, and don't address these problems.
i don't know how many pts i've seen crash on me, all what started out as constipation and ended up as impaction.
the impactions are a domino effect to a whole set of secondary complications.
a pt has a lg bm, and voila, everything goes back to normal.
it's ridiculous and it's pitiful, that such a simple intervention, goes ignored.
no, it's not r/t being busy.
it's much more r/t "i'm above that", "that's disgusting", "i'm not going to do that".
inevitably, you spend a heck of a lot more time, trying to rectify the situation.
basic nsg care, has gone out the window.
i'm just waiting for a healthy dose of humility, to fly back in.
pfffffffffft.
leslie

I think it has to do more with this than anything else.

I'm not a nurse, but can't consistent constipation cause bowel obstructions? That's pretty serious, especially if the pt has to have surgery, maybe part of their colon removed, a catheter and NG.

On our med surg floor, it's not really discussed. But when I float to our in house LTCF, we have a 3 ring binder with resident's name, dates and when they went and size. It's also charted on the computer. The book is used because it's easier for nurses and other staff to look at. Our protocol is that after no bm or no substantial bm and resident is having pain, MOM is ordered on the third day. If that doesn't work then there are other options. Nurses just keep going down the line until something does work.

I don't know if this is caused by constipation, then having loose bowels from too many doses of MOM, suppositories, etc, old age or both. But wouldn't it be better to get them on a schedule? That way you're not giving them MOM one day and lomotil the next. It's a constant struggle. My grandma does this. I guess it probably has to do with getting older. One of the many perks I hear.