Not enough attention to BMs in nursing today!

smilin_RN · Dec 21, 2007

HAHA

I am not sure what its like in a larger hospital, but..... the aides and I seem to have more than our share of poop... we even have names for ourselves such as......the commode commandos, the poop patrol, and the crap nazis. :troll:

of course my least favorite activity is digging someone out, i have nightmares about it. but its gotta be done some times.

EmmaG, RN · Dec 21, 2007

Thank you all for these posts! I recently had someone very dear to me become impacted because of opoid meds. He was in horrendous pain and was so sick I was scared! And then it took a good 3 weeks for his bowels to return to normal after the disimpaction (bouts of diarrhea, ironically). That experience impressed me so much that I vowed that when I become a nurse, I will make sure my patients poop! :)

Diarrhea can actually be a sign of impaction, as the liquid is the only thing able to pass the impacted stool.

dbsn00 · Dec 22, 2007

My facilty was sited by the DOH this past year for not having proper bowel protocol. :nono: Now almost everyone has colace daily & PRN MOM. This is working very well, it's rare now that we have to disimpact a resident. The CNAs on my unit are really good with informing the nurses if someone doesn't have a BM in 2 days so we can start the MOM, etc. And warm prune juice is the BOMB but my resident's are always reluctant to drink it so we use stewed prunes (warm) which works just as well and tastes better. There's nothing worse than trying to disimpact a very confused and combatative LOL...and I do not want my frail cardiac residents straining to have a BM.

AprilFro · Dec 22, 2007

I work on a spinal cord injury unit where most of the patients cannot have a BM on their own so we automatically do bowel programs in the evening with suppositories. It is routine nursing care for our unit, but I so notice that when our patients are sent to the hospital for emergencies and are kept their for care, they do not have a BM for several days and come back to us with an impaction. They do get very sick and some do not realize that you have to POOP to stay alive!

leslie :-D · Dec 22, 2007

It is routine nursing care for our unit, but I so notice that when our patients are sent to the hospital for emergencies and are kept their for care, they do not have a BM for several days and come back to us with an impaction. They do get very sick and some do not realize that you have to POOP to stay alive!

dig that. (ha!)

wouldn't you think it common sense, that neuro pts require active intervention w/b&b?

*shaking my head*

leslie

psalm, RN · Dec 22, 2007

HAHA
I am not sure what its like in a larger hospital, but..... the aides and I seem to have more than our share of poop... we even have names for ourselves such as......the commode commandos, the poop patrol, and the crap nazis.
of course my least favorite activity is digging someone out, i have nightmares about it. but its gotta be done some times.

Make sure you double-glove!! Seriously, you dont' want any surprises when you withdraw your digits from the area.

Mikey31079 · Dec 22, 2007

i work in ltc and i am all about being vigilant with the bm's. when i see people walking with their upper body tilted to one side because they havent pooped in god knows how long i tend to get a little bit pissy. and theres no way to tell exactly when they had one because for some reason i seem to be the only aide marking the book. like one of the other posters, i too had a favorite resident get sick from being constipated. she ended up with a bowel obstruction that required surgery. (i saw her a day later in the icu hooked up to the vent and i started crying so hard i had to leave because i didnt want her to hear me so upset, she was one of the ones who didnt have any family besides us at the snf so we all kind of adopted her.) sadly, she passed away from a subsequent infection.

anyway, the point im trying to make is always always check for bm's, yes i know it isnt pretty but neither is the alternative. :madface: :angryfire :nono:

Tweety, BSN, RN · Dec 22, 2007

To me it's nursing 101 and assessment to ask about their bm's. But apparently not on my unit. Recently had a patient about to go to rehab it was the rehab coordinator who told me the patient hadn't pooped in the nine days he's was in acute care. He was 16 and certainly not about to talk about such things. Another opiate tolerant patient on massive narcs. didn't poop for 14 days. I hung my head in shame for my coworkers and I addressed it in a staff meeting, but puuuleeeze.

klj836 · Dec 22, 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.

This is another point that nursing has drifted from the basics of care and many time now we nurse machines instead of people. The bath, nutrition, and daily elimination takes second place to the cardiac monitors and all those other wonderful electronics that we have to "assess" patients. We'll see some dramatic changes in the years to come, unfortunately it will be the care givers of today that will reap and receive the rewards of care given.........do we always do our best?

AtomicWoman · Dec 22, 2007

Diarrhea can actually be a sign of impaction, as the liquid is the only thing able to pass the impacted stool.

You're right. While he was impacted, some diarrhea was able to get by the impaction. But even long after his disimpaction, he had bouts of diarrhea. Which he said he preferred to being impacted! :uhoh21:

AtomicWoman · Dec 22, 2007

HAHA
I am not sure what its like in a larger hospital, but..... the aides and I seem to have more than our share of poop... we even have names for ourselves such as......the commode commandos, the poop patrol, and the crap nazis.
of course my least favorite activity is digging someone out, i have nightmares about it. but its gotta be done some times.

Since I am not yet even in nursing school, I gotta ask you: Where do you *learn* to "dig someone out"? Is that a skill you learn in nursing school, or is it OJT? :lol2:

AtomicWoman · Dec 22, 2007

There's nothing worse than trying to disimpact a very confused and combatative LOL...and I do not want my frail cardiac residents straining to have a BM.

You make a good point about your cardiac residents. I don't think most people realize how much chest pressure can build up when someone strains and holds their breath at the same time (as so many people do).