Question About Standing Orders for Constipation...

[skittlebear]

If someone has standing orders due to constipation that read like this:

1. Milk of Mag. if no results...

2. laxative PO 10mg. if no results...

3. Bisacodyl supp. if no results

4. Fleets Enema

How long between each of these steps do you actually wait before converting to the next step? Also, is it okay to go from Milk of Mag to Fleets Enema? Do you have to call the doctor to ask about this or can this be a nursing judgement? Thanks

[kcalohagirl]

Most of our patients are post CABG or valve replacement. We generally don't worry that muh about no BM until Post op day 3. Then we call in the "stronger measures". *grin*

All our patients get senokot QHS unless for loose stools. Usually a BM will happen by POD 3. If not, we have standing orders for MOM and the "magic bullet" = dulcolax. My personal favorite (and the PAs have been known to write for exactly that) is what I call "the bomb". Warm prune juice, plus MOM, plus a splash of sprite.

Works like a charm.