Treating constipation in active dying process?

What are your practices regarding constipation in the last days/hours of life? I am referring to a person who is minimally or unresponsive, mottled, cheyne-stoking, etc. Are you continuing with dulcolax supp and enemas at this point? I've searched everywhere for a written policy concerning this in the active dying process, but have only come up with the literature pertaining to the last 6 mo of life, or opoid-induced constipation, etc. In our area, we tend to not administer suppository or enema at this stage. The ECF i visit recently gave SSE to one of my patients in his last hours of life. Sure would appreciate your thoughts. And, blessings to you....

if death is imminent (matter of hours), i would leave it alone.

if it's impaction vs. constipation (much more uncomfortable) then i would digitally remove the stool w/a lubricated, gloved finger.

but mottling and cheyne-stoking are such advanced stages of the dying process and your pt appears comfortable, i would probably leave it alone.

if it's obvious that their constipation and/or impaction is causing discomfort, then it is your duty to do whatever it takes to relieve your patient of their pain. it really is a nursing judgement.

leslie

I have pretty much the same take on this as Leslie. Only intervene if the constipation appears to be causing the patient distress. There have been times we have taken on a patient with terminal restlessness who could not settle down until they had that stool evacuated. They needed to complete their last business here on earth before they could be at peace!

...agreed:)

if death is imminent (matter of hours), i would leave it alone.

if it's impaction vs. constipation (much more uncomfortable) then i would digitally remove the stool w/a lubricated, gloved finger.

but mottling and cheyne-stoking are such advanced stages of the dying process and your pt appears comfortable, i would probably leave it alone.

if it's obvious that their constipation and/or impaction is causing discomfort, then it is your duty to do whatever it takes to relieve your patient of their pain. it really is a nursing judgement.

leslie

This is our policy as well.

There have been times we have taken on a patient with terminal restlessness who could not settle down until they had that stool evacuated.

excellent point aimeee.

often times nurses overlook constipation as a source of terminal restlessness and readily give them the ativan.

i always do a digital to r/o constipation and then intervene accordingly.

leslie