Ummm..not sure how to ask this but who has experience "digging out" a patient?

[LucyLu]

I'm a relatively new nurse and I this situation came up yesterday. The patient was having difficulty with a BM. The aide came out and said "she wants the nurse to dig her out!" I've never done this. It certainly wasn't taught in nursing school. I looked it up in my "skills" book and it's not there.

So is anyone willing to share their expertise in this area? Also, is it solely a nursing responsibility? Do you need a Dr.'s order. She was a telemetry patient, post lap. choley. HELP!!!!

[nursedawn67, LPN]

I use lots of lubricant, which I try get all along the edges of the stoool i feel. I wear 2 gloves (nothing worse than finding my glove broke), very gently with my index finger I break up the stool and pull it out, being carefull not to disrupt the tissue of the rectal area. Can be a very tedious job I find, because I am careful and because I work in a nursing home and have some demented people that resisit it, but it is better then having that same resident impacted.

We don't require a doctor's order to digitally remove BM, but we do chart what we did and what was removed (color, consistancy, resident tolerance). I don't know about a post surgical telemetry patient as far as orders go.

[canoehead, BSN, RN]

You need an order. It's an invasive procedure, with risk of triggering the vagal nerve. It's not an easy procedure either, like trying to pick up Jello with a finger. If the patient is used to someone doing that regularly they lose their own evacuation reflexes, not to mention the demoralization of someone sticking a finger up their butt. I would rather call for an order of GoLytely or lactulose, personally, and start a strict bowel regime.

Try everything else first...including a retaining enema to let the hard stool absorb moisture, and an mineral oil enema to make the passage slick and easy. Then try a pudding of allbran cereal, applesauce and warm prune juice, just a couple ounces.

[Roy Fokker, BSN, RN]

"Bobbing for apples" anyone?

[LucyLu]

I guess I can see the need in a nursing home but does this occur often in the hospital setting?

[Gennaver, MSN]

I guess I can see the need in a nursing home but does this occur often in the hospital setting?

I do not know what to consider "often" but, I have seen it a bit. In one hospital where I worked it was a task relegated to the assistants, (however this was rare and I was intimidated because there is vagal stimulation with this and you cause a drop in someone's blood pressure -as you do with suctioning respiratory secretions).

It is necessary and a little digital excavation of stool can help to prevent an impaction from causing an eventual Ileus, (among other reasons) right?

Gen

[all4schwa]

You'll find it more in the nursing home where people are more likely to have sluggish bowels.

[Quickbeam, BSN, RN]

Even nursing homes don't do this much anymore. Back in the 70's when I was a CNA, the RNs did this every day. Now? My LTC friends say it is almost never done anymore.

[NurseLatteDNP, MSN, DNP, RN]

We get it often in our hospital, but our little town is mostly populated by people ove the age of 60. And we have many nursing home patients who are used to manually remove their own bowels every day.

[dcnballmom, ASN, RN]

in my LTC we have a very strict bowel regimen so this doesnt occur too often - i agree with the lots of lubricant - double glove - be as gentle as you can - - we also need a physicians order for this - and it is also a no- no for us to document anything about patients not having bowel movements for several days as this is considered a sentinel event - and we were cited as such by surveyors once - we use that trusty MOM - followed by suppostitory - followed by enemas - i think i pass out a gallon of lactulose a week - and a special "recipe" that consists of pureed prunes, fiber, and flavored with cherry pie filling - that seems to help - and dont forget that plenty of fluids thing too - hope you dont have to "dig" too often as this is a degrading procedure not only to your patients but to you also -good luck in your nursing career

[crissrn27, RN]

Lots of lubricant, and double glove, if you have to do this. I found that a dose of MOM and a cup of hot coffee, or warm prune juice, followed by getting the pt up to the toliet (if medically possible) works wonders. I would try this first. It is very hard for anyone to use a bedpan for a bm and the "natural" state of sitting up for a BM does great!

[Cattitude]

And be very careful with anyone with a cardiac hx or even those over the age of 55 or 60. I swear my first code was because me and another nurse disimpacted her earlier that evening!