You need an order to remove a fecal impaction digitally right?

[lashuna1028]

One of my problem patients was complaining of not have a BM in 7 days. I did my assessment and all okay with abdomen. She requested a suppository, I told her I will have to call MD for order. So before I could get to it, she calls her husband crying on phone. He comes rolling in with his wheel chair and bang his walking cane on the counter saying I need to "make it snappy! or else she going to have to go to the hospital" (Just giving you a picture of what this couple) You know how the elderly are obsessed with their bowels. I explained to him that I am trying to get a hold of a MD to get orders.

I finally reach MD and get orders for stat KUB and 1 ducolax supp. When I go into room and explain orders they change mind, refused supp and said I need to take it out digitally, I told him no and that req an order from MD, then he started explaining another nurse did it for her... blah blah.

They finally agreed for supp, so I gave it. At time didn't feel impaction...

I went ahead and gave DON a call because like I said this is a problem patient that exaggerates and throws everything out of proportion. You know the ones that says someone hit them or stole this and that, etc..

But she tells me I didnt need an order for digitally removing a fecal impaction... Am I going crazy or what? Which is it?

[pumpkin92356]

I have just one question, Most facilities start measures to assist residents in having regular bowel movements within 2 to 3 days. You said your resident stated she hadn't had a bowel movement for seven days. My question is why wasnt something done before seven days? I hope I didn't misunderstand you? Does she say this even though it is reported that she has went sooner than 7 days? If it isn't charted then the state is going to assume that she hasn't went no matter what you or whoever says to the contrary. Far as I know you must have orders to digitally remove feces. It is extremely dangerous if you don't know what you are doing.

Thanks pumpkin92356:D

[debRN0417]

double post...sorry

[debRN0417]

As a surveyor the word "impaction" or documented "disimpacted" causes my hair to stand up. No resident should ever get to that point. If you have orders from the physician to "assist resident to evacuate their bowels, if needed"( or something to that effect), then that is a gentler way of saying it and you are not saying that they are impacted, which as CapeCod Mermaid has already said, is a sentinel event. Sometimes, as some of you have already said, the stool is right there and just needs a little digital stimulation in order to "assist". A physicians order is always good practice when you are doing something to a resident which could cause problems, (bleeding, perforation...ect...)

[gigiNaz]

Nursing is one of the fields where we must CYA, and not with a tissue.

When in doubt, call the PCP or NP and request proper intervention according to the patient.

A huge MUST is prevention. Many factors can contribute to constipation.

Let's see...inactivity, narcotic medication, poor fluid intake, decreased fiber intake, etc. etc...

Of course this population of octo- nano- and even centi-genarians have almost all the right ingredients for this problem.

We used to dulc and dilly patients (quads and paras need to have regular bowel care to prevent autonomic dysreflexia).

With cardiac patients, this is a no-no. One can stimulate the vagus nerve causing N/V hypotension and possibly slowing the HR to dangerously low levels (requiring atropine inj).

I for one am glad we aren't necessarily "obligated" to remove fecal impactions/hard stool in this area of nursing. There just aren't that many healthy hearts.

And... no MOM for some pts. with renal disease. Can cause magnesium toxicity.

[LakesideRN]

In my work I always go with I need a doctors order unless it specifically states I can do that in my policy and procedure manual. Since I work with pscy geratric pts it can get interesting when talking about bowels. I always love the guy who takes 4 fibercare every time there is a new staff giving meds and ends up spraying the walls of his bathroom on my shift. But you arn't kidding about the obsession with bowels.

HILARIOUS!!

[LakesideRN]

YES!! You do need a doctors order for it. Things can happen, but if the baby is crowning, some times you need to help with the delivery.

Its been many a year since I've needed to do this. We are big on prevention.

So...if this resident had it done once.....why does she need it again? What orders were put in place to prevent this? Why did it take 7 days? The state would have a field day with this one.

LOL!!