Reasonable Rascal
10-26-03, 02:24
At work roday we had a doc Rx a "milk and molasses enema" for a resident with an obstruction. I must admit I had never heard of such a thing, and no, it didn't work very well. But then there were complicating factors.
Meantime I resolved to Google the treatment. I found this thread on Nurse.com. The recommendations were so complete I decided to include the whole post. The "M & M" recipe is found at the end.
RR
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IMO, all rehab/LTC/post surgery patients should have standing orders for a bowel program, in this day and age! Good topic for a Quality indicator audit. Like P-RN advice too.
What is affect of surgery or advanced elderly age? Decreased peristalsis of bowel.
What will help increase peristalsis? Irritant like roughage: fruits + fiber, laxatives or mobility.
Assess GI: check bowel sounds, distension, patients prior BM pattern and any GI meds taken/bowel regimen in past--use whats worked before prior to trying something new.
Active ingredient of Colace (docusate sodium) + Surfak (docusate calcium) is a stool softener, minimal effect to push stool bulk out.
Better choice is a laxative or laxative with softener: Surefire choices from 25+ yrs in nursing
1. Senna concentrate with docusate sodium: e.g. Senakot S(laxative plus softener)...I get CVS brand for Grandmom $10.00 cheaper. Liquid version is Fletcher's Castoria. Good for narcotic induced constipation, used as many as four tabs BID
2. MOM
3. Warm prune juice 1-2 oz.
4. Biscodyl tabs
5. Mag Citrate or Phospho soda
6. Lactulose (many pts won't take as too sweet...don't use with diabetics).
7. Fiber powders + tablets: Ok if client used in past, many pts don't drink enough fluids afterwards or only drink half dose.
Good LTC recipie is equal amounts applesauce, prune juice and bran mixed together. Start with 1 tbsp BID, increase 1 TBSP at a time after two days: 2 tbsp AM, 1 tbsp PM...2 days later 2 TBSP BID....if no result try 3 tbsp AM, 2 tbsp PM...etc ---most patients will be regular with this regimin.
[RR's note: we use this in our facility. It's called Apple Delight. I honestly don't know if anyone finds delight in it.]
Enemas:
Fleets---if hard balls use Mineral oil enema: Snake rectal tube or old foley cath up past impaction to deliver enema.
Soap suds
Dynamite: Milk and Molasses Enema (never failed me, too!) I've used equal amounts: 1 cup milk + 1 cup Brear Rabbit Mollasses (favorite as dark n thick)...mix together in saucepan on stove till well blended then cool to room temp : check temp on inside of your wrist.
Tombstone epitaph: Have glove + lubricant, will travel!
Meantime I resolved to Google the treatment. I found this thread on Nurse.com. The recommendations were so complete I decided to include the whole post. The "M & M" recipe is found at the end.
RR
--------------------------------------------------
IMO, all rehab/LTC/post surgery patients should have standing orders for a bowel program, in this day and age! Good topic for a Quality indicator audit. Like P-RN advice too.
What is affect of surgery or advanced elderly age? Decreased peristalsis of bowel.
What will help increase peristalsis? Irritant like roughage: fruits + fiber, laxatives or mobility.
Assess GI: check bowel sounds, distension, patients prior BM pattern and any GI meds taken/bowel regimen in past--use whats worked before prior to trying something new.
Active ingredient of Colace (docusate sodium) + Surfak (docusate calcium) is a stool softener, minimal effect to push stool bulk out.
Better choice is a laxative or laxative with softener: Surefire choices from 25+ yrs in nursing
1. Senna concentrate with docusate sodium: e.g. Senakot S(laxative plus softener)...I get CVS brand for Grandmom $10.00 cheaper. Liquid version is Fletcher's Castoria. Good for narcotic induced constipation, used as many as four tabs BID
2. MOM
3. Warm prune juice 1-2 oz.
4. Biscodyl tabs
5. Mag Citrate or Phospho soda
6. Lactulose (many pts won't take as too sweet...don't use with diabetics).
7. Fiber powders + tablets: Ok if client used in past, many pts don't drink enough fluids afterwards or only drink half dose.
Good LTC recipie is equal amounts applesauce, prune juice and bran mixed together. Start with 1 tbsp BID, increase 1 TBSP at a time after two days: 2 tbsp AM, 1 tbsp PM...2 days later 2 TBSP BID....if no result try 3 tbsp AM, 2 tbsp PM...etc ---most patients will be regular with this regimin.
[RR's note: we use this in our facility. It's called Apple Delight. I honestly don't know if anyone finds delight in it.]
Enemas:
Fleets---if hard balls use Mineral oil enema: Snake rectal tube or old foley cath up past impaction to deliver enema.
Soap suds
Dynamite: Milk and Molasses Enema (never failed me, too!) I've used equal amounts: 1 cup milk + 1 cup Brear Rabbit Mollasses (favorite as dark n thick)...mix together in saucepan on stove till well blended then cool to room temp : check temp on inside of your wrist.
Tombstone epitaph: Have glove + lubricant, will travel!