Adventures Of Princess poo poo

Earlier this week, one of my patients was severely constipated after extended periods of narcotic use for chronic pain. After 24 hours of giving him a wide assorment of laxatives, I came on duty with the order to give the patient
1) Senokot (oral)
2) Dulcolax (oral)
3) Surfak (oral)
4) Fleets phosphosoda (oral)
5) last but not least, a Milk & Molasses enema (no that's not oral).

They were gentler when they bombed Baghdad during the Gulf Wars.

The patient was unwilling to take all of this medication, so we made a compromise to start with the easier stuff (firecrackers) and work our way through the heavier stuff (dynamite) and, only if necessary, would we pull out the big guns (hydrogen bombs).

We jettisoned the bombs at 0600.

I had never administered a Milk & Molasses enema, and had to do some research that included specific ingredients. Turns out the proper ratio is 120cc molasses (which came from pharmacy) and 120cc of whole milk. I put both in a plastic graduated cylinder and put it in the microwave for a couple of minutes, testing it between my fingers to be sure it was not too cold or too hot.

Throughout the warming process, several nurses and patient care techs wondered what wonderful dessert I was making in the microwave.

I poured the mixture into a standard enema bag. As I placed the patient into the proper position (left side with right knee bent), I sort of poo poo'd the idea of such an Old Wives' approach.

Boy was I wrong. Within 5 minutes of the administration, the patient had multiple soft stools (the consistency of warm rice pudding), and kept having them about every 10 minutes for more than an hour.

Due to poor mobility, whenever he'd turn from the bed to the commode, some poo poo would squirt out all over his bed and floor. I did pad his bed with "chux" (nurse-ese for padding that can be removed and replaced when soiled so the whole bed need not be changed) but it was still going to fast for me to keep up. No need to tell you what happened when he thought he'd just fart.

My other patient was admitted for hyperkalemia (high serum potassium levels). The treatment for that is a drug called Kayexelate, which can be administered either orally or rectally. Kayexelate causes the body to excrete potassium through the large bowel.

Yep. That means diarrhea.

Large piles of soft diarrheal stool every ten minutes for two hours.

My other patient had a neurogenic bladder, which basically means that when the bladder fills with urine, stretch receptors initiate the urge to void, usually such that the patient is incontinent. So whenever her light came on, I had about 2 minutes to get in there and move her to the bedside commode or I'd end up with a wet bed.

I was able to keep up with it for an entire 12-hour shift, and actually did a good job.

Mr. Milk and Molasses finally slowed down just before I went off duty (although had frequent trips to the commode for all of that day until I came back the following night).

Mr. Kayexelate's potassium dropped to normal limits after only one dose.

Mrs. Neurogenic bladder made it to the commode successfully (if not gracefully) the entire night, and I only had to change the chux once.

I slept the dreamless Sleep of the Dead that day.

Comments

[Eric]

I can handle just about anything except for sputum (like in suctioning traches or ET tubes). Blood and Gore don't bother me except when it involves the eyes, nose, mouth (and probably ears).

Oh, and I once took a bucket of vomit from my patient -- was all calm, cool, collected, and professional -- then went to the patient's bathroom, and promptly threw up. I hope the patient didn't hear me.

[Maria, The Wuss]

And that, Eric, is why I admire nurses. One of many reasons.

There is a tolerance level amongst health care workers for excrement. I actually can deal with urine and feces really well, but I can't graciously deal with sputum, phlegm, and vomit. I'm always worried I'm going to start yakking when I'm holding the basin for the patient... and when those Yankaurs are sucking out all of those nasty yellow goobers from the throats... YUCK.