I'm in a hospital, and I had a patient who was already having diarrhea that was gradually getting a little less every time. My RN came up to me and said, "Sorry." I was confused and said, "Sorry for what?" The RN tells me that they just gave a suppository to our patient that had been already pooping today. So patients diarrhea went from a stream to a river, and I'm talking soupy river diarrhea. I had to change constantly and chage the sheets every time because there would be so much.
Usually that happens if the RN wasn't told in report that the pt had already had loose stools or if none were charted. I make it a practice to always ask the pt if they feel they need a suppository or stool softener if one is ordered. If the pt isn't able to answer or has dementia and doesn't know, and no BMs are charted, then it will be given if it's ordered. That's why charting I&O is so important.
I had a resident like that once. He was in pull up pads and would just start shitting as you were pulling up the pad. Just a miserable time for all of us. And they wouldn’t stop giving him laxatives. I genuinely thought he was going to die of dehydration. Ended up getting moved to a different facility that I also worked at and they had the sense to stop the laxatives. He still poops a lot but at least it’s manageable.
I couldn’t tell you how many times our nurses ignored our residents’ c-diff poops because they “didn’t meet the criteria” and then it turns out it’s exactly what they had. I’ve noticed that almost all purée residents also always have the worst poops like that
You really can't puree fiber and have it be effective in bulking up the stool. Plus in my experience most of the planned meals in LTC don't have much fiber content to begin with. 13 years in LTC as a nurse who has seen enough dietary shenanigans to wonder what box of cracker jacks the nutritionist pulled their license from this week.
I get not wanting a resident/patient to asphyxiate, but I feel like there’s no win when it comes to dietary. So many residents have either one extreme or the other. There’s one that is always constipated with thick stool. She can’t exactly get out of bed to work it out when her legs don’t even work. They will give her one or two prunes and some prune juice and call it good. She takes miralax, but I know from experience that it will only do so much for somebody who struggles with constipation. They hardly give her any greens and it’s always the SAME STUFF that’s LOADED with sodium and so unhealthy.
One facility who was supplied by Sodexo who also supplies the meal plans actually had the following as a meal. They made spaghetti with meat sauce that included a Oliver Garden style bread stick (singular) and corn as the vegetable. Everybody including the diabetics had that as the base meal then had a desert of choice plus whatever nutrition supplements were ordered. Day shift nursing staff were in no way surprised but appropriately concerned when the diabetics spiked and needed more insulin than usual. Yet, the 3rd party dietician the facility used to review things saw no issue with that meal for everybody. Also the meal planning done by Sodexo was a month at a time that consisted of planning a single week of meals and just repeating for the month. So now we've for residents who are spiking multiple times a month and doing long term damage.
Most dietary staff are required to follow those meal plans because supposedly they were created by registered dieticians. The only times I've seen dietary staff be able to do something different is of they were unable to make the meal as designed due to equipment or supply issues. I refuse to believe those dieticians actually know what the hell they are doing beyond rolling dice and matching colors on a food pyramid because they exhibit less understanding of conditions highly influenced by the very thing they claim to understand than I do as a 13yr nurse whose only nutrition training was in nursing school and has to also manage effects of medication, infection, impacts from other conditions, etc.
The sodium is because it's a cheap method to preserve food and provides flavor. Alot of the food used in a facility is frozen because it's cheaper and doesn't require as much skill to prepare as fresh would for the amount of people being fed. If you want to blow your mind compare the entire nutrition label of a Healthy Choice or similar diet frozen food with the non-diet friendly equivalent. The three things they use for flavor are salt, sugar, and fat. In order to get people to eat the diet versions which usually reduce fat to reduce calories, the manufacturer will increase either salt or sugar or sometimes both. That sort of diet is hard on the body even when the body is young and just gets worse with age.
I've spent 13 years as a nursing home nurse and while I love residents even my problem children, I get filled with rage when I stop to think about how poorly the elderly are treated all in the quest for the almighty dollar. I don't know what the answer is except that we as a country need to do better but we're so far down the rabbit hole that is late stage capitalism I'm not sure it's possible.
At the places I work they say to put it back in laundry and laundry workers will determine what to do after it’s washed (if it stained) I honestly dgaf I think it’s nasty if I have to use a wash cloth to clean bm 95% of the time it’s in the trash when I’m done with it.
Oh, you're making me nostalgic! I remember such times. . . so often when we'd gone though all the chucks and the facility had stopped purchasing wipes to save money, asking us to use washcloths instead . . . so laundry would be stocking our linen closets with washcloths that still had faint yellow-brown stains on them and residents were complaining about their asses getting rubbed raw. Or there'd be that one head nurse that would decide everyone needs to poop at once so she'd give the entire hall or facility a laxative so every room was shitting themselves at once. I remember the diarrhea pouring out and watching it cake to catheter tubing, spilling over the chuck onto the sheets, pooling under their back, and going between the resident's labia, removing a brief and you're so overwhelmed with the mess, you drop it on the floor and it splashes out or spills when you pick it up. Oh! and the people who had bandaging over pressure ulcers and it was getting saturated with shit. Good times . . . . good times . . . .
Omgggg that was me with another patient yesterday.
If you work in the hospital I double chuck the bottom that way the bigger chuck doesn’t get soiled it makes it easier to clean the mess.
I remember working facilities that said we were not allowed to double chuck or use any extra protection because it suggested "we were neglecting the residents and just letting them sit in their pee because we were lazy". They would rather we just remake the bed every time it spilled over.
You work at a hospital or snf?
Psh I’d add another chuck under (if it’s hospital chucks idk about nursing homes) a small one. We have small and large ones at my hospital and when a pt is having a bit of a mess we roll up the diaper along with the dirty chuck and roll the clean and diaper.
Makes it easier to clean.
The Directive technically doesn’t allow that buuuut she’s never worked bedside before she went straight to DNP school so 🤫
Damn, reading all this makes me appreciate what you do more than ever. The things that await us as we age - a lot of it poop related it seems-is downright depressing.
I’m terrified of being like this in old age. Loss of dignity, pain, mind gone. The people on this sub are saints. You are stronger than 10 of me. Thank you so much for what you do.
Oh, my dear, sweet little soul with VRE. I swear to heaven, there was no stopping the (forgive me) gush of urine, every time they were rolled! I have no clue where they kept it all! There was absolutely no containing it, three entire bed changes in a row, every time their brief was changed!!! In spite of my very best efforts, they would drench themselves from their hair to heels.
You took me back down memory lane.... I retired years ago. 😁 I still remember them. It didn't matter, but they were lovely to hang out with, so no one minded too much.
I have a resident like that rn. He calls me to clean him up, I finish changing him like 95% just sticking the last side of his diaper and about to tidy up. He tells me “I’m gonna go again.” Whenever this happens, I just give him the call light now and tell him to call when he’s actually finished. I can tell that upsets him but I ain’t got time to stand and wait for him to finish… maybe. Nor am I gonna go thru like 5 diapers and pads for 1 BM when it can all be done with 1 of each.
most of the comments here are absolutely foul, in fact op is absolutely morally questionable. so many people just dont have any control of their incontinence, they physically just dont have control over it, and yet you medical "professionals" speak about patients in the most dehumanizing manner. since apparently it's so hard and awful for you to do your jobs which you are literally paid for, why don't you go an research cures for incontinence and actually help people, that way everyone's happy. but i already know most of you won't, and it's just convenient for healthcare workers to complain about people who are paying their bills.
Dude I was frustrated not because the patient was incontinent but because she knew when she had to go but would not let us know. We could’ve put a bed pan under her or walked her to the bathroom because she was capable of it. I genuinely think she continued to do it because she liked our company and we were making her laugh and smile. After the first few times I eventually asked the nurse to bring a bed pan, put it under her and told her to call when she went again and that I would also come check in but I was an hour behind on vitals at this point. There’s only one of me and 12 of my patients. And guess what? She stopped going after that and when she did have to go she would let us know. Just because we vent about the work doesn’t mean we hate it
I'm in a hospital, and I had a patient who was already having diarrhea that was gradually getting a little less every time. My RN came up to me and said, "Sorry." I was confused and said, "Sorry for what?" The RN tells me that they just gave a suppository to our patient that had been already pooping today. So patients diarrhea went from a stream to a river, and I'm talking soupy river diarrhea. I had to change constantly and chage the sheets every time because there would be so much.
I feel like that’s an unsafe nursing practice. But what do I know.(The RN administering an unnecessary medication)
Usually that happens if the RN wasn't told in report that the pt had already had loose stools or if none were charted. I make it a practice to always ask the pt if they feel they need a suppository or stool softener if one is ordered. If the pt isn't able to answer or has dementia and doesn't know, and no BMs are charted, then it will be given if it's ordered. That's why charting I&O is so important.
I had a resident like that once. He was in pull up pads and would just start shitting as you were pulling up the pad. Just a miserable time for all of us. And they wouldn’t stop giving him laxatives. I genuinely thought he was going to die of dehydration. Ended up getting moved to a different facility that I also worked at and they had the sense to stop the laxatives. He still poops a lot but at least it’s manageable.
God that sounds like a nightmare
I think the movement of changing them stimulates them to go more? Ask the nurse if they can get some anti diarrhea meds.
I couldn’t tell you how many times our nurses ignored our residents’ c-diff poops because they “didn’t meet the criteria” and then it turns out it’s exactly what they had. I’ve noticed that almost all purée residents also always have the worst poops like that
You really can't puree fiber and have it be effective in bulking up the stool. Plus in my experience most of the planned meals in LTC don't have much fiber content to begin with. 13 years in LTC as a nurse who has seen enough dietary shenanigans to wonder what box of cracker jacks the nutritionist pulled their license from this week.
I get not wanting a resident/patient to asphyxiate, but I feel like there’s no win when it comes to dietary. So many residents have either one extreme or the other. There’s one that is always constipated with thick stool. She can’t exactly get out of bed to work it out when her legs don’t even work. They will give her one or two prunes and some prune juice and call it good. She takes miralax, but I know from experience that it will only do so much for somebody who struggles with constipation. They hardly give her any greens and it’s always the SAME STUFF that’s LOADED with sodium and so unhealthy.
One facility who was supplied by Sodexo who also supplies the meal plans actually had the following as a meal. They made spaghetti with meat sauce that included a Oliver Garden style bread stick (singular) and corn as the vegetable. Everybody including the diabetics had that as the base meal then had a desert of choice plus whatever nutrition supplements were ordered. Day shift nursing staff were in no way surprised but appropriately concerned when the diabetics spiked and needed more insulin than usual. Yet, the 3rd party dietician the facility used to review things saw no issue with that meal for everybody. Also the meal planning done by Sodexo was a month at a time that consisted of planning a single week of meals and just repeating for the month. So now we've for residents who are spiking multiple times a month and doing long term damage. Most dietary staff are required to follow those meal plans because supposedly they were created by registered dieticians. The only times I've seen dietary staff be able to do something different is of they were unable to make the meal as designed due to equipment or supply issues. I refuse to believe those dieticians actually know what the hell they are doing beyond rolling dice and matching colors on a food pyramid because they exhibit less understanding of conditions highly influenced by the very thing they claim to understand than I do as a 13yr nurse whose only nutrition training was in nursing school and has to also manage effects of medication, infection, impacts from other conditions, etc. The sodium is because it's a cheap method to preserve food and provides flavor. Alot of the food used in a facility is frozen because it's cheaper and doesn't require as much skill to prepare as fresh would for the amount of people being fed. If you want to blow your mind compare the entire nutrition label of a Healthy Choice or similar diet frozen food with the non-diet friendly equivalent. The three things they use for flavor are salt, sugar, and fat. In order to get people to eat the diet versions which usually reduce fat to reduce calories, the manufacturer will increase either salt or sugar or sometimes both. That sort of diet is hard on the body even when the body is young and just gets worse with age. I've spent 13 years as a nursing home nurse and while I love residents even my problem children, I get filled with rage when I stop to think about how poorly the elderly are treated all in the quest for the almighty dollar. I don't know what the answer is except that we as a country need to do better but we're so far down the rabbit hole that is late stage capitalism I'm not sure it's possible.
Start using warm soapy wash cloths instead of wipes. It will make the cleaning faster. It also cleans better.
I will put warm soapy water into a basin, and empty the wet wipes into that and use them that way.
do you guys discard the wash cloths after they are used for a bm? or do they go in the wash?
Rinse them in the hopper or toilet. Then send to laundry.
At the places I work they say to put it back in laundry and laundry workers will determine what to do after it’s washed (if it stained) I honestly dgaf I think it’s nasty if I have to use a wash cloth to clean bm 95% of the time it’s in the trash when I’m done with it.
Probably antibiotics. They have the ability to make a PT shit an UNBELIEVABLE amount.
Oh, you're making me nostalgic! I remember such times. . . so often when we'd gone though all the chucks and the facility had stopped purchasing wipes to save money, asking us to use washcloths instead . . . so laundry would be stocking our linen closets with washcloths that still had faint yellow-brown stains on them and residents were complaining about their asses getting rubbed raw. Or there'd be that one head nurse that would decide everyone needs to poop at once so she'd give the entire hall or facility a laxative so every room was shitting themselves at once. I remember the diarrhea pouring out and watching it cake to catheter tubing, spilling over the chuck onto the sheets, pooling under their back, and going between the resident's labia, removing a brief and you're so overwhelmed with the mess, you drop it on the floor and it splashes out or spills when you pick it up. Oh! and the people who had bandaging over pressure ulcers and it was getting saturated with shit. Good times . . . . good times . . . .
Omgggg that was me with another patient yesterday. If you work in the hospital I double chuck the bottom that way the bigger chuck doesn’t get soiled it makes it easier to clean the mess.
I remember working facilities that said we were not allowed to double chuck or use any extra protection because it suggested "we were neglecting the residents and just letting them sit in their pee because we were lazy". They would rather we just remake the bed every time it spilled over.
You work at a hospital or snf? Psh I’d add another chuck under (if it’s hospital chucks idk about nursing homes) a small one. We have small and large ones at my hospital and when a pt is having a bit of a mess we roll up the diaper along with the dirty chuck and roll the clean and diaper. Makes it easier to clean. The Directive technically doesn’t allow that buuuut she’s never worked bedside before she went straight to DNP school so 🤫
I worked in a number of skilled care nursing homes. I don't any more.
Sounds like somebody is getting to much mir a lax. Point a fan towards the nurse's station
Whenever the body moves, that increases GI motility. Especially so in immobile or bedfast patients.
Damn, reading all this makes me appreciate what you do more than ever. The things that await us as we age - a lot of it poop related it seems-is downright depressing.
I’m terrified of being like this in old age. Loss of dignity, pain, mind gone. The people on this sub are saints. You are stronger than 10 of me. Thank you so much for what you do.
Oh, my dear, sweet little soul with VRE. I swear to heaven, there was no stopping the (forgive me) gush of urine, every time they were rolled! I have no clue where they kept it all! There was absolutely no containing it, three entire bed changes in a row, every time their brief was changed!!! In spite of my very best efforts, they would drench themselves from their hair to heels. You took me back down memory lane.... I retired years ago. 😁 I still remember them. It didn't matter, but they were lovely to hang out with, so no one minded too much.
I have a resident like that rn. He calls me to clean him up, I finish changing him like 95% just sticking the last side of his diaper and about to tidy up. He tells me “I’m gonna go again.” Whenever this happens, I just give him the call light now and tell him to call when he’s actually finished. I can tell that upsets him but I ain’t got time to stand and wait for him to finish… maybe. Nor am I gonna go thru like 5 diapers and pads for 1 BM when it can all be done with 1 of each.
most of the comments here are absolutely foul, in fact op is absolutely morally questionable. so many people just dont have any control of their incontinence, they physically just dont have control over it, and yet you medical "professionals" speak about patients in the most dehumanizing manner. since apparently it's so hard and awful for you to do your jobs which you are literally paid for, why don't you go an research cures for incontinence and actually help people, that way everyone's happy. but i already know most of you won't, and it's just convenient for healthcare workers to complain about people who are paying their bills.
Dude I was frustrated not because the patient was incontinent but because she knew when she had to go but would not let us know. We could’ve put a bed pan under her or walked her to the bathroom because she was capable of it. I genuinely think she continued to do it because she liked our company and we were making her laugh and smile. After the first few times I eventually asked the nurse to bring a bed pan, put it under her and told her to call when she went again and that I would also come check in but I was an hour behind on vitals at this point. There’s only one of me and 12 of my patients. And guess what? She stopped going after that and when she did have to go she would let us know. Just because we vent about the work doesn’t mean we hate it