Enema Administration – Flashcards

Instillation of a solution into the rectum and large intestine

-Left-side position (preferred): lie on left side with knee bent, and arms resting comfortably (for visualization of rectum) -Knee-chest position: kneel, then lower head and chest forward until left side of face is resting on surface with left arm folded comfortably

distend the intestine and irritate the intestinal mucosa>increasing peristalsis>excretion of feces and gas -pt may ℅ abdominal cramping d/t peristalsis being stimulated and urgency

-constipation -fecal impaction -bowel stimulation -cleansing the bowel prior to a diagnostic procedure -remove feces prior to a surgical procedure -administer drugs or anesthetic agents -stimulate peristalsis -may be used in combination with Mg Citrate

-gastric bypass, stapling, colonic surgery -GI perforation or obstruction -gynecological surgery or radiotherapy -paralytic ileus-lack of peristalsis -ulcerative and inflammatory conditions -high blood pressure: can increase BP d/t straining -cardiac patients: increased fluid will cause vagal stimulation>dysrhythmias can drop HR (bradycardia) -renal impairment: may cause electrolyte imbalance because a lot of enemas contain Mg & Phosphate (Monitor Mag+Phos+Ca) -diarrhea (DUH) -dehydration: may cause dehydration because of pulling of fluid -children <2 y/o -high phosphate levels: many times renal patients have high phosphate levels -hyper or hypo parathyroidism -rectal bleeding (don't aggravate and make it worse) -caution in elderly because of comorbidities -contraindicated in pregnant women

-hypertonic: draws H2O into colon, 5-10 min -hypotonic: distends colon, soften feces and stimulate peristalsis, 15-20 min -isotonic: distends colon, soften feces and stimulate peristalsis, 15-20 min -soapsuds (castile soap): irritates mucosa and distends colon, last resort and not usually used, 10-15 min -oil (mineral, olive, cottonseed): lubricates/softens feces and colonic mucosa, 30 min-2-3H

-Example: Fleet Enema -Action: osmotic effect -Time of effect: 5-10 min -Volume of amount: 90-120 mL -Adverse Effects: Na retention

-Example: Tap water enema -Action: distends colon, stimulates peristalsis, softens feces -Time of effect: 15-20 min -Volume of amount: 500-1000 mL -Adverse Effects: fluid and electrolyte imbalance, water intoxication

-Example: NS -Action: distends colon, stimulates peristalsis, softens feces -Time of effect-15-20 min -Volume of amount: 500-1000 mL -Adverse Effects: Na retention

-Example: Castile Soap -Action: irritates mucosa, distends colon -Time of effect: 10-15 min -Volume of amount: 500-1000 mL -Adverse Effects: irritation, damage to mucosa, last resort enema, not commonly used

-Example: mineral, olive, cottonseed -Action: lubricates feces and colonic mucosa, softens stool -Time of effect: 30 min-2-3H -Volume of amount: 90-120 mL -Adverse Effects: fluid and electrolyte imbalance

-cleansing: primarily to remove feces, pre-op, dx -carminative: primarily to remove gas -retention: to introduce oil or medication in sigmoid colon -return flow: aka Harris Flush, getting rid of gas

-prevent escape of feces during surgery. primarily used to remove feces because we don't want feces to contaminate the surgery table. -diagnostic testing: colonoscopy -constipation or impaction -large volumes of H2O given with cleansing enemas -similar to IV, on a pole

-clean the RECTUM and SIGMOID COLON only -client maintains a LEFT LATERAL POSITION -force of solution depends on... a. height of the solution container b. size of the tubing c. viscosity of the fluid d. resistance of the rectum: patient may have hemorrhoids causing resistance -container should be no higher than 30 cm or 12 inches above the rectum

-clean as much of the colon as possible -client changes from a left lateral position to the dorsal recumbent position to the right lateral position to cover all surfaces -the higher the solution container is held above the rectum, the faster the flow and greater the force -container height ranges from 30-49 cm or 12-18 inches above the rectum -45 cm or 18 inches preferred: height determined for greatest degree to stimulate peristalsis -stimulates peristalsis -used as an intervention for constipation -used as a bowel prep prior to diagnostic procedure if everything else hasn't worked -when administering, make sure to clamp off tube with your hand, then open clamp on tube and regulate amount entering rectum with hand -be sure to lubricate end of enema

-expel gas -distends the rectum stimulating peristalsis -60-80 mL is instilled

-introduces oil or medication into the rectum and sigmoid colon -the liquid is retained 1-3H -softens the feces to lubricate the rectum and anal canal thereby facilitating the passage of feces -may be used in unconscious patients or coma, still position

-expels gas -alternating flow of 100-200 mL of fluid into and out of the rectum and sigmoid colon stimulating peristalsis -repeated 5-6x until gas is expelled and abdominal distention is relieved

-solution should be warm: 37C or 100F, NEVER GIVE A COLD ENEMA, IRRITATIVE -lubricate the rectal tube approximately 5 cm or 2 inches, enemas come lubricated but grab extra lube to ease insertion -place on LEFT lateral position with the right leg flexed -insert the tube 7-10 cm or 3-4 inches -administer SLOWLY -encourage the client to retain the solution, if pt can not retain solution, may have to repeat but not in the same day, wait 24-48H -assist to defecate -document -prior to giving enema: asses pt hx for cardiac issues, ask when pt usually has a BM and try to time it, don't want to waste time -bring extra towels -when squeezing enema, roll up like a toothpaste tube

-preferred position for infants and children: dorsal recumbent -isotonic/normal saline -in a child, insert the tube 5-7 cm or 2-3 inches -in a infant, insert the tube only 2.5-3.75 cm or 1-1.5 inches

<18 months: 50-200 mL 18 months to 5 y/o: 200-300 mL 5 to 12 years of age: 300-500 mL 12 years old and older: 500-1000 mL

-verify the order -clear understanding of why patient is receiving -VERIFY NO LATEX ALLERGIES: tubing on enema is made of latex and we may have to use silicone -co-morbidities -last BM: size and qualities -is abdominal distention present -check packaging for manufacturers instructions -face shield (just in case) -know the correct type of solution or the size to be used -the age of the patient -level of alertness in the patient -level of patient tolerance -is N/V or fever present: PC of vomiting: dehydration -check the rectal area for signs of irritation -store enema solutions at room temperature: DO NOT MICROWAVE THEM, rub in hands to warm -warm slightly prior to administration -temp should never exceed 105F -have water proof pad or incontinence pads available and position under the buttocks -cover the patient, provide for privacy -even though tip comes pre-lubricated, add extra lube to prevent damage, irruption and makes it easier to insert

-when giving a tap water enema, be aware that tap water is hypotonic and don't want to cause circulatory overload -soapsuds enemas are usually not given before a rectal exam or procedure involving viewing of the colon by a scope -ADMINISTER IT SLOWLY -instruct patient to retain it as long as possible -place the bedpan or commode nearby or make sure the patient can safely get to the bathroom -EXERCISE GOOD JUDGEMENT -does the patient have sphincter control -can the patient retain the enema -can the patient use the toiler, bed-side commode, bedpan -have appropriate equipment ready to avoid multiple trips -NEVER EVER FORCE A TUBE OR ENTRY INTO RECTUM

-if the patient is unable to contract the anal sphincter muscles and hold the solution -place the patient on the bedpan, commode or toilet and administer -if the patient is in bed, elevate the HOB slightly and place a pillow in the lumbar region

-cardiac conditions -reproductive surgery -abdominal perianal repair -rectal surgery -colostomy -genitourinary surgery -receiving radioactive isotopes: seeds may come out -rectal or vaginal bleeding

-results -type of solution used -length of time the solution was retained -was there relief of gas or abdominal distention -if pt has no BM, make sure to pass the info to the next nurse, notify MD if no BM continuously