Enema Powepoint
-
Upload
sherraine-lim -
Category
Documents
-
view
317 -
download
11
Transcript of Enema Powepoint
EnemaIs the process of instilling a solution/fluid
through the anal sphincter into the rectum and large intestine for a therapeutic purpose.
-The action is to distend the intestine and to irritate the intestinal mucosa, thereby increasing peristalsis and excretion of feces and flatus
Types of EnemaCleansingCarminativeRetentionReturn-Flow enema
Cleansing Enema To prevent the escape of feces during surgery To prepare the intestine for certain diagnostic tests such
as x- ray or visualization tests To remove feces in instances of constipation and
impaction Cleansing Enema may also be: High-given to cleanse as much of the colon Low-is used to clean the rectum and sigmoid colon only
The force of flow of the solution is controlled by the ff:
The height of the solution containerSize of the tubingViscosity of the fluidResistance of the rectum
Commonly Used Enema Solutions Solution
Constituents Action Time to
Take Effect
Adverse Effect
Hypertonic 90-120 ml. of sol.(e.g., sodium phosphate)
Draws water into the colon
5-10 min Retention of sodium
Hypotonic 500-1,000 ml. of tap water
Distends colon, stimulates peristalsis, and soften feces
15-20 min Fluid and electrolyte imbalance, water intoxication
Isotonic 500-1,000 ml of normal saline(9mlNaCl to 1,000 ml water)
Distends colon, stimulates peristalsis, and soften feces
15-20 min Possible sodium retention
Soapsuds 500-1,000ml(3-5ml soap to 1,000ml water)
Irritates mucosa, distends colon
10-15 min Irritates and may damage mucosa
Oil(mineral, olive, cotton seed)
90-120ml Lubricates the feces and the colonic mucosa
½-3 hrs
Carminative Enema: -Is given primarily to expel flatus -The solution instilled in to the rectum release
gas, which in turn distends the rectum and the colon, thus stimulating peristalsis
-For adult, 60-80 ml of fluid is instilled Retention Enema -Introduces oil or medication into the rectum
and sigmoid colon -The liquid is retained for a relatively long
period(e.g.1-3hrs) -It soften the feces and lubricate the rectum
and anal canal, thus facilitating passage of the feces
Antibiotic Enemas- Are used to treat infection locally
Anthelmintic Enemas- are used to kill helminthes such as worms and intestinal parasite
Nutritive enemas- Are used to administer fluids
and nutrients to the rectum
Return-Flow Enema: - Is used to occasionally to expel flatus - Alternating flow of 100ml to 200ml of fluid
into and out of the rectum and sigmoid colon stimulates peristalsis
-This process is repeated 5 or 6 times until the flatus is expelled and Abdominal distension is relieved
Precautions: -Can lead to fluid overload, bowel irritation, and loss of
muscle tone of the bowel and anal sphincter. - Never deliver more than three consecutive enemas
to treat a patient. - A patient with diarrhea may not be able to hold an
enema. - Must be used with caution in cardiac patients who
have arrhythmias or have had a recent myocardial infarction.
- Should not be given to patients with undiagnosed abdominal pain because the peristalsis of the bowel can cause an inflamed appendix to rupture
- Should be used cautiously in patients who have had recent surgery on the rectum, bowel, or prostate gland.
-If the patient has rectal bleeding or prolapse of rectal tissue from the rectal opening, cancel the enema and consult with the physician before proceeding
-Do not force the enema catheter into the rectum against resistance
-Use only mild castile soap for soapsuds enemas because other soap preparations are too harsh and irritate the rectal tissue.
Complications: -Include irritation, swelling, redness,
bleeding, or prolapse of the rectal tissue -Pain or burning during enema instillation Equipment: -Incontinence sheet -Bedpan or commode -Disposable gloves -Gauze -Lubricating jelly -Enema -Jug/container
Procedure in Administering an Enema:
1. Assessment a. When the client last had a bowel movement
and the amount, color,and consistency of the feces
b. Presence of abdominal distention c. Whether the client has sphincter control d. Whether the client can use a toilet or
commode or must remain in bed and use a bedpan 2. Planning: a. Determine whether a physician’s order is
required b. Determine the size of the rectal tube to use
specified by the doctor c. Determine the presence of kidney or cardiac
disease
3. Implementation:
Preparation: a. Lubricate about 5cm(2 in) of the rectal
tube b. Run some solution through the connecting
tubing and the rectal tube to expel any air in the tubing
c. Close the clamp
Performance: a. Explain the procedure b. Wash hands, apply clean gloves and
observe appropriate infection control procedure
c. Provide for client privacy d. Place client to a left lateral position, with
right leg acutely flexed as possible and the linen-saver pad under the buttocks
e. Lift the upper buttocks and insert the rectal tube smoothly and slowly into the rectum, directing it toward the umbilicus
f. If there is resistance at the internal sphincter, ask the client to take a deep breath, then let a small amount of solution run through the tube
g. Never force tube or solution entry
H. Slowly administer the enema solution
- Raise the solution container, and open the clamp to allow fluid flow
- If client complains of fullness or pain, use the clamp to stop the flow for 30 seconds, and then restart the flow at slower rate
- After all the solution has been instilled or when client can’t hold anymore and feels the desire to defecate , close the clamp, and remove the rectal tube from the anus
- Place the rectal tube in disposable towel as you withdraw it
I. Encourage the client to retain the enema
- Ask the client to remain lying down
- Let the client retain the solution for the appropriate amount of time. 5-10 min. for a cleansing enema; 1 to 3 hours for retention enema
J. Assist the client to defecate
K. Document type of solution; length of time solution was retained; amount, color, and consistency of the returns
Aftercare: - Remain near the patient - After instillation of solution to client with
retaining enema apply gentle pressure to the rectal opening using a 4×4 gauze
- Tuck a 4×4 gauze pad between the buttocks to collect seepage.
- Cover the patient after the procedure and instruct him or her to lie still for five to 10 minutes or longer if a medicated solution or retention enema is administered.
- Wash items that might be reused, such as non-disposable enema bags and tubing
in warm soapy water. Rinse and allow them to air dry
- Place disposable items, gauze pads, and gloves in a trash bag, then seal and discard it
- Assist the patient to the bathroom or with the bedpan after he or she has held the
enema solution for the correct amount of time - Hands should be washed after performing the
procedure. Note the results of the enema