A. ENEMAS – introduction of a solution into the large intestine, usually to remove feces Types a. Cleansing Enemas – given to remove feces from the colon - to relieve constipation or fecal impaction - to prevent involuntary escape of fecal material during surgical procedures - to promote visualization of the intestinal tract by radiographic or instrument exam - to help establish regular bowel function during bowel training - solutions used for cleansing are tap water, normal saline solution, soap solution and hypertonic solution i. Hypertonic (tap water) and Isotonic (normal saline) solution enemas – large volume enemas that result in rapid colonic emptying - hypertonic solutions draw water into the colon, stimulating the defecation reflex Retention Enemas –retained in the bowel for a prolonged period i. Oil- Retention Enemas – lubricate stool and intestinal mucosa, making defecation easier ii. Carminative Enemas – help to expel flatus from the rectum and provide relief from gaseous distention - common solutions include milk-and-molasses (equal parts) and magnesium sulfate-glycerin water (MGW = 30 mL magnesium sulfate, 60 mL glycerin, 90 mL warm water) iii. Medicated Enemas – provide medications that are absorbed through the rectal mucosa iv. Anthelmintic Enemas – destroy intestinal parasites v. Nutritive Enemas – administer fluids and nutrition rectally c. Return-Flow Enemas – (Harris Flush) enemas are occasionally prescribed to expel flatus - for adults, 100 to 200 mL of solution is instilled into the rectum and sigmoid colon b. 1.

- solution container is lowered so that the solution flows back into the container - procedure is repeated 5 or 6 times - terminated when abdominal distention is relieved - if solution return solution becomes thick with feces, it is replaced by fresh solution 2. Equipment – include flexible bottle containing hypertonic solution with an attached prelubricated firm tip about 5 to 7.5 cm (2 to 3 in.) long - for tap water, saline solution, or soap solution enemas, a container, rubber or plastic tubing with side openings near its distal end, a tubing clamp, lubricant, and the solution are needed B. RECTAL SUPPOSITORIES – conical or oval solid substance shaped for easy insertion into a body cavity and designed to melt at body temperature - types include fecal softeners (useful when stool is hard); some direct action on the nerve endings in the rectal mucosa (useful for weak muscle tone or poor innervation); some liberate carbon dioxide when moistened, which causes distention, stimulating elimination impulses C. ORAL INTESTINAL LAVAGE - used to cleanse the intestine of feces - prescribed by physician and can be administered before diagnostic tests that require a clear bowel for visualization purposes or as a “bowel prep” before intestinal surgery D. DIGITAL REMOVAL OF STOOL fecal impaction – prolonged retention or an accumulation of fecal material that forms a hardened mass in the rectum - prevents passage of normal stools - liquid fecal seepage with no passage of feces is an indication of impaction - if other interventions fail, impaction must be broken up manually - physician’s order is required - may cause great discomfort as well as irritation of rectal mucosa and bleeding - digital removal can stimulate the vagus nerve, resulting in slowed heart rate E. MANAGING BOWEL INCONTINENCE

bowel incontinence – inability of the anal sphincter to control the discharge of fecal and gaseous material - cause is usually an organic disease, resulting either in a mechanical condition that hinders the proper functioning or an impairment in the nerve supply to the anal sphincter 1. Rectal Indwelling Catheter – used for patients with uncontrollable diarrhea, relatively little research supports the safety of this procedure - some concerns include the possibility of worsening the diarrhea due to stimulating of the sensory nerve fibers in the rectum or the possibility of rectal perforation and development of necrosis - most experts agree that indwelling rectal catheters should not be used to manage large volumes of diarrhea 2. Fecal Incontinence Pouch – an alternative measure to protect perianal skin from repeated episodes of fecal incontinence - nursing responsibilities include careful regular assessment and documentation of the perianal skin condition and attentive management of the drainage system Designing and Implementing Bowel Training Program - purpose is to manipulate factors within the person’s control (food and fluid, intake, exercise, time for defecation) to produce the elimination of a soft, formed stool at regular intervals without a laxative Meeting the Needs of Patients with Bowel Diversions stoma – intestinal mucosa is brought out to the abdominal wall, structure formed by suturing the mucosa to the skin ostomy – general term for an opening into the body, used to refer to an opening created for the excretion of body wastes - if surgery is not emergent, patients meet with a specially trained registered nurse called a wound, ostomy, and continence nurse (WOCN) and together they determine the ideal location for the stoma ileostomy – allows liquid fecal content from the ileum of the small intestine to be eliminated through 4. 3.

the stoma - continent ileostomy is an alternative to the traditional surgical procedure - internal pouch created that the patient accesses through a nipple like valve constructed from the ileum on the abdominal wall - no need for an external device - ileoanal reservoir is another alternative - terminal ileum is sutured directly to the anus, a pouch is created and the patient is able to control expulsion through the intact anal sphincter - may be temporary (for repair after inflammatory disease, some types of intestinal surgery or injury) or permanent (for debilitating intestinal diseases or caner of the colon or rectum colostomy – permits formed feces from the colon to exit through the stoma - may be temporary (for repair after inflammatory disease, some types of intestinal surgery or injury) or permanent (for debilitating intestinal diseases or caner of the colon or rectum

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