CHINESE GENERAL HOSPITAL COLLEGES

COLLEGE OF NURSING (S.Y. 2020-2021)
286 Blumentritt St., Sta. Cruz, Manila

Name: Andres, Ellana Maria E. Date: April 27, 2021

Year and Section: BSN 2D CI: Ms. Jocelyn T. Danga RN,
MAN
Case Study - Skill 6
CASE SCENARIO:
A 55-year-old client was admitted due to stomach pain. He complained of having constipation
problem often. Xray results that the client has fecal impaction. The attending physician ordered
administration of cleansing enema.
QUESTIONS:
1) What are the purposes of Cleansing Enema?
The purpose of cleansing Enema is to prevent the release of feces while the patient is in surgery.
This could also be used if the patient is undergoing for colonoscopy or x-ray for the physician to
visualize the intestines clearly.
2) Discuss the 3 Types of Cleansing Enema.
Cleansing Enema have three types. First is the large volume enema, which purpose is to clean the
colon including the stool inside it. This is for patients having constipation and for patients who
are undergoing before a colonoscopy procedure. In this type, the amount used is about 500-1000
ml and the bag is raised as high as 18 inches above the anal opening. Second is the small volume
enema, which purpose is to clean the sigmoid colon of patients who are constipated. In this type,
the amount used is less than 500 ml and the bag is raised no higher than 12 inches. Third is the
prepackaged disposable enema, which purpose is also for patients who are constipated. In this
type, the amount used is 90-120 ml solution.
3) Discuss the different solutions used in Enema procedure.
The first type of solution is the hypertonic solution which contains 90-12 ml of solution. Its
action is to draw the water into the color and usually it takes 5-10 minutes for it to have an effect.
The second type is hypotonic solution which contains 500-1000ml of tap water. Its actions are to
distend the colon, stimulate peristalsis and soften the feces and it takes 15-20 minutes for it to
have an effect. The third type is isotonic solution which contains the same amount in hypotonic
solution but this uses normal saline. Its action and time for it to have an effect are the same with
the hypotonic solution. The fourth type is the soapsuds solution which contains the same amount
in hypotonic and hypertonic solution. Its actions are to irritate the mucosa and distend the colon
and usually it takes 10-15 minutes for it to have an effect.

4) Enumerate and discuss at least 3 kinds of most commonly used Enema.

 Anthelmintic enema is used help destroy and expel intestinal parasites. Before giving the
treatment to the patient, there’s a need first for the bowel to cleansed. The solution used is
usually a hypertonic saline solution.
 Nutrient Enema is used to supply food and fluids to the body. This is particularly used for
patients who have haemophilia. The solutions used are normal saline, 2 to 5% of glucose
saline, 120 ml of peptonized milk and the amount solution is 1100 to 1700 ml in 24 hours
or 180 to 270 ml at 4-hour intervals.
 Oil enema is used to soften the feces especially if the patients have severe constipation to
avoid straining and injury to the sutures and wounds. It should be retained for half an
hour to 1 hour to effectively soften the feces. This should be followed by a soap and
water enema to open the bowels. The solutions used are olive oil, gingerly oil, castor oil
and the amount of solution to be used is 115 to 175 ml.

5) What is the nursing consideration in administering enema procedure?

The nursing consideration in administering enema procedure is the nurse should encourage
the patient to retain the fluid as long as possible. This is to induce peristalsis and cause
evacuation of feces. The nurse should also get the patient's history to see if the patient has a
condition such as paralytic ileus rectal bleeding, abdominal pain, prolapsed rectal tissue,
myocardial infarction, or arrhythmias. Since in this case enema is contraindicated to prevent
further complications. And also, to see if the patient has any allergies. The nurse should answer
all the concerns that the patient has to relieve the anxiety.
References

Cruz, R. (2019). Types of Enemas. Retrieved April 15, 2021, from

https://www.peoi.org/Courses/Coursesen/nursepractice/ch/ch12e1.html

Kavalauskas, S. (2016, September 14). How to Give an Enema | Enema Administration Clinical
Nursing Skills. Retrieved April 27, 2021, from https://www.registerednursern.com/how-to-
give-an-enema-enema-administration-clinical-nursing-skills/

Kernisan, L. (2018). How to Evaluate, Prevent & Manage Constipation in Aging. Retrieved
April 27, 2021, from https://betterhealthwhileaging.net/how-to-prevent-and-treat-
constipation-aging/

Nursing Times. (2006, May 16). How to administer an enema. Retrieved April 27, 2021, from
https://www.nursingtimes.net/clinical-archive/gastroenterology/how-to-administer-an-
enema-16-05-2006/

Ponni, P. (2019). Abdominal Distension and Treatment of Colon (Enema – Purpose,

Classification, Methods, Procedure and After Care of Patients). Retrieved April 15, 2021,
from https://www.canestar.com/abdominal-distension-and-treatment-of-colon--enema---
purpose--classification--methods--procedure-and-after-care-of-patients-.html