FUNDAMENTALS OF

Types:
HIGH ENEMA
 Cleanse as much as the colon as possible
NURSING PRACTICE  Achieved by: changing position from LEFT
lateral to DORSAL RECUMBENT to RIGHT
ENEMA lateral
An enema is an introduction of fluid into the lower  Solution container is held 12-18 inches
bowel through rectum for the purpose of LOW ENEMA
cleansing or to introduce medication or  Used to clean the rectum and sigmoid colon
nourishment. only
PURPOSES OF ENEMA  Solution container is held 12 inches
 To stimulate defecation and to treat TYPES OF SOLUTIONS USED
constipation HYPERTONIC
 To soften hard fecal matter  Action
 To administer medication o Draws water into the colon
 To induce peristalsis o Promotes defecation
 To relieve gaseous distention  Adverse effect
 For diagnostic procedure o Sodium retention
Constipation is a common gastrointestinal HYPOTONIC
condition. It occurs when the colon is unable to  Action
remove waste through the rectum. People with this o Distends colon, stimulates peristalsis, and
condition have three or fewer bowel movements softens feces
over a seven-day period. Mild constipation often  Adverse effect
occurs when you don’t eat enough fiber or drink o Fluid electrolyte imbalance
enough water on a regular basis. Daily exercise o Water intoxication
also helps to prevent constipation. ISOTONIC
 Action
An enema administration is most commonly used o Distends colon, stimulates peristalsis, and
to clean the lower bowel. However, this is normally soften feces.
the last resort for constipation treatment. If diet and  Adverse effect
exercise are not enough to keep you regular, your o Possible sodium retention
doctor might recommend a laxative before trying
an enema. In some cases, laxatives are used the
night before an enema administration to
encourage waste flow.

Enemas may also be used before medical

examinations of the colon. Your doctor may order
an enema prior to an X-ray of the colon to detect
polyps so that they can get a clearer picture. This
procedure may also be done prior to a
colonoscopy.
TYPES OF ENEMA
CLEANSING ENEMA
 Cleansing enemas are water-based and
meant to be held in the rectum for a short time
to flush your colon. Once injected, they’re
retained for a few minutes until your body rids
itself of the fluid, along with loose matter and
impacted stool in your bowel.
 Intended to remove feces
SOAP SUDS
 Action
o Irritates mucosa and distends the colon
 Adverse effect
o Irritation and damage to the mucosa
OIL
 Action
o Lubricates the feces and colonic mucosa
CARMINATIVE ENEMA
 A small volume enema given to release flatus.
 Traditionally the enema consisted of two
ounces of glycerin, one ounce of magnesium
sulfate (epsom salts) and three ounces of
water.
 The combination of ingredients stimulated
peristalsis resulting in a bowel movement in
which feces and flatus are expelled.
 The advantage in times past of using the
carminative enema was that the low volume

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 made it comfortable for the patient to retain, IF RESISTANCE PERSISTS WITH THE ABOVE
and it took little time to administer. INTERVENTION
 The enema is not in common use today since  STOP and report to the MD!
similar results can be obtained using ADMINISTER THE SOLUTION
prepackaged small volume enemas such as  Slowly
the Fleets saline enema, the Fleets bisacodyl o Avoids cramping
enema or a bisacodyl suppository. IF (+) CRAMPING AND FULLNESS
 When using the traditional carminative  Lower the enema can
enema, instruct the patient to try to retain the  Stop the infusion for 30 seconds
enema for five to ten minutes before expelling.  Restart at a lower rate
RETENTION ENEMA RETAIN THE SOLUTION
 A retention enema also stimulates the bowels,  Remain lying down
but the solution that is used is intended to be INSTRUCTION AFTER DEFECATION
“held” in the body for 15 minutes or more.  Do not flush
RETURN-FLOW ENEMA o RN needs to evaluate the feces
 A return-flow enema, or Harris flush, is used DOCUMENT THE PROCEDURE
to remove intestinal gas and stimulate
peristalsis. A large volume fluid is used but
the fluid is instilled in 100-200 ml increments.
 Then, the fluid is drawn out by lowering the
container below the level of the bowel. This
brings the flatus out with the fluid.
MATERIALS
 Waterproof pad
 IV Pole
 Enema Can/ Bag
 Rectal Tube
 Water soluble lubricant
 Bedpan
 Towel
 Clean Gloves
 Rectal Tube Sizes
o ADULT: Fr 22-30
o Children: Fr. 14-18
o Infant: Fr. 12
ADMINISTERING ENEMA
Preparation:
 Lubricate about 2 inches of the rectal tube
 Prime the tubing of a large volume enema
o Might cause embolism or abdominal
distention
Position
 LEFT lateral position with leg acutely flexed
Insertion of the tube
 Slowly directing TOWARDS THE UMBILICUS
Length of Insertion
 3-4 inches
IF (+) RESISTANCE
 Take a deep breath
o Relaxes the sphincter
 Run small amount of solution
IF RESISTANCE PERSISTS
 Withdraw the tube
 Check for any stool that may have blocked the
tube
o (+) flush and retry
 Perform DRE(Digital rectal exam) to ascertain
fecal impaction

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 
URINARY
TRIPLE - LUMEN - used for bladder irrigation
or Cystoclysis

CATHETERIZATION
Definition
 In urinary catheterization, a catheter (hollow
tube) is inserted into the bladder to drain or
collect urine. There are two main types of
urinary catheterization: indwelling
catheterization and and non-indwelling
catheterization.
Purposes SIZE OF CATHETERS
 Relieve urinary retention  Male Fr. 16 -18
 Obtain sterile urine specimen  Female Fr. 12 - 14
 Measure residual urine  Child Fr. 8 - 10
 Empty the bladder before, during and after  Infant Fr. 5 – 8
surgery
 Allows accurate measurement of urine output
 Bladder irrigation (Cystoclysis)
 Administration of medication
TYPES
INDWELLING CATHETER
 A Foley catheter is a thin, sterile tube inserted
into the bladder to drain urine.
 Because it can be left in place in the bladder
for a period of time, it is also called an
indwelling catheter.
 It is held in place with a balloon at the end,
which is filled with sterile water to prevent the
catheter from being removed from the
bladder.
 The urine drains through the catheter tube
into a bag, which is emptied when full.
NON-INDWELLING CATHETER
 A simillar type of catheter will be inserted but
will not be left in place. this is used for a one
time evacuation of urine. often referred to as
an intermittent catheter.

MATERIALS
 Catheter
 Betadine
 Urine Bag
 KY Jelly
 Syringe (10mL)
 Sterile Water
 Forceps
 Sterile Cotton Balls
 Kidney Basin
 Sterile Drape
 Tape to secure the catheter
TYPES OF CATHETERS
 SINGLE LUMEN - used for one time
catheterization.
 TWO - LUMEN - also called an indwelling
foley or retention catheter.

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URINARY CATHETERIZATION Secure the catheter
APPLYING AN EXTERNAL CATHETER  Female
ASSESSMENT o Inner thigh
 Inspect the penis for swelling and excoriation  Male
o Contraindication for condom catheter o Lower abdomen
POSITION o Upper thigh
 Supine
PREPARATION
 Perform perineal care
APPLICATION
 Roll the condom smoothly LEAVING 2.5 cm
(1 in) between the end of the penis and the
plastic connecting tube
SECURE THE APPLIANCE Secure the collecting bag
 Firmly but not tightly with tape or Velcro  Hook on the bed frame
If will remain in bed o Always lower than the bladder
 Collection bag attached to bed frame Instruction of removal
If ambulatory  Exhale slowly and deeply
 Attached to the legs Complication
URETHRAL URINARY CATHETERIZATION  UTI
POSITION
 FEMALE  Date and time of the procedure
o SUPINE, knees flexed and hips externally  Amount of sterile water used for the balloon
rotated inflation
 MALE  Size and type of catheter used
o SUPINE, thighs slightly abducted apart  Amount, color, turbidity of urine output
Prevent infection  Client’s feedback
 Do perineal care  Example
Lubricant o June 15, 2020/ 9am Inserted a Fr12 foley
 Water-soluble catheter with 10ml sterile water for
Insert the catheter balloon inflation, collected 80ml , pale
 Length yellow, slightly turbid urine. There was no
o F:4 inches noted complains of pain or discomfort.
o M:8 inches CONTINUOUS BLADDER IRRIGATION
Instruction to facilitate  Cystoclysis
Insertion  Often used post genitourinary surgery
 Take a slow deep breath Purposes
 Insert upon exhalation  To wash out the bladder
Urine begins to flow  To apply medication on the bladder lining
 Advance the catheter 2 inches farther  To maintain or restore patency of the tube
CATHETER ACCIDENTALLY CONTACTS Access Device
LABIA/ VAGINA  Three- way or triple lumen catheter
 New catheter must be used Prevent infection
 Catheter should be left in place (vagina) until  Sterile technique
new catheter is inserted IRRIGATE THE BLADDER
o Avoid mistake in insertion  Open the regulating clamp (40-60 gtts/minute)
 Assess the drainage for amount, color, and
clarity
When to increase flow rate
 Drainage is BRIGHT REDD
Regain urinary control after removal
 Perform KEGEL EXERCISES
o Pointers: the drainage should equal the
amount of irrigant plus the expected urine
output

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