BAYERO UNIVERSITY KANO

COLLEGE OF HEALTH SCIENCE

FACULTY OF ALLIED HEALTH SCINCE

DEPARTMENT OF NURSING SCIENCE

NURSING PRACTICE

GROUP FIVE (5)

PRESENTATION TOPIC: “ENEMA AND SUPOOSITORIES”

29TH FEBRUARY, 2020.

GROUP MEMBERS
NAME REGISTRATION NUMBER
AISHA BAFFA ABUBAKAR AHS/18/NUR/00292
HALIMA HASSAN BELLO AHS/18/NUR/00268
AHMAD SAGIR AHS/17/NUR/00060
ZAINAB MUHAMMAD INDEE AHS/18/NUR/00290
AUWAL KABIR ALI AHS/17/NUR/00037
FARIDA ADAM SA’EED AHS/17/NUR/00014
IMRANA RABI’U AHS/17/NUR/00059
KHADIJA MUHD KABIR AHS/17/NUR/00
NAFISA LAWAN AHS/17/NUR/00038
ALAWIYYA IDRIS AHS/18/NUR/00299
ISAAC HABILA AHS/18/NUR/00300
MUSTAPHA HAMISU AHS/18/NUR/00
HARIS HUSSAINI AHS/17/NUR/00029
HABIBA MUSTAPHA IBRAHIM AHS/18/NUR/00280
ABDULLAHI SULAIMAN AHS/17/NUR/00067
SHAFA’ATU ABDULLAHI MAKULA AHS/17/NUR/00
SAUDA MHAMMAD GARBA AHS/18/NUR/00263
SALVIA DADAH AHS/16/NUR/00429
BALA SALE ABDURRAHMAN AHS/17/NUR/00
HASSANA ALIYU DAUDA AHS/17/NUR/00

TOPIC OUTLINE:

ENEMA

 Definition
 Types
 Purpose/reasons
 Indication
 Contraindication
  Amount of solution required
 Mode of action
 Requirement
 procedure

SUPPOSITORIES

 Definition
 Types/kind
 Composition
 Requirement
 Procedure
 Difference between enema and suppositories
 conclusion

ENEMATA

 DEFINATION

Enema is defined as the introduction of solution in to the rectum to promote

evacuation of feaces or as a means of introducing medicinal substances or nutrient.

 TYPES OF ENEMA

There are two main types of enema

1. EVACUANT ENEMA: they are the types of enema that the fluid inserted
are to be returned outside e.g. ENEMA SAPONIS
2. RETENTION ENEMA: they are the type of enema that the fluid inserted
will be retained in the body. E.g. RECTAL SALINE ENEMA

Other types of enema based on their actions include:

 OIL RETENTION ENEMA: given to softens feaces so that it may be
expelled.
 CARMINATIVE ENEMA: given to aid in expelling flatus.
 EMOLIENT ENEMA: given to soothe irritated mucous membrane
 BARIUM MEAL ENEMA: given for diagnostic purpose in which a
barium is introduced in to the lower colon

 PURPOSE/REASON FOR CARRINGOUT ENEMA

1. In order to empty the bowel of feaces and flatus
2. To introduce medicinal substance
3. As pre-operative procedure for patient undergoing surgery or general
anesthesia
4. Before and after special exams and x-ray. e.g. sigmoidoscopy and
endoscopy
5. In constipated patients when other method failed
6. Before delivery
7. Occasionally to obtain a specimen

 INDICATION
1. Constipated patients
2. Patients undergoing surgery
3. Patients undergoing diagnostic examination

 CONTAINDICATION
1. Rectal prolapse
2. Ulcerative colitis
 3. Paralytic ileus
4. Patients that undergo colon surgery

 AMOUNT OF SOLUTION TO BE INSERTED

 ADULT: 500-1000mls
 CHILDREN:250-400mls
 INFANTS:30-60mls

 DANGERS ASSOCIATED WITH ADMINISTRATION OF ENEMA

 If the solution used is too hot, can cause scalding of the rectal mucosa
 If the solution used is too cold, may cause shock
 Highly concentrated Soap used may cause enema rash
 If air is injected in to the bowel may cause considerable pain and
discomfort.
 MODE OF ACTION

Enema act in three ways:

1. Its irritate the mucous membrane of the colon, causing peristalsis and
emptying of bowel
2. Its lubricate the bowel and softening the feaces
3. Its breaks up the feacal mass, stretches the rectal wall thereby initiating
defeacation reflex
Examples of enema to be returned: ENEMA SAPONIS
 REQUIREMENT
A trolley procedure
TOP SHELF
 Tray containing rectal tube or large catheter(size 16),glass connection, 2-3
feet of wide rubber tubing
 Dressing towel and mackintosh
 A jug containing 1litre of soap solution at temperature of 37.2 0c
 A large bowl
 Lubricants e.g. KY –jelly
 Large funnel
 Clip for the rubber tubing
BOTTOM SHELF
 Bedpan
 Treatment sheath
 Toilet roll

 PROCEDURE
 Inform the patient and gain consent
 Dissolve a piece of soft soap in a little hot water to hasten its dissolving, add
up water after its dissolve at the required tempreture
 Put the patient in left lateral position or sim’s position, fold the bed clothes
sufficiently
 Screen the bed and close nearby window
 Placed the mackintosh and dressing towel beneath the patient buttocks
 Lubricate the end of the rectal tube or catheter, make sure the tube is air
free ,pinch with either fingers or a clip and introduce it to the rectum, slowly
pass it up to 4-10inche
  Relieve the pressure on the tube and then pour in the solution slowly and
encourage the patient to hold it until you finished introducing the required
amount
 Pinch the rectal tube and withdrawn it, disconnect it immediately from the
glass connection and discard it in to the kidney dish for subsequent washing
and boiling, return the tubing connection and funnel to the bowl
 The patient may need to use bedpan immediately, but he should be
encourage to hold the enema for a few minutes, he may be helped to do so
by holding a pad of two against the anus
 Clear the tray and thank the patient
Example of enema to be retained
RECTAL SALINE: the fluid used may be normal saline, saline glucose 10%
is sometimes used
 REQUIREMENT
Tray is needed

1 pint measure holding 10-15 of the required fluid at 370c

 Catheter NO 8
 12-16 inches fine rubber tuber tubing
 Enema cup
 Small funnel
 Bowl containing 2 linen squares and a pad Vaseline
 Lotion thermometer( not taken to the bedside)
 PROCEDURE
 Inform the patient and gain consent
 Screen the bed and close nearby window
  If possible arrange the patient in the left lateral position
 Lubricate the catheter, make it air free, and slowly pass it in to the rectum
for some 4-10inches
 Funnel should be held on level with the buttocks and the fluid passed by
syphon age so that the fluid is being absorbed by the bowel wall all the time.
The nurse should sit and take approximately 20 minutes over this procedure.
 Pinch and withdraw catheter
 The patient should not be disturbed as much as it is possible for at least half
an hour
 Clear tray, wash and boil the apparatus
N:B the foot of the bed may be elevated to aid retention of the fluid

After the completion of the procedure, the nurse should observe the following:

1. The amount of feaces passed and the quantity of fluid returned

2. The consistency of the feaces
3. The color of the feaces
4. Any abnormalities present e.g. blood,mucus,pus and worms
5. Observe the patient for any sign of discomfort or pain, dizziness or any
feelings of faintness during the procedure.

SUPPOSITORIES

 DEFINATION
They are solid dosage form that is inserted in to the rectum, vaginal or urethra. Its
dissolve or melt at body tempreture and exert local or systemic effects.

 COMPOSITION

Suppositories have a base made from substances like gelatin or cocoa butter or
similar substances such as polythene glycerol, hydrogel that surround the drug. The
type of material used depend upon the type of suppositories, type of drug and the
condition in which the suppositories will be served.

 TYPES/KIND OF SUPPOSITORIES

There are three main types;

1. Rectal suppositories
2. Vaginal suppositories
3. Urethral suppositories
 RECTAL SUPPOSITORIES: they are kinds of suppositories inserted
in to the rectum about an inch long and have a rounded or bullet
shaped tip e.g dulcolax
 VAGINAL Suppositories’ they are kinds of suppositories inserted in
to the vagina, they are oval shaped e.g. clindamycin vaginal cream,use
in the treatment of bacterial or fungal infection. Its normally comes
with a plastic applicator.
 URETHRAL SUPPOSITORIES: they are the kinds of suppositories
inserted in to the male urethral, they are very rare, only one kind,
MUSE, which men with erection problems can use to take drugs e.g.
alpostradil, it’s about the size of grain of rice.

 REQUIREMENTS:
Tray is required, containing the following:

1. Kidney dish containing the suppositories

2. A rubber finger stall
3. Right hand glove
4. Linen square
5. Lubricants
6. Bed pan in case of rectal suppositories
7. Catheter in case of urethral suppositories

 PROCEDURES:

RECTAL SUPPOSITORIES

 Explain the procedure to the patient and gain consent

 Draw curtains/screen the bed/close nearby windows
 Ask the patient to empty his colon if there is urge for defecation by giving
him bedpan
 Put the patient in left lateral position or sim’s position
 Put on finger stall, lubricate it with a lubricant
 Hold the suppositories between the thumb and first finger and insert it in to
the anal canal, then use the finger to push the suppository gently in to the
rectum for 2-3inches.

VAGINAL SUPPOSITORIES

 Explain the procedure to the patient and gain consent

 Draw curtains/screen the bed/close nearby windows
 Put the patient in a lithotomy position or dorsal recumbent
  Gently put the applicator in to the vagina as far as it will go without making
the patient feel discomfort
 Press on the plunger at the end of the applicator in order to push the
suppositories inside the vagina,then remove the applicator
 Allow the patient to lie down for a few minutes’ to let the vagina
suppositories drug dissolved.

URETHRAL SUPPOSITORIES

 Explain the procedure to patient and gain consent

 Screen the patient bed
 Insert urinary catheter in order to empty the bladder and then remove its
immediately after it is empty
 Remove the cover from the applicator
 Stretch the penis to its full length to open the urethral, put the applicator in
to the tip of the penis
 Gently push the button at the top of the applicator until its stops, hold it for a
seconds
 Sway the applicator from side to side to make sure the suppository drug is
inside the urethra
 Pull out the applicator, while the penis is still pull out, massage it firmly
between the hands for at least 10seconds to help the medicine dissolve
easily.
CONCLUSION:

Enema and suppositories are both used in the treatment of constipation. Both have
impressive 90% absorption rate-this is what makes them appealing to those who
want powerful detoxification result, suppositories are solid in nature while enema
are liquid, suppositories exert action within an hour while enema exert action
within five minutes or less.

REFERENCES:

1. Procedure manual book, school of nursing Kano.

2. Procedure manual, department of nursing science, buk.
3. www.slideshare.net