EMILIO AGUINALDO COLLEGE

School of Nursing

PERFORMANCE EVALUATION TOOL

NCM 116 CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND

GASTRO-INTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION
(ACUTE AND CHRONIC)

Procedure: Administering an Enema

NAME OF STUDENT: Ali Hassan, Amal

SECTION/GROUP: BSN4-1 Date: 18-10-2021

LEGEND:
4 Very Satisfactorily Performed
(Student performs consistently in an effective and efficient manner)
3 Satisfactorily Performed
(Performance is usually effective and efficient but not always)
2 Fairly performed
(Progress in performance is too slow to judge satisfactorily; task performance is not properly for
majority of the time)
1 Poorly performed
(No progress in performance has been demonstrated, and or performance is consistently
inefficient)

Procedure: Administering an Enema

Preparation
1. Assess
 When the client last had a
bowel movement, the
amount, color and
consistency of feces.
 Presence of abdominal
distention.
 Whether the client has
sphincter control.
 Whether the client can use a
toilet or commode, or must
remain in bed and use a
bedpan.
2. Determine:
 Whether a primary care
provider’s order is required.
 The presence of kidney or
cardiac disease that
contraindicates the use of
hypotonic solution.
4 3 2 1 REMARKS
(Kindly put your rationale on this
box)
The purpose of this
procedure is to provide
clinicians with information
on the safe and effective
bowel management of
patients in the hospital
.
Your doctor may also order
an enema before medical
procedures.
caution is necessary with
hypertonic saline in patients
with congestive heart failure
 or renal insufficiency due to
their already increased fluid
and sodium loads.

3. Assemble equipment Rationalize and indicate examples of

 Disposable linen-saver pad uses or clinical procedures that uses
 Bath blanket large- volume enema and small -
 Bedpan or commode volume enema:
 Clean gloves
 Water-soluble lubricant, if
tubing not prelubricated
 Paper towel
Large-volume enema
 Solution container, with
tubing of correct size and
tubing clamp.
 Correct solution, amount,
and temperature.
Small-volume enema
 Prepackaged container of
enema solution with
lubricated tip
4. Lubricate about 5 cm (2 inches) of Why need to lubricate?
the rectal tube. Lubricant reduces friction as
enters rectal canal.

5. Run some solution through the
connecting tubing of a large-
volume enema set and the rectal
tube, to expel any air in the tubing;
then close the clamp.
Why need to expel air from tubing
and close clamp?
To avoid air entering the
rectum and causing further
discomfort.

Procedure
1. Introduce yourself and verify the
client’s identity; explain to the
client what you are going to do,
why it is necessary, and how he/she
can cooperate. Indicate that the
client might experience a feeling of
fullness while the solution is being
administered.
2. Perform hand hygiene and observe
other appropriate infection control
procedures.
3. Provide for client privacy.
To verify if it’s The right
patient, and to ensure that the
patient understands the
procedure and given their valid
consent.
For infection prevention and
control
To avoid unnecessary
embarrassment and to promote
dignity care
4. Assist the adult client to a left
lateral position, with the right leg
as acutely flexed as possible and the
linen-saver pad under the buttocks.
5. Insert the enema tube.
For clients in the left lateral position,
lift the upper buttock.
Insert the tube smoothly and slowly
into the rectum, directing it toward
the umbilicus.
Insert the tube 7-10 cm (3-4 inches)
If resistance is encountered at the
internal sphincter, ask the client to
take a deep breath, then run a small
amount of solution through the tube.
Never force tube or solution entry. If
instilling a small amount of solution
does not permit the tube to be
advanced, or the solution to flow
freely, withdraw the tube. Check for
any stool that might have blocked the
tubing insertion. If present, flush it
and retry the procedure. You may
also perform a digital rectal
examination, to determine if there is
an impaction or other mechanical
blockage. If resistance persists, end
the procedure and report the
resistance to the primary care
provider and nurse in charge.
6. Slowly administer the enema
solution.
Raise the solution container, and open
the clamp to allow fluid flow
or
Compress a pliable container by hand
During most low enema, hold or hang
This allows ease of passage into the
rectum by following the natural
anatomy of the colon. This position, I
gravity will aid the flow of the
solution into the colon. Lastly to
reduce potential infection caused by
soiled linen.
Why patient need to be on left lateral
position and why need to lift the
butoocks?
Why need to insert it slowly?
To avoid any damage or hurt
Why it need to be inserted in
(3-4 inc)? For adults size to access
the rectum easy
To ensure that the tube or nozzle is in
rectum
Rationalize
To flush the stuck in stool ,
This technique will help the client
with more comfort.
Rationalize
To avoid more harm than good
Without Tube  if resistance
Report if we canot perform the
procedure
Rationalize
To avoid increasing peristalsis. The
slower the rate at which the fluid is
introduced, I the less pressure is
exerted on the intestinal wall
Rationalize
To allow normal flow of the fluid
Rationalize
 the solution container no higher than Clamp to stop the then ask the patient
30 cm (12 inches) above the rectum. if he or she feels any discomfort
During a high enema, hang the
solution container approximately
45cm (18 inches) above the rectum.
Administer the fluid slowly, if the To avoid any through
client complains of fullness or pain,
lower the container or use the clamp
to stop the flow for 30 seconds, and
then restart the flow at a slower rate.
If you are using a plastic commercial Rationalize
container, roll it up as the fluid is To help assess the client to defecate .
instilled.
After the solution has been instilled, To help assess the client to defecate .
or when the client cannot hold
anymore and feels the desire to
defecate, close the clamp and remove
the rectal tube from the anus.
Place the rectal tube in a disposable To prevent contamination
towel as you withdraw it
7. Encourage the client to retain the enema
 Ask the client to remain rationalize
lying down.
 Request that the client retain
the solution for the
appropriate amount of time
—for example, 5-10 minutes
for a cleansing enema, or at
least 30 minutes for a
retention enema.
8. Assist the client to defecate.
Assist a client to a sitting position on rationalize
the bedpan, commode or toilet.
Ask the client who is using the toilet rationalize
not to flush it down yet, The nurse
needs to observe the feces.
If a specimen of feces is required, ask rationalize
the client to use a bedpan or
commode.
Variation: Administering an Enema to an incontinent client
Procedure
After the rectal tube is inserted, have rationalize
the client assume a supine position on
a bedpan. The head of the bed can be
elevated slightly, to 30 degrees, if
necessary, for easier breathing. Use
pillows to support the client’s head
and back.
Variation: Administering a Return-flow Enema
Procedure
For a return-flow enema, the solution rationalize
 (100-200 ml for an adult) is instilled
into the client’s rectum and sigmoid
colon. Then the solution container is
lowered so that the fluid flows back
out through the rectal tube into the
container, pulling flatus with. The
inflow-outflow process is repeated
five or six times, and the solution is
replaced several times during the
procedure if it becomes thick with
feces.
9. Clean up patient or if patient is able rationalize
to wash self, offer tissue, wet wipes,
soap and water for hand washing
10. Reposition client comfortably back in rationalize
bed.
11. Perform after care procedures as rationalize
disposal of used supplies as wet
wipes, waterproof pads etc.
12. Remove used gloves. Using gloves reduces transfer
of microorganisms.

13. Perform hand hygiene. rationalize

14. Document the procedure. Timely and accurate
documentation promotes
patient safety.

Document:
 The type and volume of
appropriate enema given.
 The type of solution, length
of time solution was retained
(the amount, color and
consistency of the returns,
and the relief of the flatus
and abdominal distention in
the client record.
Total

GRADING SYSTEM

Performance Score _________ x 90% = ______

Punctuality and Grooming _________ x 10% = ______

Total = ______

Evaluated by: Conformed by:

____________________________ ______________________________
Signature over printed name Signature over printed name