NCM 116

TOPIC:
SKILLS LECTURE
FINALS
 TOPIC OUTLINE
2

q DEFINITION OF TERMS
q TYPES OF ENEMA AND INDICATION
q COMPLICATION
q SPECIAL CONSIDERATION
q ADPIE
ENEMA
 DEFECATION
4

oIt is the Expulsion of feces in the

rectum
oInvoluntary movement
oit takes 24- 48 hours to pass through
the large intestine
o150 - 300 grams / day
oconsist of 75% water and 25 % solid
food
PERISTALSISlS
5
 WHAT IS ENEMA?
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oA PROCEDURE OF EVACUATION
OR WASHING OUT OF WASTE
MATERIALS(FECES OR STOOL)
FROM PERSON’S LOWER BOWEL.
oIT INVOLVES INSTILLING A
SOLUTION INTO THE RECTUM,
COLON & LARGE INTESTINES
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The action of enema is to

distend the intestines and
sometimes to irritate the
mucosa to increase
peristalsis and the
excretion of feces and
flatus.
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1. CLEANSING ENEMA
2. RETENTION ENEMA
3. RETURN FLOW
4. CARMINATIVE ENEMA
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1. CLEANSING ENEMA
oThis is intended to remove feces in
order to :
A. prevent escape of feces
during surgery
B. for diagnostic test - X-ray or
colonoscopy
C. constipation or impaction
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1. CLEANSING ENEMA
oStimulates peristalsis by irritating
the colon and rectum
A. much HIGH ENEMA- to
clean as of the colon as
possible (1000 ml)
B. LOW ENEMA - to clean
the rectum and sigmoid
colon only (500 ml)
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TYPES OF ENEMA
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2. RETENTION ENEMA
oIntroduces oil into the rectum
and sigmoid colon
ooil is retatined in 1 to 3 hours
oto soften fecesand to
lubricate the rectum and anal
canal
oTo facilitate feces
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3. RETURN FLOW ENEMA

oAlso known as colonic irrigation/
Harris Flush
o350 - 500 ml to stimulate peristalsis

and expulsion of feces

orepeated 5 - 6 times

o15 - 20 mins
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3. CARMINATIVE ENEMA
oTo expel flatus
o60 - 180 mls of fluid
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CONTRAINDICTION/
PRECAUTION
 CONTRAINDICATION
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oA PATIENT WITH DIARRHEA /

INFLAMMATORY BOWEL DISEASE
oMUST BE USED WITH CAUTION IN

CARDIAC PATIENT - VALSALVA

MANUEVER
 CONTRAINDICATION
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oCANNOT BE GIVE TO PATIENT WITH

UNDIAGNOSED ABDOMINAL PAIN -
RUPTURE OF APPENDIX
oMUST BE CAUTIOUS- RECENT

SURGERY ON RECTUM, BOWEL OR

PROSTATE GLAND
 CONTRAINDICATION
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oDO NOT FORCE THE CATHETER

AGAINST RESISTANCE - TRAUMA
oBOWEL OBSTRUCTION
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CHECKLIST
ASSESSMENT
 PURPOSE
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o To relieve constipation or
fecal impaction
oPrevent involuntary escape of
fecal material during surgical
procedures
 PURPOSE
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oPromote visualization of
intestinal tract during intestinal
exam
oHelp to establish regular bowel
function during bowel training
program
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EQUIPMENT
ASSESSMENT
 EQUIPMENT
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oSolution as ordered by the physician at a

temperature of 105F to 110F (40C to 43C) for
adults in the prescribed amount.
oDisposable enema set, which includes a solution
container and tubing
oWater-soluble lubricant

oIV pole
 EQUIPMENT
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oNecessary additives, as ordered

oWaterproof pad

oBath thermometer (if available)

o Bath blanket

oBedpan and toilet tissue

 EQUIPMENT
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oDisposable gloves
oAdditional PPE, as indicated

oPaper towel

oWashcloth, soap, and to

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ASSESSMENT
ASSESSMENT
 ASSESSMENT
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o1.ASSESS THE LAST BOWEL MOVEMENT,

ABDOMEN AND RECTAL AREA FOR ANY
HEMORRHOIDS, SORES AND TEARS.
- These factors helps to identify the need for enema and the type of enema to
be used. It also establishes baseline data for bowel function
 ASSESSMENT
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o1.ASSESS PRESENCE OF PAIN IN THE

ABDOMEN
- There may be a presence of other medical condition that may aggravate and
rupture if enema is continued.
 ASSESSMENT
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o1. ASSESS PRESENCE OF INC. ICP, GLAUCOME

OR RECENT RECTAL OR PROSTATE SURGERY
o- these condition are contraindicated to the use of enema.
 ASSESSMENT
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o1. Determineclient’s evel of understanding of

enema
o- allows nurse to plan for appropriate teaching measure and fot tmely
intervention.
 ASSESSMENT
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oASSESS LABORATORY WORKS.

o- To determine any abnormalities in the system.
 ASSESSMENT
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o1. Check clients medical record to clarify

reasons for enema
o- determines the purpose and allows preparation for special procedure or
relief of constipation

2. Check Doctor’s order

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CHECKLIST
ASSESSMENT
 CHECKLIST
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o1.Verify the order for the

enema. Bring necessary
equipment to the bedside stand
or overbed table.
 CHECKLIST
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o2.
Perform hand hygiene and
put on PPE, if indicated.

o3. Identify the patient.

 CHECKLIST
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o4.Close curtains around the bed and close the

door to the room,if possible. Explain what you
are going to do and why you are going to do it to
the patient. Discuss where the patient will
defecate. Have a bedpan, commode, or nearby
bathroom ready for use.
 CHECKLIST
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o5. Warm solution in amount ordered, and check

temperature with a bath thermometer, if available.
If bath thermometer is not available, warm to
room temperature or slightly higher, and test on
inner wrist. If tap water is used, adjust
temperature as it flows from faucet
 CHECKLIST
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o6.Add enema solution to container. Release

clamp and allow fluid to progress through tube
before reclamping.
 CHECKLIST
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o7. Adjust bed to comfortable working height,

Position the patient on the left side (Sims’
position), as dictated by patient comfort and
condition. Fold top linen back just enough to
allow access to the patient’s rectal area. Place a
waterproof pad under the patient’s hip.
o8. Put on nonsterile gloves.
 CHECKLIST
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o9.Elevate solution so that it

is no higher than 18 inches
(45 cm) above level of anus.
Plan to give the solution
slowly over a period of 5 to
10 minutes. Hang the
container on an IV pole or
hold it at the proper height.
 CHECKLIST
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o10. Generously lubricate end

of rectal tube 2 to 3 inches (5
to 7 cm). A disposable
enema set may have a pre-
lubricated rectal tube.
 CHECKLIST
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o11.Lift buttock to expose

anus. Slowly and gently
insert the enema tube 3 to 4
inches (7 to 10 cm) for an
adult. Direct it at an angle
pointing toward the umbilicus,
not bladder. Ask patient to
take several deep breaths.
 CHECKLIST
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o12.If resistance is met while

inserting tube, permit a small
amount of solution to enter,
withdraw tube slightly, and
then continue to insert it. Do
not force entry of the tube.
Ask patient to take several
deep breaths.
 CHECKLIST
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o13. Introduce solution slowly over a period

of 5 to 10 minutes. Hold tubing all the time
that solution is being instilled.
o14. Clamp tubing or lower container if
patient has desire to defecate or cramping
occur. Instruct the patient to take small,
fast breaths or to pant.
 CHECKLIST
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o15. After solution has been

given, clamp tubing and
remove tube. Have paper
towel ready to receive tube
as it is withdrawn.
 CHECKLIST
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o16.Return the patient to a comfortable

position. Encourage the patient to hold
the solution until the urge to defecate is
strong, usually in about 5 to 15 minutes.
Make sure the linens under the patient
are dry. Remove your gloves and ensure
that the patient is covered.
 CHECKLIST
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o17.Raise side rail. Lower bed

height and adjust head of
bed to a comfortable position.

o18. Remove additional PPE,

if used. Perform hand
hygiene.
 CHECKLIST
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o19. When patient has a strong

urge to defecate, place him or her
in a sitting position on a bedpan or
assist to commode or bathroom.
Offer toilet tissues, if not in
patient’s reach. Stay with patient
or have call bell readily accessible.
 CHECKLIST
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o20.
Remind patient not to flush the
commode before you inspect results of
enema.

o21.Put on gloves and assist patient, if

necessary, with cleaning of anal area.
Offer washcloths, soap, and water for
handwashing. Remove gloves.
 CHECKLIST
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o22.Leave the patient clean

and comfortable. Care for
equipment properly

o23. Perform hand hygiene.

 CHECKLIST
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o24. Document the procedure

Ø type and amount of sol.
Ø color, consistency and amount of stool
Ø condition of the patient
Ø vitals signs( before and after)
Ø adverse effect
Ø presence of discomfort