ENEMA

Is a solution introduced into the rectum and large intestines. Action: to distend the intestine and sometimes to irritate the intestinal mucosa, thereby increasing peristalsis and the excretion of feces and flatus.

The term enema is used to refer to the process of instilling fluid through the anal sphincter into the rectum and lower intestine for a therapeutic purpose.

An enema administration is performed using a flexible plastic rectal tube with several large holes in the tip. This is connected to the tubing from a solution bag or container.

An enema can also be performed using a prepackaged solution that comes in a soft plastic bottle with a pre-lubricated prerectal tip attached. Enema solutions are prepared using plain tap water or saline, soapsuds solutions, oil solutions, or various medication solutions.

Purposes Relieves abdominal distention. constipation and discomfort  Stimulates peristalsis  Resumes normal bowel evacuation  Cleanses and evacuates colon  .

Cleanse the bowel before a bowel exam or before bowel surgery.  .  Deliver medication directly onto the rectal mucous membranes to be absorbed into the bloodstream.

water 90ml. TYPES of Enemas Cleansing enema. Stimulates peristalsis through large volumes of solutions.) .is given enemaprimarily to expel flatus. glycerin 60ml. 2. MGW solution (magnesium 30ml.1.intended to enemacompletely remove feces. Carminative enema.

reduce (Kayexalate)dangerously high serum potassium levels. Sodium polystyrene (Kayexalate). 1-3 hours) 1a. Medicated Enema. Retention enema.TYPES of Enemas 1.contain Enemapharmacological therapeutic agents. . Neomycin enema.reduce bacteria in the enemacolon before bowel surgery.g.introduces oil or enemamedication into the rectum and sigmoid colon. The liquid is retained for a relatively long period (e.

Oil retention enema. .oilSmall volume. 4.b. absorption of oil softens stool.oil-based solution. *alternating flow of 100 to 200 ml of fluid into and out of the rectum and sigmoid colon stimulates peristalsis. This process is repeated five or six times until the flatus is expelled and abdominal distention is relieved. Return flow enema ± used occasionally to expel flatus. enema.

is salinesafest.TYPES of Enemas 5. Tap water (hypotonic) enemaenemashould not be repeated after first installation. 6. Physiological normal saline. Used for infants and children. If prepared at home mix 500 ml of tap water with 1 teaspoon table salt. .

. Soapsuds solutions. Hypertonic solution.useful to patients solutionwho can¶t tolerate large volumes of fluid.pure soap added to solutionstap water or normal saline. Ratio ± 5ml pure soap solution is to 1000ml warm water or saline. Only 120-180 ml (fleet enema) 1208.TYPES of Enemas 7. Use only castile soap.

ADMINISTERING ENEMA .

packet of water-soluble waterlubricant . Castile soap. protective plastic linen saver.Equipments  Two pairs of non sterile gloves  IV pole and enema set up (administration bag or bucket with rectal tubing.

as prescribed by physician: Adult 750-1000 ml 750Children up to 350 ml For infants up to 250 ml  Thermometer  Bedpan or bedside commode  .Solution for enema.

Disposable waterproof bed pan  Basin of warm water  Soap  Wash cloth  Towel  Room deodorizer  .

Physician¶s order for type of enema 2. Agency policy and physician¶s order regarding performance of procedure .ASSESSMENT Assessment should focus on the following: 1.

hard small stools) . Indicators of complications (ex. lower abdominal pain. Time of bowel movement and usual bowel evacuation pattern 4.3.

5. spinal cord injury) . Hx of factors that may contraindicate enema or present complications during enema administration (ex. Cardiac dysrhythmia or bradycardia. recent rectal or pelvic surgery.

changes in activity pattern. Client¶s dietary habits (ex.6. frequency of use of laxatives or enemas . Intake of liquids and fibers).

Client¶s mental status and any fears associated with procedure .7. Abdominal status: presence of bowel sounds 8.

Presence of ulcerations. during and after enema . excoriation) 10. hemmorhoids.9. before. Vital signs. tears. Status of anus and skin surrounding buttocks (ex.

11. Client medications that decrease peristalsis. such as narcotics . Client knowledge regarding promotion of normal bowel evacuation 12.

fiber. decreased food. or surgery Acute abdominal pain related to bowel distention from constipation or from procedure . or fluid intake.NURSING DIAGNOSIS Nursing diagnosis may include the following: Constipation related to immobility.

OUTCOME IDENTIFICATION AND PLANNING Desired Outcomes Sample desired outcomes include the following: Client evacuates moderate to large amount of stools Client verbalizes pain relief within 1 hour .

IMPLEMENTATION Preparation: 1. Lubricate about 5 cm (2inch) of the rectal tube (some commercially prepared enema sets already have lubricated nozzles) Rationales: Lubrication facilitates insertion through the sphincters and minimizes trauma .

‡ 2. . Air instilled into the rectum. Run some solution through the connecting tubing of a largevolume enema set and the rectal tube to expel any air in the tubing. then close the clamp. although not harmful. causes unnecessary distention.

Introduce yourself and verify client¶s identity. What you are going to do Why it is necessary How he/she can cooperate   Discuss how the results will be used in planning further care or treatments Indicate that the client may experience a feeling of fullness while the solution is being administered Reduces anxiety Gain patient¶s trust and cooperation . Explain procedure to the client.PERFORMANCE/PROCEDURE 1.

 Reduce the transfer of microorganism  To protect the patient from embarrassment .2. Perform handwashing Apply clean gloves observe appropriate infection control procedure. Provide for client privacy. 3.

which are on the left side Having the right leg acutely flexed provides adequate exposure of the anus . and the linen ±server pad under the buttocks.4. Assist the adult client to a left lateral. This position facilitates the flow of solution by gravity into the sigmoid and descending colon. with right leg as acutely flexed as possible.

Gently spread the buttocks with non dominant hand Insert the tube smoothly and slowly into the rectum. the angle follows the normal contour of the rectum To ensure good visualization of the anal opening Slow insertion prevents spasm of the sphincter muscles. Insert the rectal tube. directing it toward the umbilicus. facilitating entry .5.

Insert the tube adult 7 to 10 cm (3-4 inches) (3because the anal canal is about 2.5 inches) child (2-3 inches) (2- Prevents rectal trauma.5 to 5 cm (1-2 inch) (1long infant (1 to 1. places tube in far enough to cleanse colon .

procedure and ask the client to take report the a deep breath. then resistance to the run a small amount physician and the nurse in charge.If resistance is If resistance encountered at the persists. end the internal sphincter. of solution through the tube Never force tube or  To relax the internal anal solution entry. sphincter .

lower solution container. and release the clamp to allow fluid flow. . Administer the fluid slowly. Slowly administer the enema solution. If the patient complains of fullness or pain. Raise the solution container.6. use the clamp to stop the flow to 30 seconds and then restart the flow at a lower rate  Administering the enema slowly and stopping the flow momentarily decrease the likelihood of intestinal spasm and premature ejection of the solution.

 Administer all solution or as much as client can tolerate. be sure to clamp tubing just before all of the solution clears the tubing  Delivers enough solution for proper effect. prevents infusion of air .

7. Slowly remove rectal tubing while gently holding buttocks together  Prevents accidental evacuation of solution .

Remind client to hold solution for amount of time appropriate for type of enema -reposition client for comfort -place call light and bedpan or bed side commode within easy reach Ensures optimal effect Facilitates comfort Provides means of contacting nurse. provides receptacle for enema solution .

   Discard or restore equipment appropriately Discard gloves and perform hand hygiene Check client every 5-10 minutes to assess if client is still able to retain enema  Promotes clean environment Reduces microorganism transfer Reassess client¶s condition and retention of enema   .

Ask the client who is using the toilet not to flush it.8. ask the client to use a bedpan or commode A sitting position facilitates the act of defecation The nurse needs to observe the feces . Assist the client to defecate Assist the client to a sitting position on the bedpan. commode or toilet after retention time have expired or when client can no longer retain enema. If a specimen of feces is require.

Apply glove and perform perineal care with soap and water.9. eliminates odor  Reduces microorganism transfer . Spray room deodorizer after evacuation Perform hand washing  Removes residual stool spoilage.

Document the following: Type and amount of solution used Procedure completion with date and time and color.10. consistency and amount of stool expelled Condition of anus and surrounding area before and after procedure .

Vital signs before and after enema Description of and interventions for any adverse reactions experienced during the procedure Abdominal assessment before and after enema Client teaching regarding prevention of constipation .

After enema the rectum was free of hard stool. Desired outcome met: Client states abdominal pain relieved after enema . and abdomen is now soft.EVALUATION Were desired outcomes achieved? Example of evaluation include: Desired outcome met. client expelled gas.

Bowel sounds auscultated in four quadrants before and after procedure. No signs of adverse effects. .Example: Date: June 17. Vital signs stable before and after enema. Client verbalized measures for promoting normal bowel evacuation. 2010 Time: 8:00am Soap suds enema (750 ml) given. Anus intact without irritation. Large amount of dark brown stool returned after enema. Abdomen soft and non distended.

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