Podcast
Questions and Answers
A patient with a spinal cord injury requires a rectal tube insertion. Which potential complication should the nurse prioritize when monitoring this patient?
A patient with a spinal cord injury requires a rectal tube insertion. Which potential complication should the nurse prioritize when monitoring this patient?
- Autonomic dysreflexia (correct)
- Infection at the insertion site
- Electrolyte imbalances
- Necrosis of the rectal mucosa
A patient is scheduled for a cleansing enema in preparation for a diagnostic procedure. After inserting the enema tube, the patient reports severe cramping. What is the most appropriate initial nursing intervention?
A patient is scheduled for a cleansing enema in preparation for a diagnostic procedure. After inserting the enema tube, the patient reports severe cramping. What is the most appropriate initial nursing intervention?
- Administer pain medication as prescribed
- Immediately stop the enema administration (correct)
- Instruct the patient to take deep breaths
- Lower the height of the solution container
A nurse is teaching a patient how to administer a suppository at home. Which instruction is most critical to ensure patient safety and medication effectiveness?
A nurse is teaching a patient how to administer a suppository at home. Which instruction is most critical to ensure patient safety and medication effectiveness?
- Retain the suppository for at least 5 minutes before expelling
- Store suppositories at room temperature for easy access
- Maintain proper hygiene throughout the procedure (correct)
- Insert the suppository at least 4 inches into the rectum
A nurse is preparing to perform a colostomy irrigation. Which factor is most crucial to assess prior to initiating the irrigation?
A nurse is preparing to perform a colostomy irrigation. Which factor is most crucial to assess prior to initiating the irrigation?
During a routine ostomy appliance change, a nurse observes that the patient’s peristomal skin is excoriated and erythematous. What is the most appropriate initial nursing intervention?
During a routine ostomy appliance change, a nurse observes that the patient’s peristomal skin is excoriated and erythematous. What is the most appropriate initial nursing intervention?
A patient reports feeling resistant during a rectal tube insertion. What is the most appropriate action for the nurse?
A patient reports feeling resistant during a rectal tube insertion. What is the most appropriate action for the nurse?
A patient is prescribed a bisacodyl suppository for constipation. Prior to administering the suppository, which condition should the nurse rule out?
A patient is prescribed a bisacodyl suppository for constipation. Prior to administering the suppository, which condition should the nurse rule out?
A patient with a history of heart failure is ordered to receive a cleansing enema. Which type of enema should the nurse question?
A patient with a history of heart failure is ordered to receive a cleansing enema. Which type of enema should the nurse question?
A patient who recently underwent a colostomy is scheduled for their first irrigation. What is the most important teaching point the nurse should emphasize?
A patient who recently underwent a colostomy is scheduled for their first irrigation. What is the most important teaching point the nurse should emphasize?
A nurse is changing an ostomy appliance for a patient with a newly formed stoma. Which characteristic of a healthy stoma should the nurse report immediately?
A nurse is changing an ostomy appliance for a patient with a newly formed stoma. Which characteristic of a healthy stoma should the nurse report immediately?
A patient with a colostomy is experiencing frequent leakage around the ostomy appliance. What is the most appropriate initial intervention by the nurse?
A patient with a colostomy is experiencing frequent leakage around the ostomy appliance. What is the most appropriate initial intervention by the nurse?
A nurse is evaluating a patient's technique for administering a cleansing enema at home. Which action by the patient requires correction?
A nurse is evaluating a patient's technique for administering a cleansing enema at home. Which action by the patient requires correction?
A patient with a history of ulcerative colitis is receiving mesalamine suppositories. What therapeutic effect should the nurse expect to observe?
A patient with a history of ulcerative colitis is receiving mesalamine suppositories. What therapeutic effect should the nurse expect to observe?
A nurse is preparing to administer a rectal tube to a patient with severe abdominal distention. Which action is most important to prevent complications?
A nurse is preparing to administer a rectal tube to a patient with severe abdominal distention. Which action is most important to prevent complications?
A nurse is teaching a patient about the appropriate timing for changing an ostomy appliance. Which statement by the patient indicates a need for further teaching?
A nurse is teaching a patient about the appropriate timing for changing an ostomy appliance. Which statement by the patient indicates a need for further teaching?
A patient with a colostomy reports difficulty passing stool despite regular irrigation. What should the nurse recommend to the patient?
A patient with a colostomy reports difficulty passing stool despite regular irrigation. What should the nurse recommend to the patient?
During the setup for a colostomy irrigation, the nurse notices that the irrigation solution is cold. How should the nurse proceed?
During the setup for a colostomy irrigation, the nurse notices that the irrigation solution is cold. How should the nurse proceed?
A patient is scheduled to receive a cleansing enema. Which position is most appropriate for the nurse to place the patient in for the administration?
A patient is scheduled to receive a cleansing enema. Which position is most appropriate for the nurse to place the patient in for the administration?
A patient with a spinal cord injury is using rectal stimulation to promote bowel movements. Which potential complication should the nurse monitor for?
A patient with a spinal cord injury is using rectal stimulation to promote bowel movements. Which potential complication should the nurse monitor for?
A nurse is caring for a patient with a new ileostomy. What is the most important factor to consider when selecting an appropriate ostomy appliance?
A nurse is caring for a patient with a new ileostomy. What is the most important factor to consider when selecting an appropriate ostomy appliance?
A patient reports persistent itching and burning around the peristomal skin despite frequent ostomy appliance changes. What is the most appropriate nursing action?
A patient reports persistent itching and burning around the peristomal skin despite frequent ostomy appliance changes. What is the most appropriate nursing action?
A patient who underwent a rectal tube insertion suddenly develops pallor and diaphoresis. What immediate action should the nurse take?
A patient who underwent a rectal tube insertion suddenly develops pallor and diaphoresis. What immediate action should the nurse take?
The healthcare provider ordered a cleansing enema for a client with constipation and abdominal distention. The client suddenly reports chest pain during the procedure. Which of the following is the priority nursing intervention?
The healthcare provider ordered a cleansing enema for a client with constipation and abdominal distention. The client suddenly reports chest pain during the procedure. Which of the following is the priority nursing intervention?
A client on long-term opioid therapy is prescribed a bisacodyl suppository. Which instruction should the nurse provide regarding the use of this medication?
A client on long-term opioid therapy is prescribed a bisacodyl suppository. Which instruction should the nurse provide regarding the use of this medication?
The nurse is teaching a client about colostomy irrigation. Which statement by the client indicates a need for further instruction?
The nurse is teaching a client about colostomy irrigation. Which statement by the client indicates a need for further instruction?
The nurse is assessing an ostomy and notes that the stoma is dark purple and dry. Which of the following is the priority action?
The nurse is assessing an ostomy and notes that the stoma is dark purple and dry. Which of the following is the priority action?
A patient reports leakage around their ostomy pouch. What is the first nursing action?
A patient reports leakage around their ostomy pouch. What is the first nursing action?
The nurse is administering a soap suds enema. The client reports discomfort and cramping during the procedure. What is the next nursing action?
The nurse is administering a soap suds enema. The client reports discomfort and cramping during the procedure. What is the next nursing action?
The health provider orders a rectal tube for a client with abdominal distention. Which information is most important for the nurse to document following the procedure?
The health provider orders a rectal tube for a client with abdominal distention. Which information is most important for the nurse to document following the procedure?
The nurse is preparing to insert a suppository. The client questions the medication, stating doubts. Next best action?
The nurse is preparing to insert a suppository. The client questions the medication, stating doubts. Next best action?
A client with an ostomy expresses concern about the odor. How should the nurse respond?
A client with an ostomy expresses concern about the odor. How should the nurse respond?
After cleansing the stoma, what is most important for the nurse to do to promote skin health?
After cleansing the stoma, what is most important for the nurse to do to promote skin health?
Flashcards
Rectal Tube
Rectal Tube
A hollow, flexible tube inserted into the rectum to relieve gas, fecal impaction, or administer medications/fluids.
Rectal Tube Indications
Rectal Tube Indications
Abdominal distension, severe constipation, neurogenic bowel dysfunction, or preparation for diagnostic procedures.
Rectal Tube Insertion - Initial Steps
Rectal Tube Insertion - Initial Steps
Verify orders, explain the procedure, gather supplies, ensure privacy, and position in the left lateral position with knees flexed.
Rectal Tube Insertion - Technique
Rectal Tube Insertion - Technique
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Rectal Tube - Nursing Considerations
Rectal Tube - Nursing Considerations
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Suppository
Suppository
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Suppository - Purpose
Suppository - Purpose
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Types of Suppositories
Types of Suppositories
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Suppository Administration - Steps
Suppository Administration - Steps
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Suppository Insertion - Technique
Suppository Insertion - Technique
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Suppository - Important Considerations
Suppository - Important Considerations
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Post suppository administration patient is ordered to:
Post suppository administration patient is ordered to:
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Cleansing Enema
Cleansing Enema
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Types of Enemas
Types of Enemas
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Cleansing Enema - Equipment
Cleansing Enema - Equipment
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Cleansing Enema: Preparation
Cleansing Enema: Preparation
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Enema Position
Enema Position
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Enema: Technique
Enema: Technique
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Cleansing Enema: Administration
Cleansing Enema: Administration
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Expected Outcomes - Enema
Expected Outcomes - Enema
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Potential Enema Complications
Potential Enema Complications
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Enema: Assessment Guidelines
Enema: Assessment Guidelines
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Enema Warning Signs
Enema Warning Signs
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Colostomy
Colostomy
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Ileostomy
Ileostomy
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Ostomy Change - Indications
Ostomy Change - Indications
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One-Piece System
One-Piece System
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Two-Piece System
Two-Piece System
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Types of Barriers
Types of Barriers
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Ostomy - Tips for Removal
Ostomy - Tips for Removal
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Ostomy: Preparation
Ostomy: Preparation
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Ostomy: Application
Ostomy: Application
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Normal Stoma Findings
Normal Stoma Findings
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Abnormal Stoma
Abnormal Stoma
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Colostomy Irrigation
Colostomy Irrigation
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Study Notes
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Bowel Elimination Procedures
- Bowel elimination procedures are essential nursing practices.
- These procedures address a range of clinical scenarios, from constipation to medication administration when the oral route is unavailable.
- Competence in these procedures promotes patient comfort, prevents complications, and supports comprehensive care.
Today's Agenda
- The presentation will cover rectal tube insertion, suppository administration, cleansing enemas, ostomy appliance changing, and colostomy irrigation.
Learning Objectives
- By the end of this session, learners will be able to demonstrate proper patient positioning.
- Learners will be able to apply safety principles, complete documentation, troubleshoot equipment issues, and communicate effectively with patients.
Introduction to Bowel Elimination Procedures
- Bowel elimination procedures promote patient comfort and dignity.
- They prevent complications like impaction and perforation.
- These procedures reduce infection risk and skin breakdown.
- They maintain normal elimination patterns and support overall recovery.
- They provide assessment data on GI function and enable medication administration when the oral route is unavailable.
- Bowel elimination procedures are an essential component of comprehensive care.
- Common clinical scenarios include constipation, fecal impaction, postoperative bowel management, and neurogenic bowel dysfunction.
- Preparation for GI procedures/surgery, fecal incontinence management, rectal medication administration, bowel retraining programs, palliative care, and spinal cord injury bowel protocols are also common scenarios.
Universal Safety Principles
- Hand hygiene involves washing hands for at least 20 seconds with soap and water or using alcohol-based sanitizer.
- Hand hygiene should occur before and after patient contact, following the 5 moments of hand hygiene.
- Client identification requires two distinct identifiers, such as name and date of birth; verify the medical record number.
- Ask patients to state their information and check the ID band before procedures.
- Patient privacy includes closing curtains/doors during exams.
- Keep voices low when discussing care, cover patients during transport, secure electronic health records, and obtain consent before sharing information.
Documentation Requirements Overview
- Required documentation template elements include the procedure type, solutions used, volumes administered, client response, and any complications.
Rectal Tube Insertion
- A rectal tube is a hollow, flexible tube inserted through the anus into the rectum.
- Used to relieve flatus (gas) or fecal impaction and administer medications or fluids rectally if needed.
- The purpose is to relieve abdominal distension and discomfort.
- It removes flatus (gas) from the lower intestine and facilitates fecal elimination.
- Clinical indications include postoperative abdominal distention and intestinal obstruction.
- Other indications are severe constipation and fecal impaction.
- Rectal tube insertion can help with neurogenic bowel dysfunction.
- It may also be part of the preparation for certain diagnostic procedures.
- Equipment needed: rectal tube with collection bag, water-soluble lubricant, clean gloves, waterproof pad, and basin.
- Verify physician's order and patient identity before starting.
- Explain the procedure to the patient and obtain consent.
- Gather equipment.
- Ensure privacy and position patient in the left lateral position with knees flexed.
- Place a waterproof pad under the patient.
- Lubricate the distal 2-3 inches of the tube with water-soluble lubricant.
- Gently separate buttocks to expose the anus.
- Ask the patient to take slow, deep breaths.
- Insert the tube 3-4 inches into the rectum using gentle pressure.
- Never force insertion if resistance is felt.
- Secure the tube to the inner thigh with hypoallergenic tape and create a tape 'chevron' for better adhesion.
- Ensure the tube is not pulling on rectal tissue.
- Document the insertion length and connect to the drainage system if ordered.
- Potential complications include rectal/mucosal trauma and perforation of the rectum.
- Necrosis of rectal mucosa, infection, and electrolyte imbalances are also potential.
- Autonomic dysreflexia (in spinal cord injury), constipation paradoxically worsening, psychological distress, and dependency on rectal tubes are risks.
- Nursing considerations include assessing for contraindications, such as recent rectal surgery, radiation, or bleeding.
- Use water-soluble lubricant generously and insert gently following the natural rectal curve.
- Secure the tube properly without tension and limit use to 30 minutes at a time.
- Monitor for signs of mucosal damage and document output and assessment findings.
- Provide privacy and emotional support; consider alternative interventions.
Suppository Administration
- Suppositories are solid medication forms designed to melt at body temperature.
- Insert them into body cavities (rectal, vaginal, urethral) and deliver medication locally or systemically.
- They bypass first-pass metabolism and are an alternative when the oral route is not possible.
- Types of suppositories include: Glycerin, Bisacodyl, Mesalamine, Prochlorperazine, Acetaminophen, Progesterone.
- Key administration points include proper storage (refrigeration if needed).
- Ensure proper positioning during insertion and maintain hygiene throughout the procedure.
- Consider timing for optimal effectiveness.
- Needed equipment include suppository medication, disposable gloves, water-based lubricant, disposable underpad, toilet tissue, waste disposal bag, and privacy screen/curtain.
- Wash hands thoroughly with soap and water and put on disposable gloves.
- Remove the suppository from the packaging and lubricate the rounded end with water-soluble lubricant.
- Position the patient on their left side with the upper leg flexed.
- Gently separate the buttocks to expose the rectum.
- Insert the suppository (rounded end first) 1-2 inches beyond the sphincter.
- Hold the buttocks together briefly after insertion.
- Encourage the patient to retain the suppository for 15-20 minutes.
- Ensure patient privacy throughout the procedure.
- Document the medication, time, and patient response.
- Store suppositories in a cool place to prevent melting.
- Before administration, explain the purpose and expected benefits and verify patient understanding and consent.
- Provide privacy during the procedure and advise the patient to empty their bladder first.
- Explain proper positioning (side-lying with top knee bent), wash hands, and wear gloves.
- Remove the suppository from the packaging and lubricate the rounded end with water-soluble lubricant.
- Explain that insertion may cause brief discomfort and instruct on proper breathing to reduce anxiety.
- After administration, instruct the patient to remain lying down for 15-20 minutes and explain that an urge to expel is normal but should be resisted.
- Advise on expected onset of action and provide tissues for comfort.
- Explain potential side effects to watch for and instruct on proper hand hygiene.
- Document administration time and provide guidance on frequency if multiple doses.
- Explain proper storage of remaining suppositories and schedule follow-up if needed.
Cleansing Enema
- A cleansing enema is a procedure that introduces fluid into the rectum and colon.
- Purpose: To remove fecal material and gas in order to relieve constipation, prepare for procedures, or administer medications.
- It may reduce abdominal distention and discomfort and be performed as part of bowel preparation protocols.
- Types of enemas include: Soap Suds (mild soap solution), Oil Retention (mineral oil), Hypertonic Saline, Tap Water, Fleet (sodium phosphate), and Medicated.
- Equipment: clean enema bag or container, appropriate tubing with a clamp, lubricant, clean water (1000-1500ml), bedpan or toilet access, gloves, waterproof pad.
- Gather equipment: clean enema bag or container, appropriate tubing with clamp, lubricant, clean water (1000-1500ml), bedpan or toilet access
- Clean water (1000-1500ml); verify physician's order.
- Check water temperature , ensure patient's privacy explain the procedure to patient.
- Left Sims' position (preferred): Patient lies on left side, right knee flexed toward chest, left arm behind body. Buttocks near edge of bed.
- Hold solution container 12-18 inches above the rectum.
- Encourage the patient to retain the solution for 5-10 minutes.
- Fluid Management: Solution temperature: 105-110°F (40.5-43.3°C),Adult volume: 500-1000 mL.
- Solution temperature: 105-110°F (40.5-43.3°C). Flow rate: Slow and steady (5-10 minutes).
- Monitor for patient discomfort or cramping
- Expected Outcomes: Relief of constipation, evacuation of fecal material.
- Improved bowel function, reduced abdominal distention.
- Assess for abdominal pain or distention.
- Monitor Vital signs, Document amount and character of output.
- Potential Complications: Rectal irritation or damage, Electrolyte imbalance.
- Fluid volume deficit abdominal cramping, Vasovagal response, peroration risk.
- Report Rectal Bleeding and or Persistent abdominal distention
Ostomy Appliance Changing
- Types of Ostomies: large Intestine diverted to abdominal wall
- ileostomy: Small intestine diverted to abdominal wall. Output consistency varies by location.
- Leakage under barrier, itching, pouch is too full.
- One-piece-barrier and pouch combined, Available in drainable and closed-end options.
- Ensure privacy and explain procedure to document, Document any skin concerns immediatelyNever pull forceps on adhesive barriers.
Colostomy Irrigation
- A procedure that involves instilling water through the stoma stimulate evaluation, helping regulate bowel, proper training if Descending of sigmoid colostomies.
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