Enema Administration Overview

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Questions and Answers

What is the purpose of an oil retention enema?

To cleanse the entire bowel completely

To stimulate peristalsis for flatus expulsion

To introduce medication for local treatment

To soften and lubricate feces for easier passage (correct)

How long should a retention enema typically be retained after administration?

Overnight

Less than 30 minutes

4 to 6 hours

1 to 3 hours (correct)

What is the primary reason for administering a carminative enema?

To cleanse the bowel

To treat local infections

To expel flatus (correct)

To administer nutrients

What is typically the volume of fluid instilled for a carminative enema in adults?

60 to 80 mL Signup and view all the answers

What technique is used in a return-flow enema to encourage bowel movement?

Alternating inflow and outflow of fluid Signup and view all the answers

What is the primary purpose of administering an enema?

To stimulate stool evacuation Signup and view all the answers

Which of the following conditions may indicate the need for an enema?

Having three or fewer bowel movements over a seven-day period Signup and view all the answers

What type of enema is primarily used to prepare the intestine for diagnostic tests?

Cleansing enema Signup and view all the answers

What temperature should the enema solution be administered at for optimal comfort?

37.7°C (100°F) Signup and view all the answers

What is a common enema solution that draws water into the colon?

Sodium phosphate (Fleet) Signup and view all the answers

What assessment should be performed before administering an enema?

Patient's overall condition and history Signup and view all the answers

Which of the following is NOT a purpose of administering a cleansing enema?

To enhance nutrient absorption Signup and view all the answers

Which statement about enema administration is correct?

An enema is used to stimulate stool evacuation in severe constipation. Signup and view all the answers

What is the first action a nurse should take before administering an enema?

Verify the client's identity Signup and view all the answers

Which of the following should be performed to prevent infection during enema administration?

Maintain hand hygiene and wear clean gloves Signup and view all the answers

What position should the client be placed in to facilitate enema administration?

Left lateral position with the right leg flexed Signup and view all the answers

What should be done to the rectal tube before insertion?

Lubricate about 5 cm of it Signup and view all the answers

Which statement about the feelings experienced during the enema procedure is correct?

The client may experience a feeling of fullness Signup and view all the answers

What should the nurse do to ensure the enema solution is adequately prepared?

Run some solution through the tubing to expel air Signup and view all the answers

Which item is essential for enema administration?

A disposable liner Signup and view all the answers

How should the enema tube be inserted into the rectum?

Smoothly and slowly towards the umbilicus Signup and view all the answers

What is the recommended depth for inserting the enema tube?

7 to 10 cm Signup and view all the answers

What should be done if resistance is encountered while inserting the enema tube?

Administer a small amount of solution through the tube Signup and view all the answers

How high should the solution container be held during the administration of a low enema?

30 cm (12 in.) Signup and view all the answers

What should a caregiver do if the client complains of fullness or pain during the enema?

Lower the container or stop the flow for 30 seconds Signup and view all the answers

What is the minimum amount of time a client should retain a cleansing enema?

5 to 10 minutes Signup and view all the answers

After administering the enema solution, what should be done with the enema tube?

Place it in a disposal towel Signup and view all the answers

How should a client be positioned to facilitate defecation after an enema?

Sitting on the bedpan or toilet Signup and view all the answers

When should a digital rectal examination be performed during the enema process?

If there is resistance to tube advancement Signup and view all the answers

What should the nurse do after administering an enema to ensure proper client hygiene?

Perform hand hygiene and document the procedure. Signup and view all the answers

For a return-flow enema, what is the typical volume of solution instilled for an adult?

100 to 200 mL Signup and view all the answers

When caring for an incontinent client receiving an enema, which position should be recommended?

Supine with the head elevated to 30 degrees. Signup and view all the answers

What is the primary purpose of documenting the results after administering an enema?

To assess and compare findings with previous assessments. Signup and view all the answers

What should a nurse monitor for in a client after administering a return-flow enema?

The relief of flatus and abdominal distention. Signup and view all the answers

Which action should be taken if a client cannot retain an enema solution for even a few minutes?

Have the client use a bedpan after insertion of the enema tube. Signup and view all the answers

What is the recommended action after inserting the enema tube for a return-flow enema?

Lower the solution container to allow fluid to return. Signup and view all the answers

What aspect of the enema administration should be evaluated against previous assessment data?

Changes in bowel movement patterns. Signup and view all the answers

Study Notes

Enema Overview

Enema administration stimulates stool evacuation and relieves severe constipation.
It involves introducing a liquid solution into the rectum and large intestine.
Doctor’s order is required for enema administration.
Ideal solution temperature is 37.7°C (100°F) to prevent discomfort and cramping.

Purpose of Enemas

Indicated for patients with three or fewer bowel movements over seven days.
Commonly used for cleaning the lower bowel prior to procedures like colonoscopy.
May involve prior use of laxatives to facilitate waste flow.

Types of Cleansing Enemas

Cleansing Enema: Removes feces to prevent escapes during surgery or prepare for diagnostic tests.
Common Solutions:
- Hypertonic solutions (e.g., sodium phosphate) draw water into the colon, with 90-120 mL used typically.

Retention Enema

Introduces oil or medication to the rectum, retained for 1 to 3 hours.
Oil retention softens feces and lubricates the rectum.
Antibiotic and nutritive enemas are also used for direct treatment and nutrient delivery.

Carminative Enema

Designed to expel flatus by instilling 60-80 mL of fluid into the rectum, stimulating peristalsis.

Return-Flow Enema

Also known as Harris flush, involves alternating the inflow (100-200 mL) and outflow of fluid to stimulate peristalsis.
Abnormal findings must be validated, such as difficulty inserting the tube or fluid retention issues.

Equipment for Enema Administration

Required items: linen-saver pad, bath blanket, bedpan, clean gloves, lubricant, and either large or small volume solution set.

Enema Administration Procedure

Introduction and identity verification are crucial before beginning.
Maintain client privacy and assist them into the left lateral position for comfort.
Proper lubrication of the rectal tube is essential prior to insertion.
Fluid administration should be slow, monitoring for pain or discomfort.
Clients should retain the enema for 5-30 minutes depending on type.

Follow-Up Steps

Assist the client to defecate once the holding period is over.
Observe the feces for analysis if needed.
Documentation should include type, volume, and results of the enema administered.

Special Considerations

For patients unable to retain the enema due to incontinence, administer while in supine position on a bedpan.
Adjust head elevation if necessary for better comfort and breathing.
Repeat inflow-outflow for return-flow enemas while documenting all pertinent information.

Evaluation

Assess and compare findings against expected results, noting any deviations and ensuring follow-up care as needed.

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Description

This quiz covers the essential information regarding enema administration, including types, purposes, and common solutions used. It is crucial for patients with severe constipation or those preparing for procedures requiring bowel cleansing. Understand the protocols and implications of administering enemas effectively.