Enema Procedure PDF

Enema LEARNING OUTCOMES ► Describe enema ► Enumerate the purpose of using an enema ► Assess the patient condition before enema administrations ► Ability to administer enema for the patient  ENEMA An enema administration is a technique used to stimulate stool evacuation....

Enema LEARNING OUTCOMES ► Describe enema ► Enumerate the purpose of using an enema ► Assess the patient condition before enema administrations ► Ability to administer enema for the patient  ENEMA An enema administration is a technique used to stimulate stool evacuation. It is a liquid treatment most commonly used to relieve severe constipation. The process helps push waste out of the rectum when you cannot do so on your own. The administration of enema is requires doctor’s order.  ENEMA solution introduced into the rectum and large intestine. The enema solution should be at 37.7°C (100°F) because a solution that is too cold or too hot is uncomfortable and causes cramping. Purpose of Enema ► People with condition have three or fewer bowel movement over a seven –day period. ► An enema administration is most commonly used to clean the lower bowel. ► In some cases laxative are used the night before an enema administration to encourage waste flow. ► Enema may also be used before medical examination of the colon. ► This procedure may also be done prior to colonoscopy.  Cleansing Enema Cleansing enemas are intended to remove feces. They are given chiefly to: Prevent the escape of feces during surgery. Prepare the intestine for certain diagnostic tests such as x-ray or visualization tests (e.g., colonoscopy). Remove feces in instances of constipation or impaction.  Commonly Used Enema Solutions Solution type: Hypertonic Constituent 90–120 mL of solution (e.g., sodium phosphate [Fleet]) Action Draws water into the colon. Time to take Effect 5–10 min Adverse Effect Retention of sodium  Commonly Used Enema Solutions Solution type: Hypotonic Constituent 500–1000 mL of tap water Action Distends colon, stimulates peristalsis, and softens feces Time to take Effect 15–20 min Adverse Effect Fluid and electrolyte imbalance; water intoxication  Commonly Used Enema Solutions Type of Solution Isotonic Constituent 500–1000 mL of normal saline Action Distends colon, stimulates peristalsis, and softens feces. Time Of effect 15–20 min Adverse Effect Possible sodium retention  Commonly Used Enema Solutions Type of Solution Soapsuds Constituent 500–1000 mL (3–5 mL soap to 1000 mL water) Action Irritates mucosa, distends colon. Time of effect 10–15 min Adverse effect Irritates and may damage mucosa  Commonly Used Enema Solutions Type of solution Oil (mineral, olive, cottonseed) Constituent 90–120 mL Action Lubricates the feces and the colonic mucosa. Time of effect 0.5–3 h Administration of cleansing enema ► Some enemas are large volume (i.e., 500 to 1000 mL) for an adult and others are small volume (90 to 120 mL), including hypertonic solutions. ► The amount of solution administered for a high-volume enema will depend on the age and medical condition of the individual. For example, clients with certain cardiac or renal diseases would be adversely affected by significant fluid retention that might result from large-volume hypotonic enemas.  ADMINISTRATION OF CLEANSING ENEMA The force of flow of the solution is governed by (a) the height of the solution container, (b) size of the tubing, (c) viscosity of the fluid, and (d) resistance of the rectum. The higher the solution container is held above the rectum, the faster the flow and the greater the force (pressure) in the rectum. During most adult enemas, the solution container should be no higher than 30 cm (12 in.) above the rectum. During a high cleansing enema, the solution container is usually held 30 to 48 cm (12 to 18 in.) above the rectum because the fluid is instilled farther to clean the entire bowel  Retention Enema ❑ A retention enema introduces oil or medication into the rectum and sigmoid colon. The liquid is retained for a relatively long period (e.g., 1 to 3 hours). ❑ An oil retention enema acts to soften the feces and to lubricate the rectum and anal canal, thus facilitating passage of the feces. Antibiotic enemas are used to treat infections locally, ❑ anthelmintic enemas to kill helminths such as worms and intestinal parasites, and nutritive enemas to administer fluids and nutrients to the rectum  Carminative Enema A carminative enema is given primarily to expel flatus. The solution instilled into the rectum releases gas, which in turn distends the rectum and the colon, thus stimulating peristalsis. For an adult, 60 to 80 mL of fluid is instilled.  RETURN-FLOW ENEMA A return-flow enema, also called a Harris flush, is occasionally used to expel flatus. 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 Administering an Enema  Administering an Enema PURPOSE To achieve one or more of the following actions: cleansing, retention, carminative, or return-flow  Administering an Enema ASSESSMENT When the client last had a bowel movement and the amount, color, and consistency of the 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  Administering an Enema PLANNING ❑ Before administering an enema, determine that there is a primary care provider’s order. At some agencies, a primary care provider must order the type of enema and the time to give it, for example, the morning of an examination. At other agencies, enemas are given at the nurse’s discretion (i.e., as necessary on a prn order). ❑ In addition, determine the presence of kidney or cardiac disease that contraindicates the use of a hypotonic or hypertonic solution.  Administering an Enema Assignment ❑ Administration of some enemas may be assigned to assistive personnel (AP). However, the nurse must ensure the personnel are competent in the use of standard precautions. ❑ Abnormal findings such as inability to insert the rectal tip, client inability to retain the solution, or unusual return from the enema must be validated and interpreted by the nurse Administering an Enema Equipment Disposable linen-saver pad Bath blanket Bedpan or commode Clean gloves Water-soluble lubricant if tubing not pre-lubricated Paper toweL  Administering an Enema 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  Administering an Enema IMPLEMENTATION Preparation Lubricate about 5 cm (2 in.) of the rectal tube (some commercially prepared enema sets already have lubricated nozzles). 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.  Administering an Enema Performance 1. Prior to performing the procedure, introduce self and verify the client’s identity using agency protocol. Explain to the client what you are going to do, why it is necessary, and how to participate. Discuss how the results will be used in planning further care or treatment. Indicate that the client may experience a feeling of fullness while the solution is being administered. Explain the need to hold the solution as long as possible. 2. Perform hand hygiene and observe other appropriate infection prevention procedures. 3. Apply clean gloves. 4. Provide for client privacy  Administering an Enema 5. Assist the adult client to a left lateral position, with the right leg as acutely flexed as possible , with the linen- saver pad under the buttocks.  Administering an Enema 6. Insert the enema tube. For clients in the left lateral position, lift the upper buttock.  Administering an Enema Insert the tube smoothly and slowly into the rectum, directing it toward the umbilicus. Administering an Enema Insert the tube 7 to 10 cm (3 to 4 in.). 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.  Administering an Enema 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 freely flow, withdraw the tube. Check for any stool that may have blocked the tube during 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.  Administering an Enema 7. 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 enemas, hold or hang the solution container no higher than 30 cm (12 in.) above the rectum Administer the fluid slowly. If the 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.  Administering an Enema If you are using a plastic commercial container, roll it up as the fluid is instilled. This prevents subsequent suctioning of the solution. After all the solution has been instilled Place the enema tube in a disposable towel as you withdraw it.  Administering an Enema 8. Encourage the client to retain the enema. Ask the client to remain lying down. Request that the client retain the solution for the appropriate amount of time, for example, 5 to 10 minutes for a cleansing enema or at least 30 minutes  Administering an Enema 9. Assist the client to defecate. Assist the client to a sitting position on the bedpan, commode, or toilet. A sitting position facilitates the act of defecation. Ask the client who is using the toilet not to flush it. The nurse needs to observe the feces. If a specimen of feces is required, ask the client to use a bedpan or commode. Remove and discard gloves. Perform hand hygiene  Administering an Enema 10. Document the type and volume, if appropriate, of enema given. Describe the results.  VARIATION: ADMINISTERING AN ENEMA TO AN INCONTINENT CLIENT Occasionally a nurse needs to administer an enema to a client who is unable to control the external sphincter muscle and thus cannot retain the enema solution for even a few minutes. In that case, after the enema tube is inserted, the client assumes a supine position on a bedpan. The head of the bed can be elevated slightly, to 30 degrees if necessary for easier breathing, and pillows used to support the client’s head and back VARIATION: ADMINISTERING A RETURN-FLOW ENEMA ✓ For a return-flow enema, the solution (100 to 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 the flatus with it. ✓ The inflow–outflow process is repeated five or six times (to stimulate peristalsis and the expulsion of flatus), and the solution is replaced several times during the procedure if it becomes thick with feces. ✓ Document the type of solution; length of time the solution was retained; the amount, color, and consistency of the returns; and the relief of flatus and abdominal distention in the client record using forms or checklists supplemented by narrative notes when appropriate.  Administering an Enema EVALUATION Perform a detailed follow-up based on findings that deviated from expected or normal for the client. Compare findings to previous assessment data if available. Report significant deviations from expected to the primary c  Book reference: Kozier and Erbs 11 edition of th Fundamentals of Nursing page 1286-1287