Tuesday, November 29, 2022
HomeCritical CareAdministration of Enema Nursing...

Administration of Enema Nursing Procedure By Nurses Note

Administration of Enema Nursing Procedure by Nurses Note

  A common procedure to relieve constipation or evacuate the lower bowel is an enema, the installation of a solution into the rectum and sigmoid colon. Faecal impaction may cause constipation or small amounts of diarrhoea or liquid faecal seepage around the obstructing impaction. Impaction may be removed manually to promote bowel elimination

Purpose of Enema Administration

  • Bowel preparation for diagnostic tests or surgery to empty the bowel of faecal content
  • Delivery of medication into the colon (such as enemas containing steroids to treat ulcerative proctitis or a Kayexalate enema to decrease the serum potassium level)
  • To soften the stool (oil-retention enemas)
  • To relieve gas (tidal, milk and molasses, or Fleet’s enemas)
  • To promote defecation and evacuate faeces from the colon for patients with constipation or an impaction
Glycerin and Sodium Chloride Enema

Indications and Contraindications of Fecal Impaction Removal

  • Consider manual removal of faecal impaction in the following patients at risk
    • Elderly people with chronic constipation or insufficient hydration, or who are inactive
    • Orthopaedic patients who have been in traction or in body casts.
    • When barium has not been adequately removed after radiologic examination.
    • Patients with neurologic or psychotic disorders.
  • Faecal impaction can occur with a descending/sigmoid colostomy. The fingers may be used to break up feces through the stoma, followed by cleansing irrigation
  • Manual removal of faecal impaction can stimulate the vagus nerve and cause syncope. It is contraindicated in the following conditions:
    • Pregnancy.
    • After genitourinary, rectal, perineal, abdominal, or gynecologic surgery.
    •  Myocardial infarction, coronary insufficiency, pulmonary embolus, heart failure, heart block.
    •  GI or vaginal bleeding.
    •  Blood dyscrasias, bleeding disorders.
    •  Hemorrhoids, fissures, and rectal polyps.

Administering an Enema

EQUIPMENT

  • Prepackaged enema or enema container.
  •  Disposable gloves.
  •  Water-soluble jelly.
  • Waterproof pad.
  • Bath blanket.
  •  Bedpan or commode.
  • Washcloth and towel.
  •  Basin.
  • Toilet tissue
Sodium Phosphate Enema

Steps of Administering an Enama

1Assess the patient’s bowel habits (last bowel movement, laxative usage, bowel patterns) and physical condition (haemorrhoids, mobility, external sphincter control).1Enema should not be given if there is a suspicion of appendicitis or bowel obstruction
2Provide for privacy, and explain the procedure to patient.2Provides comfort.
3Wash hands.3Promotes hygiene.
4Place patient on left side with right knee flexed (Sims’ position). Place waterproof pad underneath patient, and cover with bath blanket.4Allows for enema solution to flow by gravity along the natural curve of the sigmoid colon and rectum.
5Place bedpan or bedside commode in position for patients who cannot ambulate to the toilet or who may have difficulty with sphincter control.5Allows for easy accessibility.
6Remove plastic cover over tubing, and lubricate tip of enema tubing 3–4 inches (7.5–10 cm) unless prepackaged (tip is already lubricated). Even prepackaged enema may need more lubricant6Prevents trauma and eases application.  
7Apply disposable gloves7Standard precautions
8Separate buttocks, and locate rectum.8
9Instruct patient that you will be inserting tubing and to take slow, deep breaths9Allows for patient relaxation and readiness.
10Insert tubing 3–4 inches for adult patients10Prevents tissue trauma of rectum
11Slowly instill the solution using a clamp and the height of the container to adjust flow rate if using an enema bag and tubing. For high enemas, raise enema container 12–18 inches (30.5–45.5 cm) above anus; for low enemas, 12 inches. If using a prepackaged enema, slowly squeeze the container until all solution is instilled.11Rapid infusion can cause colon distention and cramping. Container elevated past 12–18 inches and controller on tubing not regulated contribute to rapid infusion
12Lower container or clamp tubing if patient complains of cramping12Allows fluid time to disperse.
13Withdraw rectal tubing after all enema solution has been instilled or until clear (usually not more than three enemas).13“Until clear” means until results do not contain faecal matter and are clear.
14Instruct patient to hold solution as long as possible and that a feeling of distention may be felt.14Promotes better results
15Discard supplies in the appropriate trash receptacle.15Maintains hygiene, minimizes patient embarrassment
16Assist patient on the bedpan or to the bedside commode or toilet when urge to defecate occurs16Prompt action will prevent soiling
17Observe enema return for amount, faecal content. Instruct patient not to flush toilet until the nurse has seen the results.17If enema has not had sufficient time to absorb, result may be mostly clear with little faecal material
18Document the type of enema given, volume, and results on the appropriate chart forms18For continuity of care.
19Assess and document presence or absence of abdominal distention after enema was given.19Relief of abdominal distention indicates success of gas relief.
20Assist the patient with washing perineum and rectal area, if indicated; may also need a clean gown or linen change.20Faecal soiling may result, especially in bedridden patients

- A word from our sponsors -

spot_img

Most Popular

LEAVE A REPLY

Please enter your comment!
Please enter your name here

More from Author

Specimen Collection Papanicolaou (Pap) Smear: Overview, Indication, Procedure

Specimen Collection Papanicolaou (Pap) Smear: The Pap smear is a tool...

Tracheostomy Dressing Care: Procedure and Indications

A tracheostomy is a surgical opening into the trachea and hence a potential route of infection, so the area should be kept clean. Tracheostomies can also cause damage to the surrounding tissues through pressure and the presence of irritant secretions

- A word from our sponsors -

spot_img

Intestinal Obstruction: Types, Causes, Symptoms, Diagnosis, Management, Complications Nursing Diagnosis

Intestinal obstruction is an interruption in the normal flow of intestinal contents along the intestinal tract. The block may occur in the small or large intestine, may be complete or incomplete, may be mechanical or paralytic, and may or may not compromise the vascular supply. Obstruction most...

Specimen Collection Papanicolaou (Pap) Smear: Overview, Indication, Procedure

Specimen Collection Papanicolaou (Pap) Smear: The Pap smear is a tool for screening of cervical cancer. Appropriate smear collection is paramount to the detection of cancer cells. In addition, if a lesion is seen or palpated, other tests, such as an ultrasound examination of the pelvis or...

Tracheostomy Dressing Care: Procedure and Indications

A tracheostomy is a surgical opening into the trachea and hence a potential route of infection, so the area should be kept clean. Tracheostomies can also cause damage to the surrounding tissues through pressure and the presence of irritant secretions

Nursing Mock Test, Nursing MCQ, DHA, HAAD, MOH PROMETRIC, AIIMS, ESI, NHM NURSING EXAM PREPARATION

Nursing Mock Test, Nursing MCQ, DHA HAADMOH PROMETRIC AIIMS ESI NHM NURSING EXAM PREPARATION Nursing Exam Preparation Nursing Mock Test Series Nursing Online Examination Free Nursing exam questions

Appendicitis: Causes, Symptoms, Diagnosis, Management, Nursing Interventions

Appendicitis is inflammation of the vermiform appendix caused by an obstruction of the intestinal lumen from infection, stricture, faecal mass, foreign body, or tumour.

Induction of labour: Indications, Method, Management, Complications, Bishop score

Induction of labour is initiated using mechanical and pharmacological methods. The intervention is necessary when the well-being of the mother or baby may be at risk if the pregnancy is continued. The parents should be in agreement and fully informed of the procedures. Indications of Labour • Post-maturity.  • PROM...

Nursing Mock Test, Nursing MCQ, DHA HAADMOH PROMETRIC AIIMS ESI NHM NURSING EXAM PREPARATION NO: 09

Nursing Mock Test, Nursing MCQ, DHA HAADMOH PROMETRIC AIIMS ESI NHM NURSING EXAM PREPARATION NO: 09 Nursing Exam Preparation Nursing Mock Test Series Nursing Online Examination Free Nursing exam questions

Psoriasis: Symptoms, Causes, Diagnosis, Treatment

Psoriasis is a chronic skin disorder characterized by excessive proliferation of keratinocytes, resulting in the formation of thickened scaly plaques, itching, and inflammatory changes of the epidermis and dermis. The various forms of psoriasis include guttate, pustular, and arthritis variants. SIGNS AND SYMPTOMS OF PSORIASIS • Approximately 85% of...

Ovarian Cancer: Causes, Symptoms, Diagnosis, Management, Nursing Diagnosis

Ovarian cancer is a gynecologic malignancy with high mortality because of advanced disease by time of diagnosis. It is the leading cause of morbidity of gynecologic cancers.  Pathophysiology and Causes of Ovarian Cancer  1. Median age is 60 years. One of 70 women will develop ovarian cancer.   2. Cause is...

Pericardiocentesis: Preparation Procedure Complications

Pericardiocentesis: Echocardiography-directed pericardial drainage is required for cardiac tamponade due to excess pericardial fluid and to obtain samples of pericardial fluid for the purposes of investigation. Preparation and equipment required for Pericardiocentesis Establish peripheral venous access, and check that full facilities for resuscitation are available. Pre-prepared pericardiocentesis sets may...

Hysteroscopy: Test Overview, Indication, Procedure, Normal Findings, Complication

Hysteroscopy test allows direct visualization of the endometrial cavity. It is indicated for women with an abnormal Papanicolaou (Pap) test, dysfunctional uterine bleeding, or postmenopausal bleeding. NORMAL FINDINGS OF HYSTEROSCOPY Normal structure and function of the uterus. TEST EXPLANATION OF HYSTEROSCOPY Hysteroscopy is an endoscopic procedure that provides direct visualization...

Levothyroxine: Action, Uses, Dosage, Side Effects Nursing Consideration

Levothyroxine: CLASSIFICATION: PHARMACOTHERAPEUTIC: Synthetic isomer of thyroxine. CLINICAL: Thyroid hormone (T4). USES OF LEVOTHYROXINE Levothyroxine: PO treatment of hypothyroidism, pituitary thyroid-stimulating hormone (TSH) suppression. IV: Myxedema coma. OFF LABEL: Management of hemodynamically unstable potential organ donors. ACTION OF LEVOTHYROXINE Converts to T3, then binds to thyroid receptor proteins exerting...