Enema Exam 3 Flashcards
What is an enema?
An enema is the introduction of solution into the rectum to soften feces and distend or irritate the colon in order to stimulate peristalsis and evacuation of feces.
What factors govern the responses to an enema?
Responses are governed by the following conditions:
* Height of the solution container
* Speed of flow
* Concentration of the solution
* Resistance of the rectum
What determines the resistance of the rectum?
Muscle tone and history of constipation or other bowel disorders determine the resistance of the rectum.
Why might a client with a long history of constipation tolerate a large-volume enema?
The rectum and colon have become distended over time.
Which types of solutions are easier to retain during an enema?
Hypotonic and isotonic solutions are easier to retain. They are common
List the purposes of enemas.
- Treat severe constipation or impaction
- Clear the colon for visualization procedures
- Empty the colon for bowel-training
- Prepare for surgeries of the lower GI tract
What is a ‘low’ enema?
A ‘low’ enema is given by standard procedure to clear the lower part of the colon.
How is a ‘high’ enema administered?
A ‘high’ enema involves the client moving through different positions to allow fluid to reach higher in the large intestine.
What is a Return-Flow Enema?
A Return-Flow Enema, known as a Harris flush, is ordered to help a patient expel flatus and relieve abdominal distention.
What volume is typically used for a Return-Flow Enema in adults?
Approximately 100 to 200 mL (3 to 7 oz) of tap water or saline.
What is the volume range for retention enemas?
Usually 90 to 120 mL (3 to 4 oz).
What are common forms of retention enemas?
- Medication enemas
- Nutritive enemas
What is the purpose of medicated enemas?
To instill antibiotics to treat infections or to introduce anthelminthic agents for intestinal worms.
What is the purpose of nutritive enemas?
To administer fluid and nutrition through the rectum for dehydrated and frail patients.
What are examples of solutions used for enemas from the kitchen?
- Milk and molasses
- Coffee
List supplies needed for enema administration.
- Enema container
- Correct enema solution
- Wipes
- Waterproof pad
- Bedpan or bedside commode
- Water-soluble lubricant
- Gloves
- IV pole
What are the types of laxatives?
- Stimulant
- Osmotic
- Bulk-forming
- Stool softeners
- Lubricants
- Prokinetic agents
What do stimulant laxatives do?
They trigger the intestines to contract and push out the stool.
What is the function of osmotic laxatives?
They draw water into the bowel from surrounding tissues to soften stools and increase bowel movement frequency.
What do bulk-forming laxatives contain?
Fiber, which soaks up water in the intestines and produces bulkier stool.
What is the role of stool softeners?
They soften dry, hard stool with water pulled into the stool from the intestine.
What is a key nursing consideration before administering an enema?
Perform a focused assessment, including bowel sounds, abdominal distention, and last bowel movement.
True or False: You should establish a stop signal with the client during enema administration.
True
What should a client be encouraged to do to avoid constipation?
Consume adequate fiber and fluids.
How far should the tip of the tubing be inserted during enema administration?
The specific distance is not provided in the text.
Enema Admin
-Ofter meds first
then give enema as last resort
Cleansing Enema
Treat severe constipation or impaction
Clear the colon in preparation for visualization procedures, such as colonoscopy
Empty the colon when starting a bowel-training program
Clear the colon for surgeries of the lower GI tract and for some pelvic surgeries
“High” and “Low” Enemas:
Critical Criteria
- Verifies order for the enema
- Selects appropriate equipment for client
- Prepares correct amount of solution assuring correct temperature (do not heat the solution)
- Drapes and positions client
- Expels air from tubing
- Lubricates tip
- Inserts colon tube appropriate distance into rectum: Adult 3-4 inches (7-10 cm)
- Holds container no higher than 12-18 inches (30-45 cm) above anus and releases clamp
- Observes client during procedure
- Assists client to toilet or places on bedpan
- Documents type of enema, amount, return, and client response
NOTE: If using commercially prepared enema, follows manufacturer’s instructions for use
Laxative Types
Laxatives
Stimulant - trigger the intestines to contract and push out the stool.
Osmotic - draw water into the bowel from the surrounding tissues to soften stools and increase bowel movement frequency.
Bulk-forming - contain fiber which soaks up the water in your intestines and produces bulkier stool. Larger stool makes the bowel contract and push out the stool.
Stool softeners - mild laxatives soften dry, hard stool with water that they pull into the stool from the intestine, making it easier to push out the stool.
Lubricants - oily laxatives coat the surface of the stool to retain stool fluid and make it easier to push out the stool.
Prokinetic agents. They stimulate contractions along your gastrointestinal (GI) tract.
What is this med used for?
IBS/chronic constatipation
Focused Assessment
Focused assessment – bowel sounds, abdominal distention, last bowel movement, change in bowel habits, normal bowel movements, history of bowel disease/obstruction, fecal impaction, rectal sphincter control
Listen to bowel sounds for?
5 mins for absent
Nurse should
- have a stop signal with patient
encourage high fiber
lower the height if in pain
tubing is inserted 3-4 inches
