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Skills 2 Lab > Enemas & Ostomies > Flashcards

Enemas & Ostomies Flashcards

1
Q

what is an enema?

A

solution into the rectum and sigmoid colon

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2
Q

what are the 3 things enemas do ?

A
  1. break up fecal mass
  2. stretch rectal wall
  3. initiate defecation reflex (peristalsis)
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3
Q

what is the most common use for an enema?

A

temporary relief of constipation

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4
Q

what are the less common indications of enemas?

A
  1. medications
  2. bowel training
  3. emptying bowel before diagnostic tests, surgery or childbirth
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5
Q

What are the 2 types of enemas?

A
  1. Cleansing enemas
  2. Oil-retention Enemas
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6
Q

What are the 4 types of cleansing enemas?

A
  1. Tap water
  2. Normal saline
  3. Hypertonic solution
  4. Soapsuds
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7
Q

how does tap water act as an enema?

A
  1. hypotonic
  2. lower osmotic pressure than interstitial space fluid
  3. tap water moves from bowel into interstitial spaces
  4. Water stimulates defication before water leaves the bowel
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8
Q

why should we not repeat tap water enemas?

A

because water toxicity or circulatory overload can occur if too much is absorbed

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9
Q

how does normal saline act as an enema?

A
  1. isotonic
  2. same osmotic pressure as fluids in body
  3. saline stimulates peristalsis
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10
Q

Which type of enema should only infants and children receive and why?

A

normal saline
because they are sensitive to fluid shifts

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11
Q

how do hyptertonic solutions act as an enema?

A
  1. exert osmotic pressure
  2. pressure pulls fluid out of interstitial spaces into the bowel
  3. low volume (120-180 ml)
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12
Q

what is the most common type of hypertonic enema?

A

Fleet enema

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13
Q

who should not have a hypertonic /fleet enema?

A

patients who are dehydrated
patients who are young infants

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14
Q

How do soapsuds act as enemas?

A
  1. intestinal irritation
  2. stimulates peristalsis
  3. only use pure castile soap
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15
Q

what type of soap should not be used for enema?

A

harsh soaps
detergents
= bowel inflammation

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16
Q

how do oil-retention enemas help ?

A
  1. lubricate the rectum and colon
  2. feces absorb oil and become softer
  3. keep enema in several hours if possible
17
Q

What 4 things can rectal manipulation do that we have to be cautious about?

A
  1. irritation to mucosa
  2. bleeding
  3. perforation of the bowel wall
  4. Stimulation of the vagus nerve
18
Q

What is the most common use for an enema?

A

temporary relief of constipation

19
Q

what is peristomal skin?

A

the skin around the stoma
needs to be kept clean and dry

20
Q

what are concerning findings to report of the stoma/peristomal skin?

A

pale/discoloured
dark spots
lesions on stoma
peristomal skin irritation
signs of infection or trauma

21
Q

how often is the stoma pouch changed?

A

2X/week
Q3 days in hospital

22
Q

what is the maximum wear time of a bag?

A

7 days if the skin in intact and healthy without leakages

23
Q

When do we have to change the bag regardless of time?

A

if it’s leaking (do not tape it)
if the patient notices itchiness or burning around the stoma

24
Q

when do we measure a stoma?

A

each pouch change for the first week
then weekly or if leakages occur post op

25
Q

Do all ostomies require pouches? why or why not?

A

Yes. because they need to catch the fecal material

26
Q

What 4 things are enemas contraindicated in?

A
  1. increased intracranial pressure
  2. glaucoma
  3. recent rectal surgery
  4. recent prostate surgery
27
Q

why do we use the Sims position?

A

To allow enema solution to flow downward by gravity along the natural curve of the sigmoid colon and rectum- improves retention of the solution

28
Q

How many cm do we go in with the rectal tubing?

A

about 7-10cm

29
Q

What are the measurements of high, regular or low enemas?

A

30-45cm above the anus - high level
30 cm above the anus - regular enema
7.5 cm for low enema

30
Q

What kind of stool do we see with iliostomies?

A

frequent and liquid

31
Q

What kind of stool do we see with ascending colon?

A

frequent and liquid

32
Q

What kind of stool do we see with transverse colon?

A

more solid, formed stool

33
Q

What do we see with a descending colostomy and sigmoid colostomy?

A

near normal stool

34
Q

Why do we measure the stoma?

A

To ensure we have the right pouch
Should be no more than 2mm larger than the stoma

Skills 2 Lab (5 decks)

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